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Neonates, infants and children who are likely to require critical care following an operation should undergo their surgery in a hospital/unit with a designated PICU or NICU.^42,43

If the patient is too sick to transfer to such a hospital prior to surgery and their current hospital has surgeons capable of operating, then transfer should occur as soon after surgery as is clinically appropriate.¹³

Non-specialist paediatric tertiary centres should have arrangements for managing and treating simple surgical emergencies in children, such as acute appendicitis. In addition, they should be able to resuscitate and stabilise critically ill infants and children of all ages prior to transfer to a specialist centre for surgery and/or critical care.

In non-specialist paediatric tertiary centres that provide level 3 care for adults, children should receive level 3 care in these areas for a short period with advice from children’s critical units in specialist tertiary paediatric centres or from regional transport teams.

There should be a designated consultant with responsibility for transfers who provides and updates a written policy for emergency transfers of critically ill children.

There should be portable age appropriate monitors, transfer equipment (including a portable ventilator) and drugs readily available to transfer critically ill children.

There should be relevant written local guidelines for transfer, with telephone numbers of the receiving unit.

Patients being transferred should normally be accompanied by a doctor or another healthcare professional (e.g. advanced nurse practitioner or anaesthetic practitioner with relevant competencies in the care of a critically ill child and transfer of intubated patients, including airway management skills). They should be accompanied by a suitably trained assistant.

Transport services should ensure that appropriate multidisciplinary arrangements are in place to review transfers and provide feedback to networked hospitals.

The operating list order needs to take account of the needs of each child, with fasting times kept to a minimum (especially in those most at risk) and whenever possible, operations with potentially longer recovery times being scheduled earlier in the day to prevent unnecessary overnight stay.