331 Improving Equity of Access in a Post-Covid World: A Closed Loop Audit of the Varicose Vein (VV) Referral to Treatment (RTT) Pathway

Aim

Restrictions in clinic, investigations and theatre capacity following COVID-19 led to a change in local CCG VV referral criteria meaning those with advanced venous disease were seen. However, it was noted that many patients attending clinic didn’t meet these new CCG criteria.

Method

Following a change in CCG criteria in April 2021, all VV referrals to vascular surgery between 01/04/21-28/02/22 (AC1) were audited and differences between the consultants’ acceptance practice was reviewed. Results were presented at clinical governance in 09/03/22, with change implemented and referrals between 01/04/22-31/07/22 (AC2) re-audited.

Results

250 VV referrals were made in AC1, 43.5% Male, mean (±SD) age 54.8 (16.9) years, by GPs (82.8%), other HCP (11.6%). 158 (63.2%) failed the criteria and should have been rejected. However, the actual rejection rate was 44.9%, with significant differences (P<0.001) in consultant practice demonstrating inequity for patients’ acceptance to be seen in clinic. 62.9% of ineligible patients attending clinic had subsequent investigations, increasing the waiting list time for all patients.

153 VV referrals were made in AC2, 43.1% Male, mean (±SD) age 55.3 (17.7) years, by GPs (86.3%), other HCPs (12.4%). 96 (63.7%) failed the criteria. However, in AC2 there was a 15.5% improvement (p = 0.02) in consultants appropriately rejecting outright and no significant differences in consultant practice (P = 0.46).

Conclusions

There is now less variation between consultants and a greater adherence to CCG criteria in AC2 demonstrating improved equity of access. There are fewer inappropriate clinic attendances, therefore less investigations and treatment booked, decreasing overall wait time and unnecessary downstream costs.