Theatres and decontamination
1. Workforce: job planning, skills mix in theatre, effective rostering, new models of care, advanced roles and management.
2. Booking and scheduling: theatre scheduling, list allocation and lookback; effective patient selection and booking; waiting list validation; booking team and structure/function.
3. Peri/Post-operative: perioperative delivery models; prehab/optimisation; criteria-led discharge; enhanced care models, enhanced recovery; day case pathways.
4. On the day: admissions process; golden patient, effective flow and handover; standardisation of equipment and consumables; the right equipment must be available on the day.
He highlighted some of the main reasons for low theatre productivity, based on GIRFT data. (See table 1.)
“It starts with the surgical review and assessment,” he commented, pointing out that low theatre productivity and delays occur when there is a failure to consider factors such as comorbidities, but we must also educate patients. “We need to ensure lists are full, with the right patients,” he pointed out. Getting admissions right and ensuring patients are ready for surgery is vital to ensuring productivity. Pre-admission calls are therefore a critical area of focus. We must also have the right number of beds and day case beds, Prof. Briggs advised. During the surgical procedure, it is important
to minimise downtime and ensure equipment is available, to prevent late starts. Theatres need to ensure effective flow, and beds need to ready for the next day, which includes getting patients
home and making sure the TTO is ready, to prevent delays in discharge. He went on to discuss capped theatre utilisation and the average case per four-hour session – from the time of the needle into the arm, to the patient leaving theatre, and the end of the procedure. “Pre-COVID, it was 76%; currently we’re 80.7%. We need to get to 85%. We’re making good progress, but we need to do that more quickly. Likewise, we now need to make sure that patients are having their procedure in the right place. We’ve been able to move many patients from the day case theatre to the outpatient procedure room, freeing up theatre space to do more day cases and maximising the theatre productivity, within the right space.
“If you look at the BADS day case and outpatient procedure rates, it was 77% pre- COVID. We’re now at 84.6%, which is a massive improvement and clearly allowing our theatres to operate much more efficiently and effectively, as well as reducing waiting times,” said Prof. Briggs. He pointed out that there are five regions
above 80% capped theatre utilisation, but there is significant regional variation. “We’ve got to try and standardise that…We’ve carried out a lot of work to reduce short notice cancellations, but there has been a steady increase from November 2024 to November 2025…We are working very hard with every Trust, trying to bring these down.”
He explained that the aim is to achieve no
greater than a 7% cancellation rate across all surgical activity. GIRFT data shows that the top reasons for cancellations were ‘surgery deferred’ (34.9%) and ‘procedure no longer
necessary’ (27.1%). Healthcare providers must avoid wasted theatre time by having discussions with patients before they come into hospital. He highlighted a case study from Newcastle
which has mobilised a consistent booking and scheduling approach, drawing on GIRFT’s practical guidance in theatre booking and scheduling. (This guidance can be viewed at: Booking:
https://gettingitrightfirsttime.co.uk/ wp-content/uploads/2024/07/Practical-Guide- Theatre-booking-guide-FINAL-V3-July-2024.pdf Scheduling: https://gettingitrightfirsttime.
co.uk/wp-content/uploads/2024/07/Theatre- scheduling-V2-July-2024-1.pdf) By introducing the guidance and partnering with local processes, they have been able to improve week-on-week, in terms of their utilisation – over a significant time period: l Week (1) – 75% to 90% l Week (2) – 67% to 80%
He went on to highlight another case study at Shrewsbury & Telford where significant improvements in theatre productivity were achieved. The total number of sessions has gone from 350 in 2023, to over 600. The average cases on a list also went from 2.2 back in 2023 to 2.7, while theatre utilisation is now above 80%. Operation cancellations have also improved. “GIRFT is also looking at total theatre estate usage – i.e. what is being done Monday to Friday with all the theatres within a Trust or surgical hub; if they are not being utilised, why not? We need to understand this, because we have over three-and-a-half thousand theatres in the NHS and we need to ensure we use them fully to bring down our waiting list – with core capacity
Table 1. Theatre pathway. 28
www.clinicalservicesjournal.com I July 2026
Credit: GIRFT.
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