333 Inequity of Access to Investigations and Treatment of Varicose Veins by Clinician Grade: A Single Centre Retrospective Audit

Abstract

Abstract Aim Following COVID-19, restrictions on investigations and theatre capacity led to a change in the Norfolk & Waveney Clinical Commissioning Group (CCG) referral to treatment (RTT) criteria for varicose veins (VV); Only >C4 disease should be treated. An audit was performed to check for variability in outcomes between grade of surgeon. Method Retrospective audit of all VV referrals between 01/04/21-28/02/22. Case notes were reviewed assessing compliance with CCG criteria by surgeon grade and subsequent referrals for investigations and treatment. Results 250 VV referrals were made, 43.5% Male, mean (±SD) age 54.8 (16.9) years. 71 were rejected outright, 158 should have been rejected and 70 were subsequently reviewed in clinic. 20 were seen by SpRs and 50 by consultants. 62.9% (22) of ineligible patients attending clinic went on to have investigations. Of those seen in clinic, 35 did not meet the RTT criteria and should have been discharged. Significant differences in discharges were seen between SpRs & Consultants (13.3% vs. 45% respectively (p = 0.046)). Duplex scans organised by SpRs (75%) were more likely to not meet the RTT criteria than Consultants (30.3%), p = 0.003. However, once a scan was performed there were no significant differences in proportion of these patients listed for treatment (64.3% vs. 29.4% (p = 0.247)). Conclusions SpRs are less likely to discharge patients from clinic who don’t meet RTT criteria than consultants and are more likely to request unnecessary investigations and treatment compared to consultants demonstrating inequity of care. SpRs should be educated on RTT criteria changes when working in different hospitals.