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Nationally agreed key performance indicators should be used to monitor the performance of the pathways for hip fractures and major trauma and reviewed by a multidisciplinary committee including a trauma lead anaesthetist. In addition, local quality indicators should be developed proactively, to support continuing improvement of these services within organisations.

Anaesthetists treating children and young people must ensure that they understand the requirements for consent in the part of the UK in which they are working.^54,56,57,58

All institutions where sedation is practised should have a sedation committee. This committee should include key clinical teams using procedural sedation and there should be a nominated clinical lead for sedation. In most institutions, the sedation committee should include an anaesthetist, at least in an advisory capacity.

Any autonomously practising anaesthetist working in neuroanaesthesia must undertake continuing professional development (CPD) in neuroanaesthesia and must have sufficient regular programmed activities within this field to ensure that their specific skills and experience are maintained.²⁷

Anaesthetists should be given support and time to familiarise themselves with non-theatre locations and local working arrangements, (e.g. during induction sessions prior to undertaking on-call responsibilities).^13,131

High-risk patients (5% or above mortality risk) or lower-risk patients undergoing high-risk surgery should receive direct consultant anaesthetist and consultant surgeon delivered care in the operating theatre.^2,178

There should be a multidisciplinary team approach to care for pregnant women requiring non-obstetric emergency surgery involving anaesthetists, obstetricians, surgeons, paediatricians and midwives.^184,185,186

The lead obstetric anaesthetist should ensure representation of the anaesthetic department at multidisciplinary meetings for service planning and governance purposes, including labour ward forum, risk management groups and incident reviews.^22,24

Anaesthetists must undertake at least level 2 training in safeguarding/child protection,¹¹⁰ and must maintain this level of competence by regular annual updates on current policy and practice and case discussion.114

All anaesthetists working in the maternity unit should have received training in human factors, addressing key factors including situational awareness, effective teamworking and communication, decision making and the effect of biases.^133,134