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Special considerations for younger children undergoing day case tonsillectomy/ adenoidectomy surgery should be made depending of expertise at the centre and current national guidelines. Skilled preoperative assessment services, including thorough assessment of children with obstructive sleep apnoea (OSA) and experienced anaesthetists and surgeon are required to deliver this safely. Surgery and perioperative care, including care on the post-anaesthetic care unit...

The Royal College of Anaesthetists has published guidance for audits and quality improvement projects in day surgery.⁶ Each day surgery unit should have a system in place for the routine audit of important basic clinical and organisational parameters such as:

• clinical: unplanned inpatient/overnight admissions following surgery, postoperative symptoms (e.g. pain, nausea and vomiting) 
• organisational: non-attendance rates, patients cancelled...

In non-specialist paediatric tertiary centres, having visiting consultant paediatric anaesthetists from specialist tertiary paediatric centres to attend operating lists to provide education and training updates should be considered. These may be part of the arrangements in place within a children’s surgery ODN. The Certificate of Fitness for Honorary Practice may facilitate such placements and provides a relatively simple system for...

An anaesthetic office, located within five minutes’ walk of the delivery suite, should be available to the duty anaesthetic team. The room should have a computer with intra/internet access to specialist reference material and local multidisciplinary evidence based guidelines and policies. The office space, facilities and furniture should comply with the Association of Anaesthetists' standards.⁸¹ This office could...

Departments should have a workforce plan in line with their overall strategy and annual business plan that includes recruitment, opportunities for flexible working and staff retention.  The plan should ensure a level of staffing and skill mix that meets current service and educational requirements with sufficient flexibility to ensure staff are not overstretched. It should be reviewed regularly and consider...

Anaesthetists should participate in departmental audit and quality improvement projects, using specific, measurable, attainable, relevant and time-bound (SMART) methodology (see Glossary) and consideration of full audit cycles (e.g. plan, do, study, act). This participation should adhere to the standards and principles outlined in the College’s Raising the Standards: RCoA Quality Improvement Compendium.⁵

Children with severe comorbidity who require emergency anaesthesia should be treated in a specialist paediatric centre. However, if transfer is not feasible, the most appropriately experienced senior anaesthetist should provide anaesthesia and support resuscitation and stabilisation, as part of the multidisciplinary team.^124,125