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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 Scotland^38,39 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.

Departments of neuroanaesthesia should be encouraged to develop research interests, even if not part of an academic department. Research collaboration with other neuroscience disciplines is good practice. Taking part in national anaesthesia and critical care projects is to be encouraged.^40,47

Audit programmes should be developed locally but should include continuous audit of transfer of brain injured patients, neurocritical care capacity and demand, rates of unplanned admission and readmission to the intensive care unit, and the caseload of trainees. In general, local practice should be audited against compliance rates with national and expert consensus guidelines.^7,40,48

Collaborative audit with the other neuroscience disciplines should be encouraged as well as close liaison and joint transfer audits with referring hospitals.⁶ 

Anaesthesia departments should make arrangements to allow anaesthetists working solo during long surgical procedures or on overrunning lists to be relieved by a colleague or AAs for meal and comfort breaks.^3,6

Regular morbidity and mortality meetings should be held jointly with neurosurgeons, interventional neuroradiologists and other relevant stakeholders.