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If responsibility for care is transferred from one anaesthetist to another, a ‘handover protocol’ should be followed, during which all relevant information about the patient’s history, medical condition, anaesthetic status, and plan should be communicated.⁶

Patients should be transferred to the ward accompanied by two members of staff, at least one of whom should be suitably trained to locally agreed standards. The anaesthetic record, recovery and prescription charts together with the postoperative plan, should accompany the patient and be clearly communicated to the receiving ward nurse.

Processes for the communication and implementation of patient safety alerts should be in place.

The introduction of clinical pathways that encompass the entire perioperative period from the preoperative evaluation to the post discharge disposition should be considered, with the aim of reducing healthcare cost while improving outcomes.¹⁹

Use of patient reported outcome measures (PROMs) to assess physiological and other recovery domains after surgery could be considered.⁴⁹

Older patients should be assessed for the risk of developing postoperative delirium. Preoperative interventions should be undertaken to reduce the incidence, severity and duration of postoperative delirium. Hospitals should ensure guidelines are available for the prevention and management of postoperative delirium that are circulated preoperatively to the relevant admitting teams.³¹

Specific, measurable, attainable, relevant and time-bound (SMART) quality improvement initiatives and safety measures could be embraced in order improve safety and develop perioperative anaesthesia services.⁵⁰

Nurturing a safety culture, learning from mistakes, preventing harm and working as part of a team are all part of the discipline of safety. To this end, shared learning and quality improvement that contribute towards improvements in safety, such as critical incident reporting with thematic analysis, and communication through morbidity and mortality meetings, could be undertaken.

Anaesthetists should participate in departmental audit throughout a full audit cycle. This participation should adhere to the standards and principles outlined in the College’s Compendium of audit recipes.⁵⁰

Postoperative care audits and quality improvement projects from the College’s Compendium of audit recipes could be considered.⁵⁰