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There should be sufficient numbers of clinical programmed activities in clinicians’ job plans to provide cover for all elective cardiac operating lists and to provide adequate emergency cover. Compensatory rest periods for out of hours on-call work should be appropriately included in rotas and job planning. This may affect the subsequent day’s scheduled theatre activity and staffing provisions should be...

Service developments outside the operating theatre (e.g. interventional cardiology) often place unintended demands on anaesthetists. The business plans for such services should include provision for anaesthetic services.

Most research in cardiac anaesthesia will be undertaken in specialist cardiac units and should be given high priority with appropriate time and infrastructure support.

Regular clinical audit of the work of cardiac anaesthesia services is essential. This should also include submission of data to national audits, such as the ACTACC national audit project. Information technology support should be available for such activities.^1,57

Centres should consider contributing to multidisciplinary national benchmarking audits such as the National Institute for Cardiovascular Outcomes Research, Getting It Right First Time, and the National Cardiac Benchmarking Collaborative.⁵⁸

All cardiac units should have regular multidisciplinary morbidity and mortality meetings. These should have a list of patients to discuss in advance, an attendance register, and minutes with learning points. Consultant or autonomously practising anaesthetists should attend these meetings and, where possible, inclusion in job plans should be considered. Trainees should be encouraged to attend during their attachments.

Robust procedures should be in place to report and investigate adverse incidents involving equipment, staff or patients. The published outcomes of these investigations should be disseminated to all relevant anaesthetists and others.

Booklets providing information for patients about their stay in hospital should be available for all patients. This will include the patient information booklets published by the British Heart Foundation on cardiac disease, prevention, treatment and lifestyle modifications. Sources of information about the anaesthetic should also be available such as those from the RCoA.^9,59,60

Information about cardiac rehabilitation generally, and information regarding the availability of such courses locally, should also be available.

Information on specific individual risks of invasive monitoring (.g. risk of injury due to arterial and central venous lines, blood product transfusion and transoesophageal echocardiography) should be available to patients.