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Facilities should be provided for regular rest breaks and refreshments as well as quiet facilities for sleep during and after shifts for anaesthetists working overnight.^34,43,50,51

The output from consultations with patients at increased risk of mortality or morbidity must be documented in the patient’s medical notes. In addition, mechanisms for clear communication of these consultations to patients, anaesthetists, surgeons, general practitioners and other healthcare workers should be in place.^6,54

Where a patient is seen prior to the day of surgery and shared decision making and discussion of anaesthetic conduct has taken place, the anaesthetist on the day of surgery has a responsibility to ensure the patient still understands and agrees with the perioperative plan.^66,67

Decision support systems for crisis scenarios should be available, for example the Association of Anaesthetists Quick Reference Handbook, advanced life support algorithm, difficult airway guidelines and major haemorrhage protocols.^144,145,146

Where the postoperative destination is not a main ICU (e.g. a level 2 HDU or specifically developed PACU), the patient should remain in PACU until they are stable and are no longer likely to require immediate support from an anaesthetist. This is of particular importance when transferring patients from recovery to level 2 critical care units that are not staffed...