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Adequate emergency theatre time should be provided throughout the day to minimise delays and avoid emergency surgery being unnecessarily undertaken out of hours when the hospital may have reduced staffing to care for complex postoperative patients. Consideration should be given to staffing of additional evening (twilight) emergency sessions with autonomously practising anaesthetists.

An anaesthetist, anaesthesia associate or advanced nurse practitioner should preoperatively assess all patients undergoing emergency surgery who require anaesthesia. Adequate time should be available for this assessment to occur as clinical urgency allows.^43,47

For children, a staff member with an advanced paediatric life support qualification or an anaesthetist with paediatric competencies should be immediately available.⁴

Training of anaesthetists includes attaining the competency to perform medical assessment of patients before anaesthesia for surgery or other procedures.⁴⁰

The secondary care clinic should be predominantly led by suitably trained nurses or other extended role practitioners using agreed protocols and with support from an anaesthetist.

Busier units should consider having two duty anaesthetists available 24/7, in addition to the supervising consultant.²⁴