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Preadmission clinics for elective neurosurgery should be available, with early input from the department of neuroanaesthesia particularly for high risk cases and those where additional time and discussion are required, e.g. awake craniotomy. All centres should be able to demonstrate that discussion of perioperative risk is routine and that specific risks related to, e.g. prone positioning are communicated.32,33,34
Hospitals should have systems in place to facilitate multidisciplinary meetings for neuroscience services.35,36
Anaesthesia departments should have a nominated anaesthetist immediately available to provide cover in clinical emergencies, as well as advice and support to other anaesthetists.5
A World Health Organization (WHO) checklist adapted for neuroscience procedures should be in use.
The theatre team should all engage in the use of the WHO surgical safety process, commencing with a team brief, and concluding the list with a team debrief.34 Debrief should highlight things done well and also identify areas requiring improvement. Teams should consider including the declaration of emergency call procedures specific to the location as part of the team brief.
For standalone neuroscience centres, local arrangements should be in place for specialist opinion and review of patients by other disciplines. A named consultant neuroanaesthetist should be identified to facilitate such liaison.
Hospitals should review their local standards to ensure that they are harmonised with the relevant national safety standards, e.g. National Safety Standards for Invasive Procedures in England or the Scottish Patient Safety Programme in Scotland38,39 Organisational leaders are ultimately responsible for implementing local safety standards as necessary.
Local guidance should be developed for the intrahospital transfer of neuroscience patients, based on guidance from Neuro Anaesthesia and Critical Care Society of Great Britain and Ireland (NACCS), Association of Anaesthetists and the Intensive Care Society.40
Each department should appoint a designated liaison consultant responsible for identifying the strategic pathways and logistical pitfalls of the intra-hospital transfer of neurosurgical patients. The appointment should ensure any identified problems are either removed or mitigated.
It is recognised that equipment for neurosurgical patients can be expensive and this should be considered through business models.
