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All areas, including emergency departments, admitting acutely ill patients should have early warning pathways.45 Acutely ill or deteriorating emergency surgical patients on a general surgical ward require prompt recognition and definitive care. So early warning pathways should be established that automatically trigger an appropriate response, this should include policies for early medical review and early escalation to the responsible...
Transport of patients within the hospital and between hospitals should be undertaken in a timely manner, without unnecessary delays and in accordance with established guidelines and standards.9,78,79,80,81
Staffing needs to be provided at a level such that emergency theatre activity and critical patient care are not compromised when intra and inter hospital transfers are undertaken.78
A parent or legal guardian should ideally be with the child up to the point of moving into the operating theatre.
All necessary equipment to facilitate safe transport of the patient should be available at all times.9,78,81
Where transfers between hospitals are foreseeable (e.g. transfers to major trauma, neurosurgical or paediatric centres) local arrangements should be in place to ensure safe and timely transfer, which may involve a retrieval service. Arrangements should be in place for appropriately trained and competent staff, insurance (personal and medical indemnity), crash test compliant equipment, ambulance booking procedures, procedures for receiving patients...
All areas in which emergency anaesthesia is undertaken should be adequately equipped and stocked at all times with the range of equipment and drugs required for immediate use in all types of urgent cases that might be reasonably expected in that hospital area. This would include equipment for children in hospitals accepting paediatric emergencies.
Specialist equipment and drugs that are not commonly used, or that are not time critical, should be available if required.
In recent years there has been a trend towards assessment of elective patients in preadmission clinics, typically one to two weeks before surgery. This allows routine paperwork and investigations to be completed before admission, permits ‘same day’ admission and reduces the likelihood of delays or cancellation.48,49,50,51 Anaesthetists should be part of the preadmission clinical...
Medication errors are consistently the second highest type of errors reported in anaesthetic practice and so all staff involved in the prescribing, preparation, administration and monitoring of drugs must be appropriately trained.82
