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A nurse-led sedation service should be supported by an appropriately trained and experienced anaesthetist at all times.⁵³

The paediatric anaesthetist should consider the patient age, physical capacity, complexity of the procedure and the status of the surgical facility before administering anaesthesia.

Standards for monitoring and recovery are stipulated by the Association of Anaesthetists and should be adhered to for all ECT cases.¹⁰

Training should be provided as part of employment induction and repeated regularly thereafter for anaesthetists, ward staff, doctors in training and allied health professionals.

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

Where a patient is seen prior to the day of surgery and shared decision making and discussion of anaesthetic conduct has taken place, the anaesthetist on the day of surgery has a responsibility to ensure the patient still understands and agrees with the perioperative plan.^66,67

Decision support systems for crisis scenarios should be available, for example the Association of Anaesthetists Quick Reference Handbook, advanced life support algorithm, difficult airway guidelines and major haemorrhage protocols.^144,145,146

Where the postoperative destination is not a main ICU (e.g. a level 2 HDU or specifically developed PACU), the patient should remain in PACU until they are stable and are no longer likely to require immediate support from an anaesthetist. This is of particular importance when transferring patients from recovery to level 2 critical care units that are not staffed...

Departments should review the responsibilities of anaesthetists as part of job planning.  This includes out of hours commitments and the scope of the individual’s practice, as well as any additional roles and responsibilities.^{17, 24, 25}

Departments should consider having flexibility in the day-to-day rota so that there are more anaesthetists working in a clinical area, such as a theatre suite, than there are procedures being carried out to ensure that this cover is always immediately available. The size of the additional staffing resource is dependent on the number of anaesthetic procedures underway simultaneously and the...