New PQIP report shows sustained improvements

New research from the Royal College of Anaesthetists (RCoA) and University College London shows sustained improvements since 2016 in five key areas of perioperative care. 

Nearly a decade of study

The Perioperative Quality Improvement Programme (PQIP) collects and analyses data on the perioperative care of patients undergoing major non-cardiac surgery and measures complications and patient outcomes. Since its inception in January 2016, PQIP has recruited over 60,000 patients at 174 hospitals across the UK. 

The latest report from PQIP represents the sixth cohort, which studied 5,794 patient episodes from 18 March 2024 to 17 March 2025. 

Sustained improvement

PQIP focuses on four top improvement priorities for improving patient outcomes: perioperative blood management, DrEaMing, utilising local data, and pain management. Sustained improvement is evident across all these areas since 2016, but more work is needed.

• Perioperative blood management

Blood management is key to reducing adverse outcomes and costs associated with perioperative anaemia and transfusion. Thankfully rates of moderate to severe anaemia have fallen from 11.3% in 2016 to 7.3% in cohort 6. 

Nationally, there has been greater attention to using tranexamic acid (TXA) to reduce surgical bleeding after the results of the infected blood enquiry. PQIP started studying rates of TXA usage in its third cohort in 2019 and since then rates have increased at every level of blood loss. 

• DrEaMing

DrEaMing is a care bundle encompassing three key elements of Enhanced Recovery After Surgery (ERAS) protocols - drinking, eating, and mobilising within 24 hours of surgery. Rates for all three of these elements, individually and collectively, have improved since 2016. One outlier is the absence of a drain after surgery - this rate has fallen from 56% in cohort 1 to 51% in cohort 6. 

• Local data

PQIP provides participating hospitals with individualised reports to facilitate systemic improvements at a local level. Tools are available on the PQIP website to help participants understand and share their data. 

PQIP benefits from the NIHR’s Associate Principal Investigator (API) Scheme, which aims to support healthcare professionals to get involved in research and is open to all non-consultant grade doctors, nursing staff and allied health professionals. To date, over 120 APIs have contributed to PQIP data collection as well as integrating their local data into real-world improvements. 

• Pain management

Effective pain management matters to patients and facilitates their overall surgical experience. A persistent finding across PQIP cohorts is an increase in pain scores from the recovery room to 24 hours postoperatively. Anticipating this ‘rebound effect’ can help manage patient pain and expectations. 

Patients have been surveyed on their perception of quality of pain management since 2016 and though rates have not improved, they have remained consistently high, with 66% of patients very satisfied in cohort 1 and cohort 6. 

Professor Ramani Moonesinghe, Chief Investigator, Perioperative Quality Improvement Programme, said:  

“The release of this sixth report from PQIP represents a big achievement for this study and its impact on quality improvement in patient care. We’ve recruited more than 60,000 participants since 2016 and are on track to reach our target of 70,000 in our next cohort.

“This year’s report shows more patients are eating, drinking and mobilising within 24 hours of surgery, which is positive for their recovery. However, we also remain challenged by some aspects of perioperative care which our patients should probably be able to take for granted – for example, individualised risk assessment before surgery, opportunities to have anaemia and diabetes optimised to reduce transfusion, complications and length of stay, and access to the right location of care after surgery. 

My biggest thanks to the many people who contribute to this vital quality improvement work, from patients sharing their experiences, our local collaborators, our researchers and analysts, and our partners in the RCoA and UCL for their support.”

Dr Claire Shannon, President of the Royal College of Anaesthetists, said:  

“Our Perioperative Quality Improvement Programme has been instrumental in driving change in hospitals across the county. It’s a great example of how supporting clinicians to use data can help improve outcomes for patients. 

“By highlighting the challenges as well as the improvements, PQIP is a valuable tool in helping us understand where we should focus our efforts across the perioperative pathway to improve care. Crucially, it gives clinicians access to local data – facilitating hospital level improvements.   

“I’m grateful to everyone who has contributed to this powerful resource for ongoing improvement in perioperative care.”