The 24/7 acute pain service should be available for neurosurgical patients and staff should be trained to address the specific needs of neurosurgical patients, such as those with impaired communication.46
Postoperative cognitive deficit (POCD) and delirium can be masked by a patient’s neurological condition. Identifying the potential causes for POCD and surveillance for delirium should be a part of the entire perioperative patient journey for all staff and the condition should be managed appropriately by the multidisciplinary team.8,49,50,51
Much of neurosurgery involves acute work with a high degree of urgency. The provision of associated services should recognise this need and inappropriate delay should not be allowed to occur as a result of lack of key personnel or facilities. Laboratory services, neuroradiology, availability of operating theatre time and sufficient levels 1–3 bed provision should all be organised to cope...
There should be sufficient numbers of clinical programmed activities in consultants’ job plans to provide cover for all elective neurosurgical operating lists and to provide adequate emergency cover.
Departments of neuroanaesthesia and neurocritical care, even if part of a large general department, should be provided with adequate secretarial and administrative support.
The neuroanaesthesia multidisciplinary team should be involved in the local and regional planning of relevant neuroscience services (e.g. thrombectomy).
Face-to-face and/or telemedicine preadmission clinics for elective neurosurgery should be available, with early input from the department of neuroanaesthesia, particularly for high-risk patients and those where additional time and discussion are required, such as awake craniotomy.33 All centres should be able to demonstrate that discussion of perioperative risk is routine and that specific risks related to, for example...
Preoperative assessment clinics should ensure that the patient is optimised as best as possible for elective neurosurgery (e.g. for correction of anaemia), as this can reduce the length of hospital stay, need for blood transfusion and postoperative morbidity.25
Patients suitable for daycase neurosurgery should be identified and should follow an agreed pathway.37
