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The hospital business plan should address the predicted growth in surgical emergencies, ageing population and any changes as a result of regional specialisation.29,127,165,166,167 Future planning should be based on accurate and timely data. Mathematical modelling for matching theatre demand and capacity could be beneficial.168
Each department of anaesthesia should have a plan in place for the emergency anaesthetic workload to be delivered effectively and safely.169
Hospitals should have a clear and explicit strategy for developing a strong safety culture that includes the following characteristics: recognition of the inevitability of errors, commitment to discuss and learn from errors, proactive identification of latent threats, and the incorporation of non punitive systems for reporting and analysing adverse events.59,170,171
Information on the risks and the common side effects of anaesthesia in children should be discussed and offered in writing to children, parents and guardians.16
Hospitals should review their local standards to ensure that they are harmonised with the relevant national safety standards, e.g. National Safety Standards for Invasive Procedures in England or the Scottish Patient Safety Programme in Scotland. 25,172
The organisational culture should seek to empower health professionals to implement the patients’ preferences, informed by discussions around risk and benefit. Healthcare should be organised from the bottom up, with ownership and decision making in the hands of professionals and patients. 2,16,152,173
Information relevant to front line staff concerning clinical outcomes, patient experience and productivity (such as theatre efficiency) should be readily available to them.26,173
The organisation must ensure that patient safety concerns are addressed and the recommendations or changes that result are fed back to procedural teams.25
Emergency and elective work should be separated (whenever practically feasible), to improve clinical care for patients.14,41
Organisations should have a service improvement team that co-ordinates national and local projects and encourages a multidisciplinary approach to emergency surgical care, using data to provide high-quality information to drive change and support service development.1,126
