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Members of clinical staff working within the recovery area should be certified to a standard equivalent to intermediate life support providers, and training should be provided.⁴⁴ An advanced life support provider or an anaesthetist should be available at all times.

When a critically ill patient is managed in a PACU because of a critical care bed is temporarily unavailable, it is necessary to have clarity as to who has the primary responsibility for the management of the patient. Usually the primary responsibility for the patient lies with the hospital’s critical care team, but other specific local arrangements may be sometimes...

Working to deliver emergency surgery is often a stressful, challenging environment. Stress, 'burn out' and mental ill health are major causes of sickness absence. NHS organisations should ensure that those in leadership positions work to promote and protect the health and well being of staff.⁵⁴

The particular needs of children should be considered at all stages of perioperative care. They should ideally attend a preoperative clinic staffed by nurses experienced in preassessing children. Children may benefit from a visit to the locality to which they will be admitted, and familiarisation with the environment and personnel.¹⁴ There should be access to play specialists.

Staff should be empowered to shape their working environment and ensure their workload is not overwhelming.²⁶

Appropriate rest breaks during and at the end of work must be provided by departmental rostering.⁵⁵ Appropriate facilities for these breaks should be provided according to defined norms.^54,56 Local arrangements might apply (depending upon the nature of the emergency work load) but they should still be within the legal requirements.

Departments should review the on-call responsibilities of anaesthetists as part of annual appraisal and job planning.⁵⁷ Reviews should take into consideration subjective assessment of fatigue and consider seeking advice from an accredited specialist in occupational medicine if necessary. This may apply, but not exclusively, to older anaesthetists.^54,58

When members of the healthcare team are involved in a critical incident, this carries a significant personal burden.⁵⁹ A team debriefing should take place after a significant critical incident. Critical incident stress debriefing by trained facilitators, with further psychological support, may assist individuals to recover from a traumatic event.⁶⁰ Following a significant critical incident, the clinical director should...

There is evidence that errors are associated with increased time spent on a task. The effect of shift patterns on work life balance should be considered when designing rotas. Job plans, including on-call responsibilities, should be constructed so that they are not likely to lead to predictable fatigue, and should be reviewed regularly.^54,61,62

All theatres must be compliant with Department of Health building regulations.⁶³ There should be provision of emergency call systems.