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Procedural sedation and analgesia in the ED should follow the recommendations from the RCoA and the RCEM.³⁷

Remote monitoring of the patient with slave screens should be available to allow the anaesthetic team to monitor the patient from outside of the magnetic field.

A fall of less than two metres is the most common mechanism of injury in older patients. Prehospital triage to aid early identification of severe injuries in older patients should be available to allow quick transfer from TU to a MTC for specialist investigation and intervention.⁹²

Hospitals must have guidelines in place to ensure the safety of children admitted to hospital, to monitor injured children known to be at risk, and identify concerns arising from any injury or pattern of injuries.⁸⁶ They must provide the appropriate training related to these guidelines.

Patients recovering from anaesthesia or all depths of sedation including mild sedation (see Glossary) in a non-theatre environment should receive the same standard of care as that required in an operating theatre.^10,11

Agreed internal referral pathways to other specialties should be in place for the minority of cases in which this may be required to expedite further investigation and patient optimisation. This should be done in close collaboration between the preoperative assessment lead and nominated representatives from appropriate specialties (e.g. cardiology, diabetes, renal, respiratory and geriatric medicine).

Operating theatre complexes require a dedicated recovery unit. This unit should be located in the operating theatre department and should be separate from the department’s admission area. It should have a separate access for transfer of patients to the ward.^185,190

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.