A high level of preparedness for uncommon anaesthesia-related emergencies saves lives and improves patient outcomes. We reviewed the guidelines already provided at Charing Cross Hospital, a tertiary neurosurgery centre, and compared them with the Guidelines for the Provision of Anaesthetic Services (GPAS)  created by the Royal College of Anaesthetists. Methods We carried out a plan-do-study-act cycle, in line with best quality-improvement practice. We reviewed the availability of emergency
... idelines at all locations where anaesthesia is delivered, theatre and non-theatre. We surveyed consultants, trainees and operating department practitioners (ODPs) within our department using a web-based questionnaire to assess the knowledge and confidence regarding anaesthetic emergencies guidelines and location of emergency drugs/ equipment. We then introduced the Quick Reference Handbook (QRH)  through a programme of written information, regular updates and recorded simulation of its use in an emergency. Results Emergency guidelines were only available in 10/20 main operating theatres and not all were up to date. We obtained a total of 35 responses in the survey (response rate 51%). Ninety per cent of consultants and 94.3% of ODPs accurately identified the location of core emergency equipment. However, only 66% of trainees were aware of the location of the equipment. All groups were less clear on the exact location of emergency drugs like dantrolene, Intralipid and anaphylaxis kit. Only 50% (17/35) identified the correct location of guidelines. Around 70% of consultants were very familiar with the use of these emergency guidelines while nearly 50% of trainees and 75% of ODPs were less familiar with its use. Of the participants, 88.5% (31/35) were aware of the QRH and half of them found it very useful. Of the consultants, 54% (6/11) had never used the QRH before; conversely, only 10% of trainees and ODPs had not used the QRH. Discussion Availability of emergency guidelines was substandard, and the awareness of the location of certain drugs was variable. In response, we have deployed the QRH in visible locations in all anaesthetic locations to provide a clear, systematic guide for dealing with anaesthetic emergencies. Location information for emergency equipment is displayed in the QRH and on wall posters, and regular drills are being run to refresh knowledge of where to find key equipment. Using a video of a simulated emergency, we raised awareness of the new guidelines and how to use the QRH.