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A well-designed preoperative service should minimise patient delays through the journey to surgery, while allowing appropriate time for initiation of interventions likely to improve patient outcome. By optimising planning of patient care, with the right staff and resources available, cancellations can be reduced and the efficiency of operating lists improved.⁷³

There should be ready access to evidence based guidelines that are appropriate for children on the following topics:

management of pain, nausea and vomiting

• fluid fasting⁶⁷
• intravenous fluid management¹⁸
• prevention of perioperative venous thromboembolism⁶⁸
• death of the child in theatre
• protocols for anaesthetic emergencies, including:
  • anaphylaxis⁶⁹
  • malignant hyperthermia
  • difficult airway management
  • airway obstruction...

When infants and children undergo procedures under sedation alone, recommended published guidance for the conduct of paediatric sedation should be used.^71,72

Guidance on preprocedure pregnancy testing in female patients should be followed.⁷¹

Quality indicators, such as unplanned inpatient admission following day case surgery, readmission within 28 days, or unanticipated admission to PICU following surgery, should be measured, collated and analysed, and can be compared within regional networks. A number of suggested audit topics specifically relating to paediatric anaesthesia are set out in the RCoA document ‘Raising the standard: a compendium of audit...

Regional networks could provide agreed quality standards for the perioperative care of infants, children and young people, and units could be encouraged to participate in regular collation of data relating to these standards. Participation in national audit should also be encouraged.⁵

Quality improvement projects in relevant areas of paediatric anaesthetic practice should be agreed and implemented.^1,70

Adoption of national initiatives, for example ’Hello my name is’ should be encouraged and evaluated.⁷⁵

Multidisciplinary audit and morbidity and mortality meetings relating to paediatric anaesthesia and procedures, including resuscitation, should be held regularly. Perioperative death in infants and children is rare. When a death occurs within 30 days of surgery, a multidisciplinary meeting should be convened and a note made in the clinical record.¹⁵ In the event of any unexpected child death...

Audit activity should include the regular analysis and multidisciplinary review of untoward incidents. Serious events and near misses need to be thoroughly investigated and reported to the relevant national agency, in line with national requirements.⁷⁷