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Agreed local guidelines should be in place and implemented on the following:

• compliance with best practice anaesthetic management protocols for hip fracture as recommended by the Association of Anaesthetists.^46,61
• tailored World Health Organization (WHO) safety checklists to discuss the requirement for use of bone cement  
• preoperative assessment for treatment escalation and cardiopulmonary resuscitation
• older people (>65...

Those who refuse transfusion of blood or blood products, whether because of adherence to the Jehovah’s Witness faith or for other reasons, should be identified early in the antenatal period. They should meet with an anaesthetist to discuss their specific wishes and should receive information about the potential risks associated with their decision to ensure informed consent process.^118...

In-situ simulation training can help to identify system process gaps.¹²³ Simulation based learning techniques should assist anaesthetists in resolving these issues and developing the necessary technical and non-technical skills.^{124,125,126,127,128,129,130,131,132}

Thoracic anaesthesia is a ‘key unit of training’ in both the 2010 intermediate level training in anaesthesia³⁴ and in the newer 2021 Curriculum Stage 2.³⁵of training. Trainee anaesthetists should be of appropriate seniority to be able to benefit from this area of training. Stage 3 training of the 2021 Curriculum also requires trainees to be proficient...

Anticipated difficulty with anaesthesia should be brought to the attention of the anaesthetist as early as possible before surgery.⁸⁰ This includes planned admission to a critical care unit, the potential need for special skills such as fibre optic intubation, obesity, complex pain problems, a known history of anaesthetic complications or patients with learning disabilities who may require additional resources...

Preoperative assessment, optimisation and shared decision making in patients with multiple comorbidities, frailty or cognitive impairment require a cross specialty approach involving anaesthetists, surgeons, geriatricians, pharmacists and allied health professionals. Liaison with a clinical pharmacist in the perioperative period will enable optimisation of medicines and improved management of the patients’ non-surgical comorbidities during this time. The development of such teams...

Anaesthetists should be involved in audit cycles, preferably using a ‘rapid-cycle’ quality improvement approach. These benchmark standards of care, and may be an effective change driver.  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.^{58,128,129,211}

In recent years there has been a trend towards assessment of elective patients in preadmission clinics, typically one to two weeks before surgery. This allows routine paperwork and investigations to be completed before admission, permits ‘same day’ admission and reduces the likelihood of delays or cancellation.^48,49,50,51 Anaesthetists should be part of the preadmission clinical...

Regular audits of the following aspects of preoperative care may include:

• the effectiveness of preoperative information provided to patients
• preoperative documentation of consultation by anaesthetists
• consent to anaesthesia
• the effectiveness of preoperative assessment services
• preoperative visiting (patient waiting time, proportion of one stop visits)
• preoperative airway assessment
• preoperative fasting in adults and children
• appropriate preoperative medication
• thromboprophylaxis
• choice of technique...