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Adequate provision should be made for an anaesthetist led acute pain service.¹²

Adequate provision should be made for a member of the anaesthetic team to visit the following groups of patients within 24 hours following their operation:

• those graded as ‘American Society of Anesthesiologists (ASA) Physical Status 3, 4 or 5’
• those receiving epidural analgesia in a general ward 
• those discharged from recovery with invasive monitoring in situ
• those for whom a...

In the main operating theatre complex, a dedicated post-anaesthesia care unit (PACU) is required. This should be located in the operating theatre department and be separate from the department’s admission area and with a separate access for transfer of patients to the ward.^10,13

Preoperative assessment, optimisation and shared decision making in older patients with multiple comorbidities, frailty or cognitive impairment require a cross specialty approach involving anaesthetists, surgeons, geriatricians, pharmacists and allied health professionals. Liaison with a clinical pharmacist to support older patients with polypharmacy in the perioperative period will enable optimisation of medicines and improved management of the patients’ non-surgical comorbidities during...

The size, design and facilities of the PACU must meet the Department of Health guidelines.¹³

All areas, including emergency departments, admitting acutely ill patients should have early warning pathways to ensure prompt recognition of a deteriorating patient to trigger an appropriate response.⁵⁷ This should include policies for early medical review and early escalation to the responsible consultant surgeon or equivalent.^{10,48,58,59,60,61}

It is recommended that a minimum of two recovery beds per operating theatre be provided,  depending on local knowledge of the clinical specialties and the number of patients.^9,13

The bed spaces should allow unobstructed access for trolleys, x-ray equipment, resuscitation carts and clinical staff. The facility should be open plan, allowing each recovery bay to be observed but with the provision of curtains for patient privacy.¹⁰

Oxygen and suction should be present in every recovery bay and ideally delivered by pipeline.¹⁰

An emergency audible and visible call system should be in place, checked regularly to maintain functionality and understood by all staff.¹⁴