This piece gives you a wider perspective on perioperative medicine over the years. How have institutions risen to this challenge and what can we learn from them? How do systems and cultures change over time? When implimenting change have you asked the following questions; Is it scientifically rational? Is it clinically reasonable? What are the risks? What are the resource implications? Are there any ethical considerations? What does the evidence advise? What are the emotional and political issues? How are you going to evaluate change?

Presented by Ross Kerridge, John Hunter Hospital, Newcastle, Australia, often cited as ‘the father of Modern Perioperative Medicine’.