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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

Some aspects of preanaesthetic assessment and preparation of the emergency patient differ from those of the elective patient. These include severity of illness, fluctuating condition of the patient, and the 24/7 nature of emergency work. Staffing levels and seniority of anaesthetists should be adequate to enable preanaesthetic planning and assessment that is appropriate to the patient’s risks associated with surgery...

As part of preoperative preparation, the plan for the perioperative management of any existing medications, such as anticoagulant drugs and diabetic treatment, should be agreed, taking into account the relative risks of stopping any medication in the light of the patient’s medical condition and the anaesthetic technique required. Advice should be sought from the multiprofessional team (e.g. medical colleagues, clinical...

Preadmission clinics for elective neurosurgery should be available, with early input from the department of neuroanaesthesia particularly for high risk cases and those where additional time and discussion are required, e.g. awake craniotomy. All centres should be able to demonstrate that discussion of perioperative risk is routine and that specific risks related to, e.g. prone positioning are communicated.^32,33,34

It is recognised that staff involved in providing care for out-of-hours vascular emergencies may differ from those involved in routine daytime care. It is essential that all staff who might potentially be involved in perioperative care of the emergency vascular surgical patient are trained and competent in the aspects of care for which they are responsible. There should be provision...

The theatre team should all engage in the use of the sequential steps from the National Safety Standards for Invasive Procedures commencing with a consent and procedural verification, and concluding the list with a team debrief or handover.¹⁶⁸ Debrief should highlight things done well and also identify areas requiring improvement.¹⁷⁰ Teams should consider including the declaration of emergency...