APOM - Getting It Right First Time

Anaesthesia and Perioperative Medicine

All surgical specialties work closely with anaesthesia and perioperative medicine (APOM), a crucial and frequent component of a hospital patient’s journey.

Anaesthesia is the largest hospital specialty in England – used in a third of all hospital admissions – whilst perioperative care aims to bring together primary, secondary and social care resources to provide a seamless patient pathway.

The overarching challenge facing the specialty concerns surgical volumes; the growing demand for surgery, an ageing population and increasing co-morbidities. These challenges add additional pressures on emergency and elective care services.

The National Perioperative Care Programme

GIRFT is collaborating with NHS England’s Digital Outpatient, Elective Recovery, and Elective Workforce Recovery teams to form the National Perioperative Care Programme, working to improve and standardise the quality of perioperative care services in England so that all patients on an elective or emergency surgical pathway have a good experience of perioperative care; that cancellations or delays to surgery for avoidable clinical reasons are minimised; and that the perioperative period is used as an opportunity to improve health and reduce health inequalities.

Find out more about this work in Associated Projects.

Dr Chris Snowden

Joint APOM Clinical Lead

Consultant anaesthetist at the Newcastle upon Tyne Hospitals NHS Foundation Trust (Freeman Hospital), and the Royal College of Anaesthetists clinical lead (joint) for perioperative medicine.

Dr Snowden trained and graduated in Newcastle upon Tyne and became a consultant anaesthetist at the Freeman Hospital in 1997. He is also an honorary senior lecturer at the Institute of Cellular Medicine at Newcastle University. Dr Snowden has a particular interest in the perioperative management of high risk patients including liver transplantation.

Dr Mike Swart

Joint APOM Clinical Lead

Consultant anaesthetist and critical care medicine at the Torbay and South Devon NHS Foundation Trust, and the Royal College of Anaesthetists clinical lead (joint) for perioperative medicine.

Dr Swart trained at University College London and undertook anaesthesia and critical care training in Oxford, Cardiff and Cambridge. For the last 18 years he has worked as a consultant in anaesthesia and critical care medicine at Torbay Hospital in Devon. Dr Swart was previously the medical lead for the Peninsula Critical Care Network and Department of Health advisor for anaesthesia to the Enhanced Recovery Programme.

Useful information

How does APOM fit with other specialties?
Anaesthesia and perioperative care runs alongside the surgical specialties, and there are also significant overlaps with diabetes, geriatric care and intensive and critical care. Perioperative medicine is becoming increasingly important as the role of the anaesthetist is broadening to cover more work beyond the theatre.

What is the purpose of the GIRFT APOM report?
To examine unwarranted variations in data and practice relating to APOM in England, particularly for clinical coding, metrics and data collection to support benchmarking and evaluation.

What data sources were used in the compilation of the APOM report?
Hospital Episode Statistics (HES), GIRFT questionnaire results and NHS Resolution data for litigation are the data sources used to analyse APOM services.

'Day surgery as the default’ is important key to tackling COVID-19 surgical backlog, says GIRFT report

Increasing the number of day case patients – those who do need an overnight stay in hospital – can help to reduce waiting times as well as improving efficiency and offering cost savings of up to £2m for every trust.

The 18 recommendations in the GIRFT report include improving enhanced recovery pathways (to ensure inpatients are discharged as early as possible), integrating perioperative care across all surgical pathways and reducing the number of cancelled operations through the use of enhanced care.

More than seven million NHS operations are performed every year which is why the assured delivery of high-quality day surgery pathways is crucial – whilst also making safer environments for patients.