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Day surgery should be a consultant or autonomously practising anaesthetist/surgeon-led service with a dedicated clinical lead or clinical director who has programmed activities allocated to the role within their job plan. The role of the clinical director is to champion the cause of day surgery and to ensure that best practice is followed. This role may involve the development of...

Agreed local guidelines should be in place and implemented on the following:

• compliance with best practice anaesthetic management protocols for hip fracture as recommended by the Association of Anaesthetists.^46,61
• tailored World Health Organization (WHO) safety checklists to discuss the requirement for use of bone cement  
• preoperative assessment for treatment escalation and cardiopulmonary resuscitation
• older people (>65...

In-situ simulation training can help to identify system process gaps.¹²³ Simulation based learning techniques should assist anaesthetists in resolving these issues and developing the necessary technical and non-technical skills.^{124,125,126,127,128,129,130,131,132}

In recent years there has been a trend towards assessment of elective patients in preadmission clinics, typically one to two weeks before surgery. This allows routine paperwork and investigations to be completed before admission, permits ‘same day’ admission and reduces the likelihood of delays or cancellation.³⁰ Anaesthetists should be part of the preadmission clinical pathway, including implementing interventions...

Anaesthetists with a job plan that includes emergency anaesthesia should demonstrate ongoing continuing education in emergency anaesthesia, and continuing professional development as required for this aspect of their work. Departments have a responsibility to enable this with local teaching where appropriate and by facilitating access to other education and training.³³ Hospitals should provide a comprehensive training programme and support...

Each DSU should have a system in place for the routine audit of important basic parameters such as unexpected admissions following surgery, non-attendance (DNA) rates, patients cancelled on the day of operation, postoperative symptoms e.g. pain and PONV and patient satisfaction.⁵⁵ The Royal College of Anaesthetists has also issued guidance for audits in day surgery.⁵⁶

Any non-trainee anaesthetist who undertakes anaesthetic duties in the labour ward should have been assessed as competent to perform these duties in accordance with OAA and RCoA guidelines.^31,55,89 Such a doctor should work regularly in the labour ward but should also regularly undertake non-obstetric anaesthetic work to ensure maintenance of a broad range of anaesthetic skills.

Women who refuse transfusion of blood or blood products, whether because of adherence to the Jehovah’s Witness faith or for other reasons, should be identified early in the antenatal period. They should meet with an anaesthetist to discuss their specific restrictions, and should receive information about the potential risks associated with their decision.^142,143 Their decision should be...