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Drugs, fluid and equipment required for resuscitation and the management of postoperative complications should be available within three minutes and regularly maintained.^10,11

There must be a system for ordering, storage, recording and auditing of controlled drugs in all postoperative areas in which they are used, in accordance with statutory legislation.¹⁵

Explicit arrangements should be made for the provision of care from specialties that are not available on site (e.g. neurosurgery, cardiothoracic, vascular, ear, nose and throat, maxillofacial, hepatobiliary, burns and plastic surgery, geriatric medicine, palliative care medicine).

There should be provision for a high level of care for emergency patients where necessary.⁴

An individualised post-anaesthesia care plan should be implemented for each patient.¹⁶

Critical care should be considered for all high-risk patients requiring emergency surgery. As a minimum, patients with an estimated risk of mortality of 5% or higher should be considered for critical care.⁵ There should be close preoperative liaison and communication between the surgical, anaesthesia and critical care teams, with the common goal of ensuring appropriate safe care in...

There should be locally agreed protocols for postoperative critical care admission, and compliance with these protocols should be audited.

Hospital level audit data should be examined to determine whether national standards for postoperative critical care admission are being adhered to. Where compliance is poor, a change of local policies and reconfiguration of services should be considered, to enable all high risk emergency patients to be cared for on a critical care unit after surgery.²

Careful records including instructions, patient observations and drug administration should be maintained (increasingly in electronic form) and recovery staff should be able to interpret the information and initiate appropriate action where necessary.

Clinical observations should be supplemented by pulse oximetry and non-invasive blood pressure monitoring until the patient is fully recovered from anaesthesia. An electrocardiograph, nerve stimulator, thermometer, glucometer and capnograph should also be readily available.^6,16,17