A Breakdown of the New GIRFT Preoperative Assessment Guidance

23 Jan

Have you seen the new Getting It Right First Time (GIRFT) Anaesthesia and Perioperative Medicine (APOM) guidance and recommended sentinel metrics?

GIRFT is an NHS initiative aimed at improving patient care by identifying and reducing variations in clinical practice. Their mission is to enhance outcomes, cut unnecessary costs, and ensure healthcare delivery is consistent, efficient, and evidence-based.

Recently, they released new guidance on preoperative assessments (POA)—a crucial step in the patient journey for anyone undergoing surgery.

In this article, we’ll breakdown:

The important bits of the new GIRFT guidance.
The sentinel metrics they’ve introduced and why they’re useful.
What these changes mean for healthcare teams.

What’s important in the GIRFT preoperative assessment guidance?

The new guidance builds on the previous version, acting more as a reminder with emphasis on early risk assessment, patient optimisation, and streamlined care pathways to ensure patients are ready for surgery.

These best practices are mandated under the NHSE 2023/24 contract. That means all NHS providers are required to implement early screening, risk assessment, and optimisation processes as standard.

The contract requires providers to:

Embed early screening and risk assessment across all pathways since April 2024.
Ensure POAs are completed before patients are listed for surgery.
Use data-driven tools like sentinel metrics to monitor and improve performance.

In addition to these requirements, the guidance includes recommendations for POA dashboards to track service efficiency. These dashboards focus on key metrics:

Preoperative process-specific metrics:

On-the-day cancellations and postponements: Highlights where issues like incomplete assessments or poor scheduling disrupt care, giving teams actionable insights to prevent them.
POA utilisation and capacity: Helps clinics avoid bottlenecks or underuse, ensuring a smoother patient experience and better resource allocation.
Patients listed for surgery without a completed POA: Reduces the risk of cancellations and wasted time by ensuring patients are fully optimised before scheduling.
Duplication rates in POA appointments: Saves time and resources by cutting down on unnecessary repeat visits, improving both patient and staff satisfaction.
Consultant anaesthetic review referrals: Identifies training gaps for non-medical POA staff, empowering them to manage more cases independently.
Fit-for-surgery pool creation: Ensures patients are optimised and ready, improving theatre scheduling and reducing last-minute stress.

Understanding the new preoperative sentinel metrics

One of the interesting additions to the new guidance is the introduction of sentinel metrics. These are designed to track surgical performance across day cases, inpatient elective care, and inpatient emergency care. Together, they provide a full-circle view of how surgical pathways are performing and where improvements are needed.

Day case metrics:

Day case admission rates
Day case (intended): successful delivery
Day case length of stay (LOS = 0)
Readmissions after day-case surgery
Cancellations

By tracking admission success, cancellations, and readmissions, healthcare teams can identify inefficiencies, streamline care, and reduce unnecessary inpatient stays.

Inpatient elective metrics:

Mean length of stay (LOS)
Index cases (LOS) (e.g., hip replacements, knee replacements, colectomies)
Readmissions within 30 days
Extended stays (e.g., intermediate procedures > 2 days, major procedures > 5 days)

Shorter stays and fewer readmissions reflect better preparation and smoother recovery, while extended stays and specific procedure benchmarks help identify areas needing improvement.

Inpatient emergency metrics:

Mean and median LOS
Readmissions within 30 days
Surgical flow (admissions without procedures)
Extended stays (e.g., >7 days or >20 days for index cases)
Index cases (LOS) (e.g., neck of femur fractures, laparotomies)
Mortality rates after major surgery

By monitoring LOS, readmissions, and mortality, these metrics help pinpoint inefficiencies, improve care for complex cases, and enhance outcomes for high-priority procedures.

What does this mean for healthcare teams?

These updates are a big step forward in standardising and streamlining preoperative assessment pathways. And making these recommendations mandatory ensures greater consistency and accountability, giving providers clear benchmarks for improvement.

However, implementation requires careful planning. Many NHS organisations are already stretched and additional requirements can pose challenges, but they are a necessary shift towards data-driven, patient-centred care.

While challenges exist, there are solutions to help teams adapt. Tools like Pathpoint ePOA can streamline early risk assessment, optimise patient pathways, and ensure compliance with GIRFT and NHSE requirements. Digitising the POA process with a good digital system not only simplifies tracking metrics and helps trusts align with GIRFT recommendations but also provides essential support to staff, empowering them to enhance care delivery.