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For patients undergoing diagnostic procedures such as MRI, although separate written consent for anaesthesia is not mandatory in the UK, all discussions about sedation and anaesthesia should be documented. Discussion should include methods of induction, associated risks, side effects and potential benefits of the procedure. It is not the responsibility of the anaesthetist to explain the indications for the procedure.^55,56

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

Adequate time for formal multidisciplinary team (MDT) handovers between shifts should be built into the timetable. In the case of the anaesthetist being otherwise engaged with work at the time of the MDT labour ward handover, a briefing from the midwifery and obstetric team should be sought at the earliest opportunity to facilitate a shared mental model of the existing...

As a basic minimum for any obstetric unit, a consultant or other autonomously practising anaesthetist should be allocated to ensure senior cover for the full daytime working week; that is, ensuring that Monday to Friday morning and afternoon sessions (see Glossary), are staffed.²² This cover is to provide urgent and emergency care, not to undertake elective work.

Ultrasound imaging equipment should be available to anaesthetists trained in its use for central vascular access and transversus abdominis plane blocks. Where staff have the relevant competencies, ultrasound may also be useful for other tasks^.54,55,56,57

Pregnant women should have access to information about the differing modes of delivery during the antenatal period and should be offered the opportunity to speak to an anaesthetist if they wish to discuss how this might affect their choices around analgesia and anaesthesia.^{142,156,157,158}

Fellowship posts should be identified to allow additional training for those who wish to follow a career in thoracic anaesthesia to help ensure there are adequate numbers of skilled anaesthetists in the specialty. These should be suitable for trainees who wish to take time out of training programmes, or for those who are post certificate of completion of training. Such...