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Near patient testing for blood sugar should be readily available for theatres.

There should be specific guidelines for assessing a suspected difficult airway in patients with spine and joint disease, and for measuring lung function in patients with kyphoscoliosis.⁷⁴

Hospitals should provide information (web based and written) on types of anaesthesia offered before the date of surgery to provide opportunity for informed consent and shared decision making.^{12 ,74, 75}

There should be an enhanced recovery programme for patients undergoing elective orthopaedic surgery, to improve the integration, efficiency and quality of care in suitable patients.^76, 77

There should be a robust procedure in place to check the specific site of surgery before anaesthesia is administered.78 This should include identifying laterality of limbs and use of an indelible mark by the responsible surgical team prior to admission to the operating theatre.

Isolated elective orthopaedic units performing major inpatient surgery should have 24/7 access to all support services including acute pain services and critical care. Local guidelines should be in place to provide safe anaesthesia care which includes preassessment screening for risk stratification, transfer criteria and postoperative care facilities.

Patients with a hip fracture should ideally have surgical treatment as soon as possible, or within 36 hours from admission.¹⁴

The following time allocation (per week) is a guide to the minimum physician anaesthetist staffing that should be provided per 1,000 inpatients passing through a preoperative preparation clinic:

• reviews and consultations  1 session per 1,000 inpatients per year (1.25 programmed activities) e.g. 3000 patients = 3 sessions

• high risk clinics 1 session per 1000 inpatients (1.25 programmed activities)

• clinical leadership...

Hospitals providing surgical treatment for hip fractures should have a formal pathway including prompt provision of analgesia (including nerve blocks when appropriate) and hydration, preoperative assessment of high risk patients by the anaesthetic team, along with, orthogeriatrician input and be prioritised on orthopaedic trauma lists.^{14,81,82,83,84}

Agreed local guidelines should be in place and implemented on the following:

• compliance with best practice anaesthetic management protocols for hip fracture as recommended by the Association of Anaesthetists^{14, 85}
• tailored World Health Organization (WHO) safety checklists to identify the potential for adverse events associated with the requirement for use of bone cement should be used during...