Search

Hospitals should have clinical guidelines, including:³⁴

involving patients in the management of their own diabetes

• ensuring that surgical patients with diabetes have an individualised explicit plan for the management their diabetes during periods of starvation and surgical stress; this may require the involvement of senior anaesthetic staff and the availability of equipment to continue or institute variable rate intravenous...

Any non-trainee anaesthetist who undertakes anaesthetic duties in the labour ward should have been assessed as competent to perform these duties in accordance with OAA and RCoA guidelines.^31,55,89 Such a doctor should work regularly in the labour ward but should also regularly undertake non-obstetric anaesthetic work to ensure maintenance of a broad range of anaesthetic skills.

There should be locally agreed guidelines for risk assessment and documentation. A number of risk prediction tools such as the Physiological and Operative Severity Score for the enumeration of Mortality and morbidity (POSSUM), Surgical Outcome Risk Tool (SORT), American College of Surgeons- National Surgical Quality Improvement Program (ACS-NSQIP), National Emergency Laparotomy Audit (NELA) are commonly used. Mortality risk should be...

Risk stratification based on clinical history may help to guide management.²⁶ However, determination of a patient’s functional capacity may be difficult if exercise tolerance is limited by peripheral vascular insufficiency, respiratory or other disease.²⁷ Clinical guidelines should be developed for further investigation, referral, optimisation and management according to local facilities and expertise.⁴