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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.⁸⁰ This office could...

All patients undergoing anaesthesia should be under the care of a consultant anaesthetist whose name is recorded as part of the anaesthetic record.^2,3,4 A staff grade, associate specialist and specialty (SAS) grade anaesthetist could be the named anaesthetist on the anaesthetic record if local governance arrangements have agreed in advance that, based on the training...

Local protocols should determine the grade, experience and competency based training of non-anaesthetist healthcare professionals undertaking preoperative assessments.⁴⁶ In addition , all members of the team including administrative, managerial and clinical staff who interact with the patient preoperatively should have skills in motivational interviewing and preoperative optimisation.^47,48 Courses such as ‘Making Every Contact Count’ may be helpful.

Risk stratification based on clinical history may help guide management.³⁶ However, determination of a patient’s functional capacity may be difficult if exercise tolerance is limited by peripheral vascular insufficiency, respiratory or other disease.^10,35 Clinical guidelines should be developed for further investigation, referral, optimisation, and management according to local facilities and expertise.³⁷

The lead obstetric anaesthetist should be responsible for the overall delivery of the service, including:

• ensuring that evidence based guidelines and protocols are in use and are up to date
• monitoring staff training
• workforce planning
• service risk management
• ensuring that national specifications are met
• auditing the service against agreed standards, including anaesthetic complication rates, as set out in the RCoA ...