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Hospitals should review their local standards to ensure that they are harmonised with the relevant national safety standards.^10,11,12 Organisational leaders are ultimately responsible for implementing local safety standards as necessary.¹³

The organisational culture should seek to empower health professionals to implement patients’ preferences, informed by discussions around risk and benefit. The ownership and decision making in healthcare should be in the hands of professionals and patients.^14,15

Information relevant to clinical staff concerning clinical outcomes, patient experience and productivity (such as theatre efficiency) should be readily available to staff.^15,16

The organisation should ensure that patient safety concerns are addressed and that the recommendations or changes that result are fed back to procedural teams.^13,17

Emergency and elective pathways should be separated (whenever practically feasible), to improve clinical care for patients.^18,19

There should be clarity of leadership and roles in the supervision of the day to day running of the anaesthetic department.

Elective theatres should offer spare capacity (such as that resulting from cancellations) to the emergency theatres.²⁰Elective cases may be cancelled, in accordance with agreed local procedures, to facilitate emergency work if required.

When members of the healthcare team are involved in a critical incident, the personal impact on individual team members can be significant.^7,21 Following a significant critical incident, the clinical director (see Glossary) or appropriate individual (head of service) should promptly review the immediate clinical commitments of the staff concerned. Relevant support for staff following a critical...

Appropriate patient centred pathways should be in place linking through to primary care, clinical policies, checklists and standard operating procedures for operating theatres.

Policies for the management of children in accordance with GPAS chapter 10: Guidelines for the Provision of Paediatric Anaesthesia Services should be held wherever children are anaesthetised or sedated.³⁹