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Isolated elective orthopaedic units performing major inpatient surgery should have 24/7 access to all support services including acute pain services and critical care. Local guidelines should be in place to provide safe anaesthesia care which includes preassessment screening for risk stratification, transfer criteria and postoperative care facilities.

The clinical lead (see glossary) anaesthetist in burn and plastic surgery units will be responsible for the provision of service, teaching, production of guidelines, management, research, and audit, and be able to support quality improvement initiatives. Sufficient time should be included in job plans to support these activities and the continuing professional development of those anaesthetists.

Where treatment is carried out in facilities normally used by adult patients, such as obstetric units or for patients requiring ECT treatment, guidelines should be in place for staff training and organisation of services.^45,46

There should be induction programmes for all new members of staff, including locums. Induction for a locum doctor should include familiarisation with the layout of the hospital and the location of emergency equipment and drugs, access to guidelines and protocols, information on how to summon support/assistance, and assurance that the locum is capable of using the equipment in that hospital...

Transport of patients within the hospital and between hospitals (e.g. transfers to major trauma, neurosurgical or paediatric centres) should be undertaken in a timely manner, without unnecessary delays, and in accordance with established guidelines and standards.^{9,40,41,42,43} Hospital transfers may involve a retrieval service.

Analgesia guidance appropriate for children should be readily available. This should include training in and the use of pain assessment using age-appropriate validated tools, prescribing of analgesics and where appropriate guidelines on the use of complex analgesic techniques such as nurse and patient controlled analgesia, epidural analgesia, peripheral nerve local anaesthetic catheters.^31,32 Regional operational delivery networks...

In all centres admitting children, one or more anaesthetist should be appointed as clinical lead (see Glossary) for paediatric anaesthesia. Typically, they should undertake at least one paediatric list each week and will be responsible for co-ordinating and overseeing anaesthetic services for children, with particular reference to teaching and training, audit, equipment, guidelines, pain management and resuscitation. There should...

A clinical lead(s) (see Glossary) for anaesthesia in the non-theatre environment should be appointed with adequate time provided within their job plan to develop the service, train staff, and ensure that safety standards are upheld.^2,5,6 The anaesthesia clinical lead for the non-theatre environment should create local consensus guidelines for the staffing of each non-theatre area where anaesthesia is delivered.

When members of the healthcare team are involved in a critical incident, the personal impact on individual team members can be significant.^7,21 Following a significant critical incident, the clinical director (see Glossary) or appropriate individual (head of service) should promptly review the immediate clinical commitments of the staff concerned. Relevant support for staff following a critical...

As a minimum, all ASA 3–5 patients and those undergoing high risk surgery should have their expected risk of morbidity and mortality estimated and documented prior to an intervention, with adjustments made in accordance with national guidelines in planning the urgency of care, seniority of staff involved and postoperative care.^{16,54,60,61, 62}