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Audit programmes should be under regular review by a clinical lead and those relating to sedation should be coordinated by a hospital sedation committee.^2,3

Regular feedback should be provided to anaesthetic staff and they should be encouraged to participate in quality improvement activities.

Compliance with agreed guidelines should be audited, such as World Health Organization surgical safety checklist compliance, equipment and monitoring standards, and anaesthetic record keeping.^1,92

Anaesthesia departments should participate in relevant audit and research activities of national bodies such as the Health Services Research Centre and National Confidential Enquiry into Patient Outcome and Death.⁹²

All episodes of anaesthesia in the non-theatre environment should be captured in a structured record within clinical notes.

Regular multidisciplinary team review should be encouraged, with appropriate service improvement initiatives and shared learning.

Contribution to airway registries, such as the Difficult Airway Society Database and Emergency Medicine Airway Registry, should be encouraged.

In a designated major trauma centre, the receiving trauma team should include an anaesthetist with appropriate airway and damage control resuscitation competencies to manage trauma patients.^48,49

The safe management of unstable patients depends on close liaison between emergency physicians, anaesthetists and intensivists.^50,51 Local collaboration and leadership through committee structure or working groups should ensure the following:

• clear guidelines are easily accessible to all staff regarding fixed contact points for anaesthetic support, channels of escalation, equipment availability, medication use and periprocedural care.⁵² Major...

Emergency airway management in the ED should follow the recommendations of the collaborative working framework of the Royal College of Emergency Medicine and the Faculty of Intensive Care Medicine.^53,54