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Access to NHS stroke prevention surgery improving

23 Oct 2013

Access to NHS stroke prevention surgery improving, but surgeons say there is still much to be done

New figures reveal that, for the first time, more than half of NHS patients who need vital stroke prevention surgery are accessing it within two weeks of experiencing symptoms of stroke or transient ischemic attack (TIA or mini stroke). However, more must be done to raise public and professional awareness about the need for quick treatment, and improve referral patterns from GPs and other clinicians. Hospital services should be organised to ensure there is rapid access to specialist imaging and care.

Figures from the fifth report of the Carotid Endarterectomy Audit report show that 56 per cent of patients who need surgery of the neck arteries in order to prevent stroke (carotid endarterectomy or CEA) are receiving it within the two week timeframe set by the National Institute for Health and Care Excellence (NICE). But the study also reveals considerable variation across the UK, with delays between patients experiencing symptoms, referral to stroke specialists and on to surgery. While some hospitals average five days from symptom to surgery, patients are waiting up to three months for their operations in others.

Mr David Mitchell, Chairman of the Vascular Society’s Audit & Quality Improvement Committee and a consultant vascular surgeon, said: “Not all patients with symptoms of stroke or TIA require surgery, however for those that do, quick access is crucial in preventing needless strokes and their associated misery. Despite the good work by many clinicians, we still have a long way to go if we are to meet NICE guidance of getting 100 per cent of patients into the operating theatre within 14 days of symptoms. However, patients undergoing this operation should be reassured, as the audit shows, that carotid surgery is being performed more effectively than ever before in the NHS, with complication rates consistently low.”

Surgeons say that most delays in meeting the two week timeframe set by NICE relate to late presentation and/or referral. Of those patients who did not meet the 14 day timeframe, 65 per cent were found to have had a slow diagnosis – either because they didn’t call 999, go to A&E or visit a GP (27 per cent), or they weren’t referred to specialist stroke centre quickly (38 per cent).

In certain regions across the UK, stroke services and vascular surgery have been centralised into larger centres where experienced multidisciplinary teams of surgeons, stroke physicians and neurologists assess and treat patients presenting with symptoms of stroke. The authors of the report point to the reorganisation of stroke services in London (which saw 17 units go down to 11), where the average delay from symptom to surgery has fallen from 12 days in 2009 to 8 days in 2012.

Professor Ian Loftus, Consultant Vascular Surgeon at St George’s Healthcare NHS Trust, said: “Stroke is the largest single cause of significant adult disability in the UK. More needs to be done to ensure the public are aware of the alarm symptoms which include sudden onset of blurred vision, slurred speech, and weakness in the face, arms or legs. We know that fast referral to specialist stroke services is absolutely vital to improving patient care and outcomes. Care should be focused in centres that are well-organised and experienced in performing stroke prevention surgery.”

The audit is the largest continuous audit of CEA in the UK. Round five includes over 5,700 cases carried out between 1 October 2011 and 30 September 2012. This represents 95 per cent of cases reported in Hospital Episode Statistics for the same period in England, 78 per cent in Scotland and 69 per cent in Wales.

Notes to editors

Carotid endarterectomy is a preventative surgical procedure. It corrects narrowing in the internal carotid artery, found in the neck. Patients presenting with symptoms of threatened stroke or TIA are at increased risk of stroke. Those who have significant narrowing of the carotid artery are at high risk of having a more severe stroke, hence urgent surgery is important to prevent this happening. The UK Carotid Endarterectomy Audit provides data about the efficiency of care and outcomes for patients who undergo surgery.

Hospital Episode Statistics contains details of all admissions to NHS hospitals and all NHS outpatient appointments in England. It is a main data source for a wide range of healthcare analyses for the NHS, government, and many other organisations and individuals.

The Healthcare Quality Improvement Partnership (HQIP) is led by a consortium of the Academy of Medical Royal Colleges, the Royal College of Nursing and National Voices. Its aims are to promote quality improvement and, in particular, increase the impact that clinical audit has on healthcare quality in England and Wales. HQIP hosts the contract to manage and develop the National Clinical Audit and Patient Outcomes Programme (NCAPOP). Their purpose is to engage clinicians across England and Wales in systematic evaluation of their clinical practice against standards, and support and encourage improvement in the quality of treatment and care. The programme comprises more than 30 clinical audits that cover care provided to people with a wide range of medical, surgical and mental health conditions.

The Royal College of Surgeons of England is committed to enabling surgeons to achieve and maintain the highest standards of surgical practice and patient care. Registered charity number: 212808.

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