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Following admission and prior to undergoing a procedure that requires general or regional anaesthesia, all patients should have a preoperative visit by an anaesthetist, ideally a person directly involved with the administration of the anaesthetic.42 This should be done to confirm earlier findings or, in the case of emergency admission, initiate preoperative anaesthetic assessment and care.
Information from the patient’s preoperative assessment should be readily available, ideally as part of an electronic patient record, so that information is easy to transfer between locations and to enable data collection for later analysis.5,80
If the patient has not been seen in a preoperative clinic, (e.g. those admitted for urgent surgery), they should undergo an equivalent assessment and preparation process with the findings documented before their final anaesthetic assessment. Most patients for expedited urgent surgery should have the same assessment and preparation as for elective surgery.
Up to date, clear and complete information about operating lists should be available to the admissions area, theatre and recovery area. Operating lists should be made available to the anaesthetist before the list starts.
The language in all communications relating to the scheduling and listing of procedures should be unambiguous. Operating lists should include details of the patient’s operation, date of birth, hospital identification number, any alerts and the ward in which they are located. Laterality should always be written in full (i.e. ‘left’ or ‘right’).168
The whole operating team should agree to any change to a published operating list. This list should be rewritten or reprinted, including a date and time of the update and should be clearly identifiable as a changed list.168 Following a change in the theatre list, a further team brief should take place and the admissions area and recovery units...
Written guidelines should outline the policy for the collection of patients from the ward or admissions unit, as well as the handover by ward staff to a designated member of the operating department staff.169
The theatre team should all engage in the use of the sequential steps from the National Safety Standards for Invasive Procedures commencing with a consent and procedural verification, and concluding the list with a team debrief or handover.168 Debrief should highlight things done well and also identify areas requiring improvement.170 Teams should consider including the declaration of emergency...
The anaesthetist should be with the patient at all times while the patient is anaesthetised. In hospitals employing AAs, this responsibility may be delegated to an AA, supervised by a consultant anaesthetist in accordance with the scope of practice for AAs.119,123
In exceptional circumstances, an anaesthetist working singlehandedly may be called to briefly assist with or perform a lifesaving procedure nearby. This is a matter for individual judgement and a dedicated ODP or anaesthetic nurse should be present to monitor the patient in these exceptional circumstances.123 This should be for as short a period as possible and the person left...
