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Patients with frailty are at increased risk of adverse postoperative outcome. Older patients undergoing intermediate and high-risk surgery should be assessed for frailty using an established tool or scoring system. Pathways of care providing proactive preoperative interventions for frailty, involving therapy services, social services and geriatricians, should be developed.^28,31,32,33 Older patients should have...

Capnography has the potential to aid early detection of airway obstruction and should be available in recovery and used in high risk cases. If patients remain intubated or they have their airways maintained with a supraglottic or other similar airway device, continuous capnography should be used.^5,10,18

A brief interruption of monitoring during transfer of the patient from theatre is only acceptable if the recovery area is immediately adjacent to the operating theatre. Otherwise monitoring should be continued during transfer to the same degree as any other intra or inter hospital transfer.¹⁷

Supplementary oxygen should be available for transport after general anaesthesia.⁵

Airway adjuncts should be available in the post-anaesthesia care unit to minimise the incidence of upper airway obstruction that may lead to post obstructive pulmonary oedema and severe hypoxaemia.⁵

Patient information should be continuously recorded and updated (in electronic or written format). Anaesthetic Information Management Systems, a specialised form of electronic health record, should be considered as electronic patient charts in the perioperative and recovery period as they provide a more accurate and complete reflection of the patient’s perioperative physiologic parameters.¹⁹

Hospitals must have local policies in place for the identification, support and safeguarding of vulnerable adults.^6,136

Staff should have regular training in the application of the legislation determining mental capacity in the part of the UK in which they are working and should have defined access to patient advocates.¹⁸⁶ This is a rapidly changing area and clinicians should have access to expert advice.

Hospitals should have policies to support patients and staff of diverse religious beliefs and cultural backgrounds.¹³⁶

Locally devised protocols should be available for discharge criteria.^10,20