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To facilitate optimal care of high risk patients, systems should be in place to ensure:^1,3,33

• timely surgical review (typically at a consultant level), and access to diagnostic imaging and urgent reporting
• documented evaluation of mortality and relevant morbidity risk prior to surgery^131,132
• communication of risk to the multidisciplinary clinical team, to...

Agreed local clinical guidelines should be in use that have been produced by an appropriately constituted multiprofessional team, comprising anaesthetists, specialist nurses, surgeons, critical care clinicians, pharmacists, specialty consultants or autonomously practising anaesthetist and managers. These guidelines should cover at least the following:

• assessment and management of pain and pruritus, including the recording of pain and itch scores^13...