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There should be locally agreed policies for the 24/7 cover of emergency surgery, prioritisation of emergency cases according to clinical urgency, and seniority of anaesthesia staff according to patient risk.¹

Appropriate clinical policies and standard operating procedures for operating theatres should be in place and available at all times, including a resuscitation policy and major incident plans.

All staff, including anaesthetic assistants, locum, agency and trust grade staff must have undergone an appropriate induction that includes the contents of relevant policies and standard operating procedures.²⁵

An escalation policy should be in place for all medical, healthcare professional and managerial staff. An emergency call system should be in place and understood by all relevant staff. This should include the names and method of contact, which should be prominently displayed in appropriate areas. Internal hospital telephone switchboards should have ready access to rotas and methods of contacts.

A clear method of communication between and within theatre teams, including related areas, e.g. obstetric or paediatric wards, should be in place concerning the urgency category of an emergency, escalation and who to contact.⁴⁷

The World Health Organization checklist must be completed for all patients undergoing surgical or invasive procedures.  An appropriate review prior to surgery, e.g. a ‘stop moment’, should be used.^{4, 33,170,188,189}

Safety requires a combination of checklists, teamwork and human factors.  'Checklists must be conducted by teams of healthcare professionals who have trained together and who have received appropriate education in the human factors that underpin safe teamwork.'²⁵

There should be a documented policy for the transfer of patients requiring anaesthetic supervision and care, including any additional requirements for transfers to another geographical site.⁷⁸

There should be a clear process in place for the referral of patients requiring critical care, including paediatric patients, to an appropriate facility.^8,73,183

The following policies should be immediately and reliably available at sites where anaesthesia and sedation are provided:

• guidelines for the management of anaesthetic emergencies including guidelines for children
• difficult airway management including ‘can’t ventilate’, and ‘can’t intubate’^94,192