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In exceptional circumstances, an anaesthetist working singlehandedly may be called to briefly assist with or perform a lifesaving procedure nearby. This is a matter for individual judgement and a dedicated ODP or anaesthetic nurse should be present to monitor the patient in these exceptional circumstances.¹²³ This should be for as short a period as possible and the person left...

Information should be made available to patients that gives details of the surgery and local and general anaesthesia for ophthalmic procedures, as well as advice on what to expect on the day of admission. The Royal College of Anaesthetists and the Royal College of Ophthalmologists have a range of booklets available on their websites to help to inform patients.^55,56,57

Preoperative assessment, optimisation, manipulation of patients’ normal drugs and shared decision making in patients with diabetes requires a cross-specialty approach based on national guidance involving anaesthetists, surgeons, diabetes physicians, diabetes inpatient specialist nurses and pharmacists. The development of such teams requires time and resources. This should be recognised and provided.^269,270

An appropriate level of staffing and suitable facilities should be available to deliver a good quality preoperative service. Non-anaesthetist health professionals, such as, specialist nurses, pharmacy staff, allied health professionals and Anaesthesia Associates (AAs) add considerable value to the service.^42,46,47

Departments should consider having a health and wellbeing lead who has access to adequate expertise and resources.⁴³,⁴⁵  The RCoA and the Association of Anaesthetists have published a model job description for this role. ⁴³

Patients undergoing regional anaesthesia should undergo preoperative preparation, where there is the opportunity to assess medical fitness and impart information about the procedure. An individualised risk-benefit assessment and discussion should occur with every patient considering regional anaesthesia. Relevant guidance should be followed where appropriate based on the patient, the procedure and the specific regional technique e.g. Association of Anaesthetists guidance...

Anaesthesia for emergency surgery should be delivered by a competent individual with appropriate supervision; the level of supervision should reflect the severity of the case and the seniority of the individual in accordance with the RCoA’s Guidance on Supervision arrangements for anaesthetists.⁹⁵

Departments should consider developing diagnostic ultrasound skills as appropriate to emergency anaesthesia. Adequate capacity for appropriate investigations depending on case mix and surgical procedures should be readily available. Basic investigations such as ECG should be considered a core skill of the emergency team. Training emergency anaesthetists special investigations such as focused ultrasound in intensive care should be considered.¹³⁷

Transfer of children to specialist centres is usually undertaken by regional paediatric emergency transfer services. Time critical transfers such as neurosurgical emergencies may need to be transferred by the referring hospital. Local policies (see Glossary) should be in place for the management of such transfers and the most experienced anaesthetist with appropriate skills; an anaesthetic practitioner should accompany the child.¹⁷³

Anaesthetists should be involved in audit cycles, preferably using a rapid-cycle quality improvement approach. These cycles benchmark standards of care and may be effective change drivers. This approach is 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 hospitals.^27,199