Search

There are validated general risk prediction tools available that assess the risk of 30-day mortality (and morbidity) following surgery, as well as procedure specific risk prediction tools for elective aortic aneurysm surgery.⁵⁹ There is also a wide variety of other screening and risk assessment tools that are useful in estimating the specific or additional risks accrued through the factors...

The ideal day surgery facility is a purpose-built, self-contained day surgery unit (DSU), with its own ward, recovery areas and dedicated operating theatre(s). This may be contained within a main hospital or in its grounds, to facilitate access to inpatient or critical care facilities, or it may be a freestanding unit remote from the main hospital site.

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.

There must be full provision of personal protective equipment and shields from blood spray, radiation and hazardous substances for all staff working in the operating theatre, and guidance provided on its usage.^86,88,89

Special care should be taken to assess social circumstances when discharging elderly patients into the care of an equally frail and elderly spouse. Home support from family or social services may be needed; for instance to ensure that postoperative eye drops are administered in an appropriate and timely fashion. This should be identified at preassessment and arranged in advance.¹

Patients requiring anaesthesia who are systemically unwell should be optimised as far as reasonably practicable beforehand.³² It is extremely rare for ophthalmic surgery to be so urgent that remedial measures cannot be taken. Arrangements for appropriate perioperative medical care should be made, with specialist input from other services as required.

Hospitals must have guidelines in place to ensure the safety of children admitted to hospital, monitor injured children known to be at risk, and identify concerns arising from any injury or pattern of injuries.^22,44 They must provide the appropriate training related to these guidelines.

Ultrasound equipment should be available for use by trained staff for transversus abdominis plane (TAP) blocks, central neuraxial blockade, placing lines and transthoracic echocardiography.  Other tasks, such as airway and gastric volume assessment, may also benefit from the availability of ultrasound.^52,53