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Information to patients should include what to expect in the anaesthetic room and operating theatre.⁸⁶

Patients from non-English speaking groups may need interpreters. Hospitals should have arrangements in place to provide language support, including interpretation and translation (including sign language and Braille).This information should comply with the NHS England ‘Accessible information Standard’.⁸⁷ Patients with learning and other difficulties may need special assistance and consideration.

All monitors should be fitted with audible alarms.⁴

Anaesthetic involvement in the leadership of cardiothoracic units should be considered.

There should be a forum for discussion of matters relevant to both surgeons and anaesthetists, for example protocol development and critical incidents.

Clinical protocols should be developed from national guidelines and reviewed on a regular basis.

Hospitals should have systems in place to facilitate multidisciplinary meetings for both cardiac and thoracic services.

The theatre team should all engage in the use of the World Health Organization (WHO) surgical safety process,⁶⁶ commencing with a team brief, and concluding the list with a team debrief. The 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...

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 (NatSSIPs) or the Scottish Patient Safety Programme in Scotland.^67,68 Organisational leaders are ultimately responsible for implementing local safety standards as necessary.

There should be sufficient numbers of clinical programmed activities in clinicians’ job plans to provide cover for all elective cardiac and thoracic operating lists and to provide adequate emergency cover.⁶⁹