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Organisations must ensure that provision is made for appropriate assessments to be carried out for patients whose care falls under the Deprivation of Liberty Safeguards, as specified by the Mental Capacity Act 2005. Provision must also be made for the involvement of independent mental capacity advocates.155
An anaesthetist should preoperatively assess all patients undergoing emergency surgery who require anaesthesia. This should take place outside of the theatre complex if possible and adequate time should be available for this to occur as clinical urgency allows.181
A full anaesthetic management plan should be recorded in the patient's records or anaesthetic chart and initiated preoperatively.176
The experience and expertise of the anaesthetist assessing the patient preoperatively should be appropriate for the complexity and level of risk of the patient.46 The decision to operate on high risk patients should be made at a senior level, involving surgeons and those who will provide intra and postoperative care.3,14,33
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
