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The lead obstetric anaesthetist should be responsible for the overall delivery of the service, which includes ensuring that evidence-based guidelines and protocols are in use and are up to date; monitoring staff training, workforce planning, and service risk management; and ensuring that national specifications are met, and auditing the service against these agreed standards, including anaesthetic complication rates. 

As a basic minimum for any obstetric unit, a consultant anaesthetist should be allocated to ensure consultant cover for the full daytime working week (that is, ensuring that Monday to Friday, morning and afternoon sessions are staffed).²⁴ This is to provide urgent and emergency care, not to undertake elective work.

Anaesthesia Associates (AAs) should work under the supervision of a consultant anaesthetist at all times as outlined by the RCoA.^48,49 In some emergency situations, a ratio of 1:1 may be more appropriate in view of the high incidence of comorbidities, complications and mortality.

In all centres admitting children, one anaesthetist should be appointed as clinical lead (see glossary) for paediatric anaesthesia. Typically, they might undertake at least one paediatric list each week and will be responsible for co-ordinating and overseeing anaesthetic services for children, with particular reference to teaching and training, audit, equipment, guidelines, pain management, sedation and resuscitation.

The use of general anaesthesia, sedation and regional anaesthesia for procedures undertaken in the ED should be managed according to guidance from the Academy of Medical Royal Colleges and Royal College of Anaesthetists.^8,9,10,11

The majority of hip fracture patients are >65 years of age and often have multiple comorbidities, some of which may be undiagnosed. Decisions on their treatment should ideally be made using a multidisciplinary team that involves senior anaesthetists, perioperative physicians, orthopaedic surgeons and orthogeriatricians, all with a specific interest in this patient population.⁵⁰

A minimum of two members of staff should be present (of whom at least one should be a registered practitioner) when there is a patient in the PACU who does not fulfil the criteria for discharge to the ward. If this level of staffing cannot be assured, an anaesthetist should stay with the patient until satisfied that the patient fulfils...

Patients requiring planned or emergency burn surgery should be cared for by theatre staff with current experience in burn care.⁴ Anaesthetists who provide emergency care outside burn services should be trained to manage the initial treatment of the patient with severe burns, including timely emergency assessment, resuscitation and transfer to a burns service.

Patients requiring planned or emergency burn surgery should be cared for by theatre staff with current experience in burn care.⁴Anaesthetists who provide emergency care outside burn services should be trained to manage the initial treatment of the patient with severe burns, including timely emergency assessment, resuscitation and transfer to a burns service.

There must be the ability to provide the patient with an appropriate chaperone, as per General Medical Council (GMC) guidance on intimate examinations and chaperones.⁴⁹ When examining a patient, anaesthetists must be sensitive to what the patient may consider as intimate. This could include any examination where it is necessary to touch or even be close to the patient.