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A full anaesthetic management plan should be recorded in the patient's records or anaesthetic chart and should be initiated preoperatively.⁴⁸

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.^4,5,19

Preoperative assessment of patients, especially those at very high risk, can benefit from a multidisciplinary team approach involving cross specialty advice.⁴⁹ Early consultation with appropriate medical specialties should occur for appropriate conditions, such as delirium, acute kidney injury, diabetes mellitus and ischaemic heart disease.⁴

All decisions concerning the consent process (see Section 9) and treatment plans, including decisions about whether or not to operate and do not attempt cardiopulmonary resuscitation (DNACPR), should be documented clearly, noting what risks, benefits and alternatives were explained to the patient within the time constraints of emergency care.^47,50

There should be a system in place for alerting medical staff to any change in the clinical condition of the emergency surgical patient while awaiting surgery.^41,51

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.^3,10

Guidelines for fasting before anaesthesia for emergency surgery should comply with national guidelines.⁵²

Guidelines for postoperative planning should include plans for nutrition, including facilitation of enteral access or vascular access for parenteral support.^53,54,55

There should be a formalised integrated pathway for non-elective adult general surgical care which should be patient centred and should include risk assessment and identification of the high-risk patient. The integrated pathway should include risk assessment and identification of the high-risk patient.^2,4,5,40

There should be locally agreed guidelines for risk assessment and documentation. A number of risk prediction tools such as the Physiological and Operative Severity Score for the enumeration of Mortality and morbidity (POSSUM), Surgical Outcome Risk Tool (SORT), American College of Surgeons- National Surgical Quality Improvement Program (ACS-NSQIP), National Emergency Laparotomy Audit (NELA) are commonly used. Mortality risk should be...