The Carotid Interventions Audit reports, commissioned by the Healthcare Quality Improvement Partnership (HQIP), focussed on the process and outcomes of patients undergoing carotid endarterectomy and include data on the characteristics of the patient, the key delays prior to surgery, the surgery itself and any post operative outcomes.
- All staff involved in organising and delivering care to patients who require carotid surgery need to examine their data and assess their performance against standards within NICE Guideline CG68.
- Clinicians should ensure that data from patients having carotid surgery are included in national clinical audit. Appropriate time within job plans must be made available for consultants to validate and act upon their data.
- Systems should be in place to ensure that coding of patients with carotid surgery is accurate. This requires close collaboration between hospital coding departments and clinicians and is likely to require regular (at least monthly) coding review meetings with the vascular team.
- Every health economy offering carotid surgery must have a clearly documented pathway of care. This should state how the patient accesses services and how they flow through to surgery if required.
- Clinicians involved in providing care to patients with TIA and minor stroke should ensure that there are agreed referral protocols to minimise delays in the pathway.
- It is recommended that referrals to vascular surgery or interventional radiology should go to a central point within the department, rather than individual clinicians. There should be someone available to deal with referrals on a daily basis. These processes should work both during the working week and at the weekend.
- Patients requiring carotid endarterectomy should be allocated to the next available operating list (ideally within 3 days of referral).
- Carotid intervention should be prioritised as urgent/emergency in all symptomatic cases.
- Clinical teams should seek feedback from patients to help improve the quality of care offered.
- Stroke teams should publicise their services to primary care and the public. Attention should be given to highlighting the importance of amaurosis fugax as this diagnosis is associated with significantly greater delays in the pathway.
The clinical audit has been running since December 2005. Round 1 included operations between 1 December 2005 and 31 December 2007. Round 2 included operations performed between 1 January 2008 and 30 September 2009 and publicly reported on 22 July 2010. Round 3, which included operations performed between 1 October 2009 and 30 September 2010, was publicly reported in June 2011. Round 4, which included operations performed between 1 October 2010 and 30 September 2011, was publicly reported in August 2012.
The Carotid Interventions Audit has now moved to the Clinical Effectiveness Unit at the Royal College of Surgeons of England to be part of the National Vascular Registry Project, which is also funded by HQIP.