UK audit protocol sets out national standards for perioperative care
Variation in perioperative care still shapes how patients move through surgery in the NHS, from preoperative preparation to postoperative recovery. The new protocol for the National Clinical Audit of Perioperative Care lays out a structured attempt to define what should be measured across services, so that differences in care can be tracked and compared in a consistent way. Rather than relying on local custom or partial datasets, the project is designed to produce a shared set of standards that can support benchmarking across specialties and care settings.
The work sits inside a familiar clinical problem: surgery is delivered by many teams, across many pathways, with wide variation in what gets documented, reviewed, and acted on. A national audit can only influence practice if its standards are specific enough to be measurable and broad enough to be meaningful across the NHS. This protocol tries to bridge that gap by building consensus first, then turning that consensus into operational audit standards for national use.
Rapid review and expert mapping feed the first draft standards
A rapid literature review has already been completed to identify existing frameworks, standards, and areas of variation drawn from academic publications, grey literature, NHS documents, and policy guidance. That search is not just a background exercise. It is the foundation for deciding which parts of perioperative care are already well defined and which gaps still need a common measurement language.
Candidate standards were then refined through a quality standard mapping exercise led by a multidisciplinary Clinical Reference Group. Patient representatives were included in that group from the start, which matters because audit standards often fail when they are built only from professional priorities. A standard that sounds rigorous on paper can still miss what patients experience as delays, anxiety, fragmented communication, or preventable complications.
The project is aiming for measurable standards rather than broad statements of intent. In audit terms, that is a critical distinction. A phrase such as “good perioperative care” cannot be benchmarked, while a standard tied to a specific process or outcome can be examined across hospitals and specialties.
Delphi panels will rate standards across clinical and patient perspectives
The main consensus method is a multiround, web-based modified Delphi process. Two stakeholder panels will take part: healthcare professionals involved in perioperative care and patients with lived experience of major surgery. Each panel will rate candidate standards using a 9-point Likert scale over at least two rounds, with predefined criteria determining which items move forward.
This structure allows the study to compare how clinicians and patients value different aspects of care. In perioperative medicine, those views are not always identical. Clinicians may focus on technical reliability, safety processes, and throughput, while patients may place greater weight on communication, coordination, and the practical experience of being moved through a complex system. A national audit built from only one of those perspectives would risk missing important sources of variation.
Quantitative results will be summarised descriptively, and consensus will be assessed using a priori thresholds applied separately to each stakeholder group. Standards meeting those thresholds will then be prioritised according to high-importance ratings and aggregated across panels. Qualitative feedback will undergo inductive thematic analysis, giving the team a way to refine wording and remove ambiguity between rounds.
The protocol does not stop at a numerical consensus exercise. After the Delphi rounds, a consensus meeting and further review by the Clinical Reference Group will refine and operationalise the final standards. In practical terms, that means the final list should be not only agreed upon, but also usable in a national audit framework.
Measurement is the point, not the paperwork
A national clinical audit only changes care if the standards are tight enough to generate action. Loose definitions create noise; measurable standards reveal patterns in delivery, referral, timing, documentation, and recovery support. The ambition here is to create a standard set that the English NHS can use to compare services and identify unwarranted variation across perioperative pathways.
The protocol is explicit that the final output will be stakeholder-informed and consensus-derived, with implementation intended for the newly commissioned NCAPC. That is a substantial operational task. Audit measures have to be interpretable by frontline teams, acceptable to patients, and realistic enough for use across diverse hospitals, not just tertiary centers with dedicated perioperative infrastructure.
A national framework also has the potential to expose whether variation arises from process gaps, inconsistent escalation, or differences in how recovery is supported after surgery. Those are the kinds of questions a good audit can answer, but only if the standards were built carefully from the outset.
Ethical approval and dissemination plan are already in place
The study has received approval from the Faculty Research Ethics Committee at the University of Southampton, and it has been prospectively registered with the Core Outcome Measures in Effectiveness Trials initiative. Findings will be published in peer-reviewed journals and presented at national and international conferences.
Dissemination has been planned beyond academic audiences. The final standards will be shared with key stakeholders including the Royal Colleges and NHS England to support implementation of the NCAPC across the English NHS. Lay summaries will also be developed with patient representatives, which should help make the final framework understandable to people who may never read the full protocol but will still be affected by its standards.
What comes next is a consensus exercise with direct implications for how perioperative care is judged on a national scale. The protocol is clear about its goal, but the real test will be whether the final standards are specific enough to measure variation and flexible enough to work across the full breadth of surgical practice in the NHS.