Theatres and Perioperative Medicine

GIRFT’s theatre and perioperative programme seeks to create solutions that will unlock the full potential of the perioperative pathway and optimise the use of theatres and surgical hubs to manage the elective backlog and deliver high quality care for patients.

Perioperative medicine is a crucial component in helping to manage complications and prevent delays on a patient pathway. However, there remains considerable variation in theatre utilisation and perioperative pathways across England, impacting the ability of systems to deliver timely care.

Data analysis and focused work with providers has identified the main reasons for low theatre and perioperative productivity. A key priority is to reduce variation and encourage best practice in the processes and treatment of patients pre- and post-surgery, as well as improving theatre utilisation, efficiency and workforce.

To support the NHS 10 Year Health Plan for England and the government’s commitment to restoring the constitutional standard of treatment within 18-weeks of referral, Integrated Care Systems (ICSs) and providers are targeted to achieve a minimum of 85% capped theatre utilisation and make best use of resources available. This target is a key enabler in operational planning guidance and is central to achieving elective recovery, reducing waiting times and ensuring patient receive high-quality care when they need it.

Meet our clinical leads

This programme is overseen by the National Theatre and Perioperative Care Programme Board, chaired by Professor Tim Briggs, National Director of Clinical Improvement, Elective Recovery and UEC, and programme lead of GIRFT.

There are five clinical leads and advisors who support this work, focusing on pre-operative assessment, theatre utilisation, anaesthesia and peri-operative medicine.

The ideal perioperative pathway

The graphic below demonstrates the ideal perioperative pathway that should be employed across all NHS trusts across England. Our discussions with trusts, data that GIRFT has access to and the reasons cited for short-notice avoidable cancellations all indicate a distinct opportunity to standardise the approach to perioperative care.

The ability to impact perioperative care across all surgical specialties can be achieved through embedding national guidance across early risk assessment, health optimisation and patient stratification, as indicated below.

Download a copy of ‘The ideal perioperative pathway’ as a PDF

Causes of low theatre productivity

The graphic below demonstrates the main reasons for low theatre productivity, based on data GIRFT has access to and what we have identified through working directly with several providers delivering intensive support. We know that optimising each step of the process can provide incremental gains in theatre productivity and will support providers in achieving the nationally recognised 85% capped theatre utilisation.

Streamlined processes, enhanced planning and the correct use of clinical, nursing and operational resources will not only result in an improved position but will also contribute to supporting theatre and perioperative teams in the execution of their role, maximise the average number of cases per theatre list and support patients in receiving surgical interventions sooner.

Download ‘Causes of low theatre productivity’ as a PDF

Theatres and perioperative programme workstreams

The graphic below illustrates the dedicated workstreams assigned to GIRFT’s theatres and perioperative programme. These can help providers and systems to get the most out of their resources by creating the best possible environment for their surgical teams and patients.

Each workstream has been selected to address key barriers to productivity, workforce and patient outcomes. From developing roles and optimising skill mix to reducing recruitment challenges, or from eliminating avoidable cancellation and embedding high-performing models in surgical hubs, the programme is designed to streamline care and improve flow. It supports in moving procedures to the most appropriate settings, using data to target improvements and implementing digitally admitted pathways.

Standardised preoperative assessment, patient optimisation and high-flow theatre models will continue to ensure timely, efficient treatment and better experiences for both staff and patients across the NHS.

Pre-operative Care

Pre-operative Assessment
Early Screening & Risk Assessment
Patient Optimisation
Booking & Scheduling

Theatre Productivity

In session Productivity
Cases per Session
Theatre Estate Usage
High Flow theatres
Short Notice Cancellations

Post-operative Care

Reducing Length of stay
Daycase as default
Enhanced care
Criteria led discharge

Data & Digital

Federated Data Platform, data driven change & the digital OR

Care in the right setting

Surgical Hubs & Right procedure, right place

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

GIRFT’s national report for APOM (2021) concluded that increasing the number of day case patients – those who do need an overnight stay in hospital – could 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 included 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.

The report found that 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.

GIRFT makes two new clinical appointments to theatres and perioperative medicine programme

New addition to series of preoperative support guides focuses on interventional radiology procedures

Guidance supports providers to reduce preoperative Group and Save testing for patients having knee and hip replacement surgery.

New addition to series of preoperative support guides focuses on the management of atrial fibrillation

Free online training for new NHS scrub practitioners, helping to improve theatre productivity

Fifth in the series of preoperative support guides – streamlining protocols for decolonisation and washes

Further Faster 20 trusts share lessons on implementing high flow lists

Study shows enhanced recovery pathways after elective surgery can help minimise stay

Guide to separating and streamlining preoperative assessments for patients having a local anaesthetic

Delivering a standardised approach to screening for MRSA

Delivering a standardised approach to preoperative urine testing

Guide to support use of preoperative tests for elective surgery

The National Theatre and Perioperative Care Programme collaborates across all interdependent national programmes that support the delivery of high-quality, efficient surgical care. The programme plays an integral role in improving and, where necessary, standardising theatre and perioperative services across England.

Find out more about this work in Associated Projects.