Each department should appoint a designated liaison consultant responsible for identifying the strategic pathways and logistical pitfalls of the intrahospital transfer of neurosurgical patients. The appointment should ensure that any identified problems are either removed or mitigated.
Communication with critical care should occur at the earliest possible time (preoperative clinic letter) to enhance the appropriate allocation of beds.
Patients should be provided written information (in a format of their choice) specific to the neurosurgical procedure they are planned to undergo, which explains the procedure, any preoperative preparation required, the risks, benefits and relevant advice in an easy to understand language.
All patients (and relatives where appropriate and relevant) should be fully informed about the planned procedure and should be encouraged to be active participants in decisions about their care, including the option of doing nothing.8
For patients undergoing diagnostic procedures such as MRI, although separate written consent for anaesthesia is not mandatory in the UK, all discussions about sedation and anaesthesia should be documented. Discussion should include methods of induction, associated risks, side effects and potential benefits of the procedure. It is not the responsibility of the anaesthetist to explain the indications for the procedure.55,56
If the patient is planned to be discharged on the same day after their procedure, relevant information should be provided on discharge, including contact details for the neurosurgical service. Other relevant recommendations for daycase anaesthesia outlined in Guidelines for the Provision of Anaesthesia Services for Day Surgery should be followed.57
For procedures such as awake craniotomies, departments should consider giving patients information in different formats including audiovisual. Consideration should be given to offering patients who are anxious about their awake procedure a prior visit to various areas of operating theatres.
The possibility of a parent or carer being present at induction and/or during recovery from anaesthesia should be explored where this is considered to be in the best interests of the patient.
Audit programmes should be developed locally but should include continuous audit of transfer of neuroscience patients, neurocritical care capacity and demand, rates of unplanned admission and readmission to the intensive care unit, and the caseload of anaesthetists in training, among others. In general, local practice should be audited against compliance rates with national and expert consensus guidelines.5,41,53
