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Adequate emergency theatre time should be provided throughout the day to minimise delays and avoid emergency surgery being unnecessarily undertaken out of hours when the hospital may have reduced staffing to care for complex postoperative patients. Consideration should be given to consultant, or suitably experienced and trained SAS doctor, staffing of 'twilight' or evening emergency theatre sessions. Job plans may...

Dedicated emergency lists for some individual surgical services, e.g. paediatrics, may be an effective use of resources and improve patient flow and care.⁴¹

Some aspects of preanaesthetic assessment and preparation of the emergency patient differ from those of the elective patient. These include severity of illness, fluctuating condition of the patient, and the 24/7 nature of emergency work. Staffing levels and seniority of anaesthetists should be adequate to enable preanaesthetic planning and assessment that is appropriate to the patient’s risks associated with surgery...

There should be a formalised integrated pathway for unscheduled adult general surgical care which should be patient centred and include:^{1,3,33,41,128}  

• a clear diagnostic and management plan made on admission⁷³
• risk assessment and identification of the high risk patient^1,3,128
• early identification of comorbidities (including diabetes...

All hospitals should have guidelines in place for the recognition and management of patients with sepsis. Compliance with these policies should be regularly audited.^9,104,105

Every hospital should nominate an anaesthetic lead (see glossary) for obesity.³⁵

There should be locally agreed policies for the 24/7 cover of emergency surgery, prioritisation of emergency cases according to clinical urgency, and seniority of anaesthesia staff according to patient risk.¹

Appropriate clinical policies and standard operating procedures for operating theatres should be in place and available at all times, including a resuscitation policy and major incident plans.

All staff, including anaesthetic assistants, locum, agency and trust grade staff must have undergone an appropriate induction that includes the contents of relevant policies and standard operating procedures.²⁵

An escalation policy should be in place for all medical, healthcare professional and managerial staff. An emergency call system should be in place and understood by all relevant staff. This should include the names and method of contact, which should be prominently displayed in appropriate areas. Internal hospital telephone switchboards should have ready access to rotas and methods of contacts.