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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

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...

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

Preoperative assessment of patients, especially those at very high risk, can benefit from a team approach involving cross specialty advice from anaesthetists, surgeons and intensivists. Early consultation with appropriate medical specialties should occur for appropriate conditions, e.g. acute kidney injury, diabetes mellitus and ischaemic heart disease.¹⁴

Following admission and prior to undergoing a procedure that requires general or regional anaesthesia, all patients should have a preoperative visit by an anaesthetist or suitably trained assistant, ideally a person directly involved with the administration of the anaesthetic.⁵ This should be done to confirm earlier findings or, in the case of the emergency admission, initiate preoperative anaesthetic assessment and care.

Anaesthetists should be involved in audit and quality improvement cycles, preferably using a ‘rapid cycle’ quality improvement approach. This approach benchmarks standards of care, and may be an effective change driver. It is also an excellent way of providing evidence of good practice as defined by the GMC, and mapping the contribution that individuals make to any service within their...

The emergency anaesthesia team should be led by a consultant anaesthetist and include all medical and other healthcare professionals involved in the delivery of anaesthesia for emergency surgery.^13,43 Part of this role should include liaison with other departments such as radiology, medicine and emergency departments (ED).

Clinical governance is the responsibility of individual institutions, and should follow the same principles that apply to medically qualified anaesthetists, ensuring:¹⁴

• training that is appropriately focused and resourced
• supervision and support in keeping with practitioners’ needs and practice responsibilities
• practice centred audit and review processes.

Many ophthalmic patients have significant comorbidities that may require optimisation and co-ordination prior to surgery. There should be a lead anaesthetist (with an appropriate number of programmed activities in their job plan and appropriate secretarial support) for preoperative assessment, who works closely with an appropriately trained preoperative assessment team.^6,7