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Patients should be admitted to a ward or alternative facility with sufficient time before the operating list on which they are scheduled. If an adequate preoperative assessment has been performed, admission can be on the day of surgery but it remains essential that the anaesthetist who will be administering the anaesthetic is able to confirm the findings of the assessment...
Hospitals should have systems in place to facilitate multidisciplinary morbidity and mortality meetings.125
There should be clear arrangements in contingency plans and an escalation policy for use should two emergencies occur simultaneously, including whom to call.
Hospitals should have approved documentation defining safe staffing levels for anaesthetists and anaesthetic assistants, including contingency arrangements for managing staffing shortfalls, and annual reviews of compliance with these should be performed.
There should be systematic measures in place to respond to serious incidents. These measures should protect patients and ensure that robust investigations are carried out by trained safety leads. When an incident occurs, it should be reported to all relevant bodies within and beyond the hospital. A system of peer review or external evaluation of serious incident reports should be...
An anaesthetist should be involved in all case reviews where the case includes anaesthetic input.
The lead obstetric anaesthetist should audit and monitor the duty anaesthetist workload to ensure that there is sufficient provision for the busyness of the unit.
There should be regular audits of the quality of clinical governance, with particular attention being paid to provision and updating of local guidelines, reviews of adverse events, and record keeping.24
There should be regular audits relating to the provision of neuraxial analgesia, with particular attention paid to midwifery staffing levels and delays between request for and delivery of pain relief, maternal satisfaction rates and recognised complications.130,131
There should be a regular audit of delays to elective caesarean deliveries.55
