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It is recommended that individual vascular anaesthetists register with, and contribute to, the UK national audit database (National Vascular Registry),⁴⁶  which incorporates a section dedicated to ‘anaesthesia’ as developed between the Vascular Anaesthesia Society of Great Britain and Ireland and partnership organisations. The systems needed to provide the necessary data should be available and supported.

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

Scheduled lists that are planned to take longer than three sessions (e.g. where a patient requires prolonged time in theatre) must be staffed appropriately to ensure that no single anaesthetist works longer than three elective sessions. Adequate rest periods during sessions must be provided. ^{31, 32, 33}

Departments should consider having a health and wellbeing lead who has access to adequate expertise and resources.⁴³,⁴⁸  The RCoA and the Association of Anaesthetists have published a model job description for this role. ⁴⁹

All anaesthetists and anaesthetic assistants as well as ODPs should receive systematic training in the use of new regional anaesthesia equipment. Provision and receipt of training should be clearly documented. Staff should not use regional anaesthesia equipment unless appropriately trained. There should be a suitable induction policy for new staff and when new equipment is introduced, with a record of...

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...

RA-UK recommend that, under certain strict criteria and as defined in RA-UK supervision guidelines, intraoperative patient monitoring may be delegated to a suitably trained health care worker who has been specifically trained in patient monitoring according to Association of Anaesthetists guidelines. This recommendation pertains to awake surgery under peripheral regional anaesthesia but excludes patients undergoing shoulder surgery in the deck...