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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

Patient reported outcomes and patient experience measures are vital and individual organisations should ensure they have mechanisms in place to capture and monitor these and take action when required.^33,204

Hospitals should have systems in place to facilitate multidisciplinary Morbidity and Mortality meetings.^1,45

Hospitals should have an ‘at risk register’ at departmental, divisional and board level. There should be a clear policy on its ownership and maintenance of the risk register. Relevant local issues pertinent to emergency anaesthesia should be included.²⁰⁵

National level audit of emergency surgical activity and outcome is essential, and all hospitals delivering emergency surgical care must contribute to the recognised national or other major audits of safe practice and critical incident reporting systems.^{1,157,212,213,214,215,216}

Outcomes for types of emergency surgery not covered by national audits should be audited via Hospital Episode Statistics for benchmarking purposes.

Local level audit of service provision and adherence to the national clinical standards for delivery of anaesthesia for emergency surgery should be an ongoing and important part of departmental audit activity.²¹⁷