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Emergency paediatric surgical care should be provided within a network of secondary and tertiary care providers. Networks should agree standards of care and formulate care pathways for emergency surgery. Departments should participate in regular network audits of emergency surgical work.^{120,121,122,123}

Children with severe comorbidity who require emergency anaesthesia should be treated in a specialist paediatric centre. However, if transfer is not feasible, the most appropriately experienced senior anaesthetist should provide anaesthesia and support resuscitation and stabilisation, as part of the multidisciplinary team.^124,125

Transfer of children to specialist centres is usually undertaken by regional paediatric emergency transfer services. Time critical transfers such as neurosurgical emergencies may need to be transferred by the referring hospital. Local guidelines should be in place for the management of such transfers and the most experienced anaesthetist with appropriate skills, together with a trained assistant, should accompany the child.¹²⁶

In the elderly, anaesthesia and surgery should be undertaken by senior staff with experience and expertise in this area in order to limit the duration of the operation and its physiological impact to a minimum.⁷  

Poor or inadequate analgesia contributes to postoperative morbidity in the elderly. Pain is poorly assessed and treated in the elderly, particularly in those patients who suffer with cognitive impairment. Specific algorithms for the assessment of pain, and postoperative analgesia protocols, are recommended in the elderly.⁷

Perioperative delirium/confusion is common and often under recognised. Hospitals should have policies to recognise and manage perioperative delirium/confusion.^7,9,117

Care pathways and the involvement of healthcare of the elderly support teams are strongly recommended. Care of older people in hospital should be delivered by staff with the correct set of skills to meet their needs.  For some, this will include review by a Healthcare of the Elderly (HCE) consultant and nutritional assessment. Provision for HCE involvement in the care...

There should be planning at local and regional level for the increase in resources that will be required for increasing numbers of elderly surgical patients.⁷

Children undergoing surgery should be grouped into paediatric lists, or together at the start of mixed lists.²²

An operating table, hoists, beds, positioning aids and transfer equipment appropriate for the care of bariatric patients should be available and staff should be trained in its use.^48,85,127