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Preoperative assessment of patients, especially those at very high risk, can benefit from a team approach involving cross specialty advice from anaesthetists, surgeons and intensivists. Early consultation with appropriate medical specialties should occur for appropriate conditions, e.g. acute kidney injury, diabetes mellitus and ischaemic heart disease.14
Patients with diabetes are at increased risk of concurrent morbidity. These conditions should be identified and optimised where and when possible.38
All decisions concerning the consent process and treatment plans, including decisions about whether or not to operate, should be documented clearly, noting what risks, benefits and alternatives were explained to the patient within the time constraints of emergency care.181,182 (See also section 9)
There should be a system in place for alerting medical staff to any change in the clinical condition of the emergency surgical patient whilst awaiting surgery.73,183
There should be provision for preoperative admission of the critically ill patient to level 2 and/or level 3 care facilities for stabilisation and optimisation if required.1,9
Guidelines for fasting before anaesthesia for emergency surgery should comply with national standards.184
Guidelines for postoperative planning should include plans for nutrition, including facilitation of enteral access or vascular access for parenteral support.185,186,187
Day surgery should be a consultant led service (surgical and anaesthetic) with a dedicated clinical lead or clinical director who has programmed activities allocated to the role within their job plan.8,9,10
An appropriately skilled and experienced resident anaesthetist should be available at all times to care for postoperative and emergency patients. The experience and skills necessary to provide this cover are not usually found in training grades below ST3.
High quality anaesthesia is pivotal to achieving successful outcomes following day surgery. The majority of anaesthesia for day surgery should be delivered by consultant anaesthetists.15,16 staff grade, associate specialist and specialty doctors (SAS) grade doctors and experienced trainee anaesthetists may also provide anaesthesia for day surgery. However, these doctors should be suitably experienced and skilled in...
