UK Audit of Vascular Surgical Services & Carotid Endarterectomy

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Summary of the UK Organisational Audit of Vascular Surgical Services 2009

Aims

1. To evaluate the current structure of vascular services within the UK.
2. To enable benchmarking of the provision of vascular services regionally and nationally.
3. To provide those involved in the organisation of vascular services with a national benchmark.
4. To identify areas of vascular service which would benefit from further evaluation and guidance.
5. To provide baseline data for a quality improvement programme in vascular surgery.
6. To stimulate improvement in the provision of vascular services.

Recommendations

Remuneration

• Where there was a large difference between the number of cases self-reported to the audit,
  than within national agency records (HES), trusts should examine their coding systems to
  assess the accuracy of their coding of these procedures.
• Trusts undertaking fewer than the minimum number of recommended cases per annum
  should link with adjacent trusts to increase workload to a safe level by centralising complex
  surgical procedures.
• Vascular services should form networks with adjacent units for local/regional governance
  and audit.

Facilities

• Vascular teams should not undertake open Abdominal Aortic Aneurysm repair without rapid
  access to cell salvage, infusers for fluid including blood and available blood products and
  haemostatic agents within one hour. Trusts without these facilities should seek to provide
  them or develop protocols for the transfer of patients to adjacent units with such facilities.
• Access to an emergency theatre should be considered essential for all vascular units.

Risk management

• Trusts should perform Endovascular Aneurysm Repair in a sterile environment.
• To minimise the risk of cross-infection, patients who have undergone arterial surgery
  should not be nursed adjacent to those with open, infected wounds or stomas.

Networks

• The requirements for 24 hour vascular cover, provision of surgical and endovascular
  training and sufficient throughput of major cases should stimulate low volume centres to
  join other vascular centres, either by formal network arrangements or centralisation.

Training

• All vascular trainees should undergo at least one year of formal endovascular training.
• Vascular trainees should be provided with better access to training in endovascular
  techniques in order to meet future patient demand.

Specialist Staffing

• As vascular surgery develops into a separate speciality, services should be re-configured to
  provide 24 hour access to both surgical and endovascular interventions.
• Vascular units should include assessment by an anaesthetist with experience in elective
  vascular anaesthesia as a formal part of pre-operative assessment and be staffed with
  anaesthetists with specialist vascular skills for emergency cases.
• Vascular patients should be nursed by teams with expertise in providing vascular care.

Patient feedback

• All vascular units should regularly seek patient views on the range of vascular services.

Summary of Clinical UK Carotid Endarterectomy Audit (Round 2)

Data were returned by 93% of eligible surgeons, reporting 70% (6970/10,022) of cases reported in
HES in the same time period (1st January 2008 to 30th September 2009).

Aims

1. To assess the current speed of delivery of CEA in the UK.
2. To assess variations in access and quality of care for patients needing CEA.
3. To assess 30-day mortality and complications rates following CEA.
4. To stimulate improvements over time in the quality of care provided to patients of CEA.

Recommendations

• While data reporting has improved, rates of data capture to national audits needs to improve
  further. Commissioners should require this from all vascular units.
• While there has been a reduction in delay from symptoms to treatment, there is significant
  room for improvement. Many patients are not being treated within the timeframe set by NICE or
  the National Stroke Strategy.
• Significant delay occurs between symptom and presentation. Better public awareness of TIA
  and stroke is needed.
• Delays in referral or due to lack of operating staff and facilities need to be addressed by trusts.
• The reported complication rates are much lower than those reported from clinical trials, it is
  recommended that all patients undergoing Carotid Endarterectomy should have both surgical
  and stroke physician/neurologist follow up