GIRFT’s national lead for preoperative assessment – Emma McCone – is the joint lead author on an important new evaluation, looking at the frequency and causes of elective surgical postponements at preoperative assessment and cancellations within 24 hours of surgery.
The study, published in the British Journal of Anaesthesia, collected incidence data across seven days in November 2024, with data from 78 trusts amounting to more than 22,000 preoperative assessment appointments and almost 20,000 planned procedures. The national preoperative assessment postponement rate was found to be 8.7%, while the national cancellation rate was 9.9%.
The Postponements and Cancellations in Elective Care (PACE) evaluation is the first national overview of elective surgical pathway disruption in the UK. It concludes with a list of ten recommendations to help reduce postponements and cancellations, many of which GIRFT is already supporting through its GIRFT Academy guidance and resources.
Emma McCone is one of 18 authors who collaborated on the evaluation, from the National Institute for Health and Care Research Central London patient safety research collaboration, NHS England, University College London and the Royal College of Anaesthetists.
Emma said:
“We welcome the publication of the PACE evaluation and the recognition that more needs to be done to support patients on surgical pathways to minimise postponements and cancellations.
“Highlighting the postponement challenges at POA has really helped to shape where our focus needs to be. Identifying patients’ perioperative risk factors much earlier in the pathway and embedding robust perioperative processes that reflect today's NHS will ensure that patients are reviewed at the right time and place, and by the most appropriate healthcare teams who can deliver personalised support.”
Since the evaluation data was gathered in 2024, GIRFT has shared a range of POA and elective surgery guidance, available to all NHS colleagues, which can support the PACE evaluation recommendations – see the links below.
Recommendations and links to supporting guidance from the GIRFT Academy
- Implement early screening for all patients on surgical waiting lists.
Support Guide for the implementation of Early Screening, Risk Assessment & Optimisation
- Establish a pool of pre-assessed, low-risk patients.
- Defer scheduling of surgery until patients are cleared by the preassessment pathway for elective P3 and P4 prioritisation categories. (This is suggested in much of GIRFT’s existing guidance)
- Patients requiring investigation or optimisation should be monitored to ensure that they are not ‘lost’ to the system.
- Ensure senior clinician input for P2 surgery postponements.
- Improve communication via a single point of contact. (all referred to referred to in our series of Theatre Productivity Training Guides)
- Adhere to national guidance for preoperative testing.
GIRFT guide to preoperative testing – MRSA
Guide to preoperative testing – NT-ProBNP and EchocardiographyGIRFT guidance for preoperative testing urine testing before elective urological surgery
Management of atrial fibrillation at preoperative assessment Waiting list, booking, and scheduling teams should adopt best practice approaches.
Practical guide on theatres booking
Practical guide on theatre waiting list management and list allocation
Practical guide on theatre scheduling
Practical guide on patient preparation and effective theatre flowAssess service needs and, if required, expand enhanced care capacity. (GIRFT guidance on enhanced care is in development)
Local and national reporting of high-quality cancellation data. (GIRFT has established a dedicated workstream to ensure good data quality)
GIRFT has also recently brought together a national medical optimisation project, co-chaired with primary care colleagues and organisations supporting perioperative care, to collaborate on areas identified by this work.
