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The experience and expertise of the anaesthetist assessing the patient preoperatively should be appropriate for the complexity and level of risk of the patient.⁴⁶ The decision to operate on high risk patients should be made at a senior level, involving surgeons and those who will provide intra and postoperative care.^3,14,33

Preoperative assessment, optimisation and shared decision making in patients with multiple comorbidities, frailty or cognitive impairment require a cross specialty approach involving anaesthetists, surgeons, geriatricians, pharmacists and allied health professionals. Liaison with a clinical pharmacist in the perioperative period will enable optimisation of medicines and improved management of the patients’ non-surgical comorbidities during this time. The development of such teams...

All areas, including emergency departments, admitting acutely ill patients should have early warning pathways to ensure prompt recognition of a deteriorating patient to trigger an appropriate response.⁶⁰ This should include policies for early medical review and early escalation to the responsible consultant surgeon or equivalent.^{10,49,61,62,63,64}