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Hospitals should contribute to national audits; benchmark themselves against national recommendations resulting from these audits and change practice in response to rapidly developing national guidance. Hospitals should develop local quality improvement programmes that are responsive to local requirements. Where data are not available from national data collections, data collection should be responsive to local issues. Clinicians performing this work should...

Hospitals should provide the services and resources required for the management of the emergency surgical patient with diabetes including explicit managerial and clinical policies.¹³⁴

Hospitals should consider appointing a lead anaesthetist for diabetes.

Preoperative fasting should be minimised as much as possible, especially for infants and younger children.^23,24

Hospitals should have mechanisms to promote early identification of the emergency surgical patient with diabetes.

Hospitals should have clinical guidelines including:¹³⁴

• involving patients in the management of their own diabetes. Most diabetic patients are experts in managing their own disease, and the management of the emergency diabetic surgical patient can usually be undertaken with only minor modifications in the patient’s usual regime.
• emergency surgery patients with diabetes should be assessed for multimorbidity and...

A multidisciplinary team approach is highly recommended, typically involving anaesthetists, obstetricians, surgeons, paediatricians and midwives.^{137,138,139,140}

Surgery should be undertaken where neonatal and paediatric services are readily available whenever possible.¹³⁷

Fetal heart rate monitoring should be available and local policies should outline its use taking into account fetal viability, the physical ability to perform it and availability of a healthcare provider able to intervene for fetal indications.^{137,138,141,142}

Informed consent for the surgical procedure should include consideration of fetal wellbeing and the possibility of caesarean delivery.¹³⁹