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Anaesthetists should participate in departmental audit and quality improvement projects, using specific, measurable, attainable, relevant and time-bound (SMART) methodology (see Glossary) and consideration of full audit cycles (e.g. plan, do, study, act). This participation should adhere to the standards and principles outlined in the College’s Raising the Standards: RCoA Quality Improvement Compendium.⁵

There should be a multidisciplinary and cross specialty programme for auditing intraoperative care.

A system for reporting and regular audit of critical incidents and near misses is an essential part of a well-led safety structure, and there should be multiprofessional involvement in this. The methodology must be explicit and identify underlying relevant factors to inform learning and development of safe systems. All staff must recognise the duty of candour and foster a culture...

Systematic audit should include the pattern of work in operating theatres.^5,282

Anaesthetists should be involved in audit and quality improvement cycles, preferably using a ‘rapid cycle’ quality improvement approach. This approach benchmarks standards of care and may be an effective change driver. It is also an excellent way of providing evidence of good practice as defined by the GMC, and mapping the contribution that individuals make to any service within their...

Regular revision at locally agreed timeframes and audit of standards of care, guidelines and protocols and critical incident reporting are essential in the continuing development and improvement of post-anaesthetic patient care.¹⁸⁵

Use of patient reported outcome measures (PROMs) to assess physiological and other recovery domains after surgery could be considered.^284,118

Nurturing a safety culture, learning from mistakes, preventing harm and working as part of a team are all part of the discipline of safety. To this end, shared learning and quality improvement that contribute towards improvements in safety, such as critical incident reporting with thematic analysis, and communication through morbidity and mortality meetings, could be undertaken.

All patients should be assessed prior to anaesthesia or anaesthesia-led sedation. This could be conducted face to face in a clinic or virtually (any interaction that does not take place face to face).^41,42 The majority of preoperative assessment will be nurse led and delivered (in association with allied health professionals and pharmacy staff) using locally agreed and developed protocols.⁴³

An anaesthetic preoperative assessment service should involve consultant anaesthetists and staff grade, specialty and associate specialist (SAS) doctors.^41,42,44 Dedicated anaesthetic presence in the preoperative assessment and preparation clinic is required for:

• the review of results and concerns identified by preoperative staff
• consultations with patients identified using a triage process to allow optimal delivery of preoperative...