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The secondary recovery area should provide essential close and continued supervision of all patients, who should be visible to the nursing staff while maintaining privacy and dignity.

The secondary recovery area should have single -sex patient toilet facilities and ability to provide drinks and snacks.²³

Secure storage for patients’ belongings and medications should be available.

Waiting areas should be available for parents and carers who need to be available to support patients immediately after surgery.

Hospitals should engage with networks in order to develop agreed care pathways based on age, comorbidity and complexity of procedure, as well as clinical urgency. Care pathways should relate to local service provision, staffing and geography.

Hospitals should liaise with the regional network lead for surgery and anaesthesia to provide input to regional audit and standards.

Hospitals that are regional specialist paediatric units should have access to a paediatric critical care transport service commissioned for the retrieval or transfer of critically ill or injured infants, children and young people.¹³

Units without inpatient paediatric beds should have a formal arrangement with a neighbouring unit, to ensure that practical assistance is available should a child require transfer.⁹ Protocols should be in place for the rapid assessment and transfer of patients to the local specialist unit within the network.¹³

Onsite ICU and HDU services should be appropriate to the type of surgery performed and the age and comorbidity of patients, and should be available to support the delivery of more complex postoperative analgesic techniques.

In hospitals with no onsite paediatric high dependency and critical care facilities, there should be the facilities and expertise to initiate critical care prior to transfer/retrieval to a designated regional PICU/HDU facility. This may involve short-term use of adult/general ICU facilities.¹³