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Collaborative audit with the other neuroscience disciplines should be encouraged, as well as close liaison and joint transfer audits with referring hospitals.⁶

Regular morbidity and mortality meetings should be held jointly with neurosurgeons, interventional neuroradiologists and other relevant stakeholders.

All departments should maintain active links to national bodies and societies (e.g. NACCS Link Doctor Scheme) to facilitate national audit and dissemination of information.

Clinical research staff allocation to clinical activities (beyond those job planned) should be limited to situations of major strain in the resources, such as major departmental emergencies.⁵⁴

It is recognised that equipment for neurosurgical patients can be expensive; this should be considered through business models.

Availability of two consultant anaesthetists, or a consultant and senior trainee or SAS doctor, should be considered for more complex procedures, such as thoracoabdominal aortic aneurysm repair.²

Continuity of care should be a priority in prolonged procedures and when this is not possible, a formal documented process with some overlap should be in place for handover of clinical care from one anaesthetist to another.³

The complexity of some procedures may necessitate anaesthetic involvement in multidisciplinary team meetings and this activity should be reflected in job plans.

Consultant or autonomously practising anaesthetists in cardiac units should be responsible for the provision of service, teaching, protocol development, management, research and quality improvement. Adequate time should be allocated in job plans for these activities.

Each unit should have a designated clinical lead (see Glossary) anaesthetist who is responsible for cardiac anaesthesia services. This should be recognised in their job plan and they should be involved in multidisciplinary service planning and governance within the unit.