Theatres, surgery, and perioperative care: Key insights from the new NHSE guidance

NHS England recently released Theatres, Surgery, and Perioperative Care: Clinical and Operational Improvement Guide as part of the NHS IMPACT programme. This guide, published alongside recent NHS funding and policy announcements such as the Elective Recovery Plan, is part of a broader series aimed at equipping healthcare teams with the tools to drive clinical and operational improvements. It outlines evidence-based interventions that can enhance patient value and service productivity, with a particular focus on delivering safe and efficient care throughout the perioperative pathway.

Having reviewed the guide, I wanted to highlight its key recommendations for improving pre-operative processes, as well as the practical solutions it offers to help healthcare teams achieve better outcomes, even amidst growing operational pressures. These insights are particularly relevant for teams across the NHS striving to balance quality care with increasing demand.

Early risk-stratification and patient optimisation 

Identifying and addressing potential health risks early is essential to ensuring patients are ready for surgery. Early risk-stratification helps reduce delays, minimise complications, and improve surgical outcomes. The guidance recommends: 
 

• Screen patients for perioperative risks early: Patients should be screened for risk factors, such as diabetes, anaemia, and obesity, as soon as surgery is being considered. Screening must happen no later than the time a patient is added to the waiting list.
  
  
• Provide personalised support based on screening results: Patients identified with risk factors should receive tailored care plans to optimise their health before surgery. This approach improves health outcomes and ensures that care aligns with patient needs and goals.
  
  
• Maintain regular contact with patients on waiting lists: For patients waiting for inpatient procedures, hospitals should check their health status every three months to ensure they remain fit for surgery and still require the procedure. When further optimisation is needed, senior clinical decision-makers should determine whether the patient stays on the waiting list, taking into account local waiting times and the duration of optimisation required.

Pre-operative assessment processes 

Preoperative assessments play a vital role in the perioperative care pathway by ensuring patients are ready for surgery and providing surgical teams with information about patient co-morbidities and risk factors so these can be managed in theatre with appropriate prevention and recovery strategies. Key recommendations include: 
 

• Focus on optimising patients for surgery: Effective pre-operative assessments ensure patients are as fit as possible for their procedure, reducing complications and supporting faster recovery. This approach not only enhances individual outcomes but also improves productivity and resource use across the surgical pathway.  
  
  
• Adopt GIRFT’s best practices: The GIRFT POA Services guidance supports non-medical pre-assessment leads, clinicians and managers who want to embed best practice in their preoperative assessment processes.  It outlines the principles for efficient and structured processes and includes advice on staffing, care pathways, and protocols, as well as practical checklists for evaluating and improving service levels. 
  
  
• Plan and integrate digital tools effectively: Leverage digital tools to streamline the preoperative pathway, ensuring thorough planning and seamless integration with existing workflows and IT systems to maximise productivity.

Avoiding delays and cancellations 

Delays and cancellations disrupt surgical pathways, leading to inefficiencies that impact both patients and staff. However, many cancellations are avoidable with the right strategies. The guide suggests:
 

• Make every contact count: Every interaction with patients offers an opportunity to provide information, answer questions, and confirm their readiness. Clear communication about surgery, recovery, and discharge builds confidence and sets realistic expectations.  
  
  
• Review patients regularly: Conduct systematic reviews of patients on waiting lists to ensure their health status and readiness for surgery remain current. Early identification of changes allows for timely interventions, reducing the risk of cancellations.  
  
  
• Provide clear and inclusive information: Patients should receive personalised, easy-to-understand guidance covering every stage of their surgical journey. This includes practical details such as what to expect, how to prepare, and logistical information like parking, visiting policies, and requirements for being accompanied home.

Essential tools for optimisation

To make it as useful as possible and to support local improvement programmes, the guidance links to a range of valuable resources and case studies. Among the key contributors is the Getting It Right First Time (GIRFT) programme which has developed the Surgical Hub Toolkit in partnership with the South West London Elective Orthopaedic Centre (SWLEOC). The toolkit offers practical solutions for effectively managing surgical hubs and includes recommendations tailored to different aspects of the perioperative journey, ensuring clinicians have the tools they need to align with national standards.  

Resources such as the surgical hub toolkit bridge the gap between guidance and implementation, providing teams with the structure they need to optimise preoperative processes. By integrating these into workflows, healthcare teams can overcome common challenges, reduce inefficiencies, and provide patient-centred care with greater confidence.  

The role of digital transformation  

While the guidance provides a clear pathway for improvement, implementing these recommendations may prove difficult. After all, having a strategy is all very well and good, but we know that ‘culture eats strategy for breakfast’! With many NHS organisations already under significant pressure, and additional requirements stretching resources further, maintaining an overarching positive culture in NHS organisations is no small feat. However, digital transformation and adoption of the right solutions can help teams address these challenges effectively.  

Recognised in the GIRFT/SWLEOC Surgical Hub Toolkit as the digital preoperative assessment tool of choice, Definition’s Health’s LifeBox solution simplifies the preoperative process and ensures both patients and clinicians are fully prepared for surgery. The accessible and personalised platform provides patients with the information they need to feel confident and supported, reducing cancellations and enhancing their surgical journey. For healthcare teams, LifeBox acts as a centralised, data-driven system that improves communication, saves clinical time, and supports alignment with frameworks like GIRFT. Hospitals using LifeBox have reported measurable improvements, including greater efficiency, better resource management, and enhanced patient outcomes.  

To learn more about how LifeBox can transform your preoperative pathways, book a demo today.