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Handover protocols should include clearly communicating and documenting the care that has been delivered and the future treatment plan for the patient. This should include DNACPR documentation if appropriate.^25,44

Organisations must create standardised documentation for patients undergoing invasive procedures that promotes the sharing of patient information between individuals and teams at points of handover, and forms a record for future reference.²⁵

There should be appropriate overlap between shift changes, to ensure adequate time for handover. Time for handover should be included in job plans and rotas and accounted for in work shift planning.^176,200

Handover of care should always be to a member of staff who is competent to look after the patient at that time.¹⁹⁷

A defined governance structure should focus on clinical outcomes, audit and regular review of practice through critical incident reporting, clinical risk management, complaints monitoring, research and development and Continuing Professional Education and Development. This should include regular discussion at Hospital Board level, executive and divisional levels and via the clinical quality review process.^33,169

Robust data collection underpins much of the success in documenting and learning from experiences.^1,33,126 All institutions providing anaesthesia care to emergency surgery patients should collect the required data to be able to produce an annual report on a variety of relevant patient morbidity and mortality metrics, including return to theatre within 24 hours. This report...

A system for reporting and regular audit of critical incidents and near misses should be in place and be multiprofessional. The methodology should be explicit and identify underlying relevant factors to inform learning and development of safe systems. All staff should recognise the duty of candour and foster a culture for reporting incidents and concerns.^17,25,58

There must be systematic measures in place to respond to serious incidents. These measures should protect patients and ensure that robust investigations are carried out by trained safety leads. When an incident occurs, it must be reported to all relevant bodies internal and external to the organisation.²⁰¹ 

Patient dignity should be maintained by ensuring appropriate equipment and clothing is available and by staff attitudes to obesity.

Organisations should have a mechanism in place for handling complaints. This should include timely full and transparent investigation and feedback to the patient and their supporters, as well as the staff involved.^202,203