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Hospitals should have a policy covering the transfer of blood products with patients to and from other hospitals.¹⁹³

Patients should be appropriately monitored during their recovery from anaesthesia or sedation.¹⁹

Inpatient pain nurse specialists providing education on the wards should have dedicated time for this role distinct from direct clinical duties.

Children should be separated from and not cared for directly alongside adults throughout the patient pathway, including reception and recovery areas. Where complete separation is not possible, the use of screens or curtains, while not ideal, may provide a solution.^32,33

To act as the duty anaesthetist without direct supervision from a consultant or autonomously practising anaesthetist, the duty anaesthetist should meet the basic training specifications and have attained the RCoA’s Initial Assessment of Competence in Obstetric Anaesthesia.^20,21

Where children are transferring from paediatric to adult services there should be the opportunity to advise them about possible changes in anaesthesia management. Examples may include the use of sedation for some procedures that previously would have been managed with general anaesthesia, or the use of alternatives to topical anaesthesia.³⁶

Patients from non-English speaking groups may require interpreters. Hospitals should have arrangements in place to provide language support, including interpretation and translation (including sign language and Braille). This information should comply with the NHS England Accessible Information Standard.⁹⁴

The use of extracorporeal membrane oxygenation (ECMO) for the management of adults with severe respiratory failure is centralised in a number of specialist cardiothoracic centres. Anaesthetists often institute ECMO and support retrieval of patients from non-specialist hospitals. Anaesthetists providing ECMO should be suitably trained.²⁹

The output from consultations with patients at increased risk of mortality or morbidity must be documented in the patient’s medical notes. In addition, mechanisms for clear communication of these consultations to patients, anaesthetists, surgeons, general practitioners and other healthcare workers should be in place.^6,54