Latest PQIP report highlights key areas of improvement
New research from the Royal College of Anaesthetists (RCoA) and UCL shows that almost one in three patients (30%) having major non-cardiac surgery do not receive an individualised risk assessment despite recommendations from NHSE and the GMC.
Data from across the country
This research was gathered as part of the 5th cohort of the Perioperative Quality Improvement Programme (PQIP). In total, 53,478 patients in 173 hospitals in England, Scotland, and Wales are included in the research (dating back to 2016), with 8,634 patients from 135 hospitals having surgery in the year between March 2023 and 2024. This represents more than 80% of eligible hospitals participating in the programme since its inception.
Why individualised risk assessments matter
Individualised risk assessments help identify pre-existing conditions that could complicate surgery. They support shared decision-making, enabling patients to provide informed consent and helping clinicians tailor care to individual needs. This process is essential to reduce patient waiting lists and healthcare costs by preventing surgery cancellations and complications. Their importance is emphasised by case law (Montgomery, 2015) and GMC guidance.
Focusing on identifying and treating anaemia
NHS England has introduced five core requirements for preoperative screening and optimisation within inpatient pathways, now embedded in the standard contract with acute care providers. These requirements include managing conditions like diabetes and anaemia before surgery. The research identifies that 67% of anaemic patients still do not receive treatment before surgery, despite even mild anaemia increasing the risk of complications.
Given ongoing shortages of blood for transfusions and recent recommendations from the infected blood inquiry, hospitals are encouraged to focus on treating anaemia preoperatively and minimising surgical blood loss through simple interventions such as administering tranexamic acid, a safe and inexpensive drug.
Positive progress and patient satisfaction
There has been positive progress in encouraging patients to drink, eat, and mobilise (DrEaM) within 24 hours of surgery, with rates increasing from 57% in 2016/17 to 70% in 2023/24. This approach not only reduces complications and hospital stays but also brings financial benefits to NHS trusts due to its status as an NHS England Commissioning for Quality and Innovation Indicator (CQUIN).
Patients are reporting high levels of satisfaction with their perioperative and anaesthetic care, with 95% satisfied or very satisfied with perioperative management and 99% with anaesthetic care.
Professor Ramani Moonesinghe, Chief Investigator, Perioperative Quality Improvement Programme, said:
“Our dedicated clinical community has once again demonstrated exceptional commitment to advancing perioperative care, Lord Darzi’s report last week, stated that NHS providers will need to ‘bring down waiting lists by radically improving their productivity’. Our report evidences multiple opportunities to achieve this ambition, by reducing cancellations, postponements and postoperative length of stay while also improving patient care and outcomes.
“My sincere thanks to all our collaborators who help make PQIP successful. Your relentless dedication to producing this comprehensive report helps drive forward the standards of perioperative care and I am grateful to you.”
Dr Claire Shannon, President of the Royal College of Anaesthetists, said:
“There is potential to improve patient care and outcomes though more consistent application of individualised risk assessments and management of conditions such as diabetes and anaemia prior to surgery. With clinical teams already stretched this is easier said than done, but NHS England’s guidance for preoperative screening and optimisation has now been built into the standard contract with acute care providers so more resources should be available to trusts to support implementation.
Since PQIP began in 2016, over 80% of eligible hospitals have participated in the programme, which demonstrates a huge commitment to improving perioperative care and patient outcomes. I am grateful to everyone who has contributed.”