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BJA Advance Access published online on June 6, 2005
British Journal of Anaesthesia, doi:10.1093/bja/aei165
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2005. All rights reserved. For Permissions, please e-mail: journal.permissions@oupjournals.org
Accepted April 25, 2005

Audit

Supervision and responsibility: The Royal College of Anaesthetists National Audit{dagger}

G. A. McHugh 1 and G. M. M. Thoms 2*

1 School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
2 Department of Anaesthesia, Central Manchester and Manchester Children's University Hospitals NHS Trust, Manchester, UK; University Department of Anaesthesia, University of Manchester, Manchester, UK

* To whom correspondence should be addressed.
G. M. M. Thoms, E-mail: gavin.thoms{at}cmmc.nhs.uk


  Abstract

Background. The Royal College of Anaesthetists audited consultant supervision and responsibility in anaesthesia in the UK during 2003.

Methods. Consultants (supervising) and non-consultants (supervised) were surveyed on their attitudes to supervision, experience of their own hospital system for supervision and of induction for new starters. Local coordination was achieved through anaesthesia audit coordinators who provided information on local policies, induction programmes and anaesthesia charts. Supervision was audited over a 5-day period.

Results. 135 departments of anaesthesia took part (43% of 315 departments), questionnaires being returned by 2297 anaesthetists. Anaesthesia record charts in use do not meet criteria considered desirable locally. Most trainees, but less than half staff grade/associate specialists, received an induction programme, often not supported by written documentation. Consultants find conflicting demands of service and supervision difficult. Many work in systems which do not permit providing direct, immediate support to those supervised. Most anaesthetists think supervision is very important. Around half disagree with national guidance that every NHS patient should have a named consultant. Two per cent of non-consultants during the audit period reported assistance from consultants not being obtainable soon enough.

Conclusions. This audit found departure from standards and the potential for risk and failure. New standards may be needed regarding anaesthesia record sheets, induction, accountability, when to seek help and care of sick patients. Supervision systems in over 40% of hospitals need review to ensure they provide a named consultant and immediate direct support for elective lists.

Keywords: anaesthesia; audit, clinical; supervision, consultant supervision.
{dagger} This article is accompanied by Editorial II.
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