Vascular Network Transfer Audit: Evaluation of Transfer Time to Theatre for Diabetic Patients Requiring Emergency Vascular Surgery in Hub-Arterial Site

Abstract

Introduction: Since the establishment of vascular network across our region under hub-and-spoke model, the arterial centre involved in this study receives referrals for diabetic foot problems requiring surgical input. With active diabetic foot problems, there is often the need for urgent assessment, investigation and intervention. The reduced vascular contribution from non-arterial centres have raised concerns in providing a service that minimises delays and prioritises patients according to clinical need, not geographical location We aimed to study the efficiency of the regional network by analysing transfer time to theatre for patients with diabetic foot problem. Methods: All patients who had lower limb amputation +/- debridement from October 2017 to October 2018 were identified from the local theatre database. Whether admitted directly to local hub or referred from the spoke sites, each patient was tracked to its original point of referral, time and date of referral was established. Knife to skin time was identified for each patient, and subsequently transfer time to theatre (TTT) - from referral to knife to skin time - was calculated for all patients. Non-diabetic and non-emergency cases were identified and excluded based on clinical records, urgency of transfer to theatre from admission, CEPOD category and inflammatory markers on admission. Transfer Time to Theatre (TTT) was calculated for 3 groups of patients; those admitted directly to the Hub site, and two other groups from Spoke sites. Results: Total of 109 diabetic patients with average age of 62 were identified who had emergency lower limb amputation +/- debridement over the course of 12 months. The average TTT was calculated for each group, TTT for Hub was 23hrs42min, for 'spoke-1' and 'spoke-2' was 39hrs30min and 32hrs42min respectively. Analysis of data sets indicated statistically significant (P< 0.05) difference in TTT for those who were admitted directly to the hub, compared to the ones referred and admitted from the spoke sites. Conclusion: The data above highlighted significant inequalities and delays across the network. Given the high morbidity and mortality of diabetic patients, we are using our findings to devise and implement guidelines to improve transfer links to arterial sites. Diabetic patients requiring emergency surgical input have high morbidity and mortality, hence it is essential to minimise delay in transfer, improve communication across sites and improve transport links. Our data highlighted significant inequalities and delays across the network. Providing that the national service specification has already defined that vascular surgery should be delivered via a hub-and spoke network model, it is essential to ensure services are running smoothly and to devise guidelines and protocols to ensure smooth transfer to arterial sites. The findings of this project led to the design and implementation of regional guidelines and initiation of prospective study which is being carried out at the moment, for identifications of pitfalls that caused the delays across the network. Disclosure: None of the authors has a financial interest or commercial association to declare in relation to the content of this project. All patient data was anonymised prior to data analysis.