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    Critical limb ischaemia in the time of COVID-19: establishing ambulatory service provision

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    URI
    https://rde.dspace-express.com/handle/11287/622335
    Author
    Chana, M.
    Muse, S.
    Ball, S.
    Bennett, R.
    McCarthy, R.
    Date
    2021-12-23
    Journal
    Annals of the Royal College of Surgeons of England
    Type
    Journal Article
    Publisher
    Royal College of Surgeons
    DOI
    10.1308/rcsann.2021.0294
    Rights
    © 2021 The Royal College of Surgeons of England
    Metadata
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    Abstract
    INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic enforced changes to healthcare services at a pace and extent not seen previously in the NHS. The Royal Devon and Exeter provides regional vascular surgery services. A consultant-led urgent 'hot clinic' was established, providing patients with ambulatory care. We aim to describe the service for critical limb ischaemia (CLI) before and during the COVID-19 pandemic, and evaluate this against recommended best practice. METHODS: Retrospective review of electronic databases and records of patients with CLI during a non-COVID vs COVID-19 period. Primary outcome measures were those established by guidance from the Vascular Society of Great Britain and Ireland. RESULTS: Non-COVID vs COVID-19: total patients n=97 vs 96, of which CLI patients n=29 vs 21. Median length of stay 15 vs 0 days (p<0.001); median time from referral to specialist review 0 vs 3 days (p<0.001); multidisciplinary team meeting (MDT) recorded 3% vs 29%; median time to intervention 6 vs 8 days; conservative management 52% vs 67%; endovascular 28% vs 10%; open surgery 21% vs 24%; 30-day survival 79% vs 76%. CONCLUSION: COVID-19 imposed a major change to the service for patients with CLI with a focus on ambulatory care pathways for diagnosis and intervention. We observe a significant reduction in overall length of stay with no clinically significant change in time to consultant review, time to imaging, overall management strategy or outcomes. The results of this study show that patients with CLI can be managed safely and effectively on an ambulatory basis in accordance with established best practice.
    Citation
    Ann R Coll Surg Engl. 2021 Dec 23. doi: 10.1308/rcsann.2021.0294.
    Publisher URL
    https://publishing.rcseng.ac.uk/doi/10.1308/rcsann.2021.0294?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed
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    The article is available via Open Access. Click on the 'Additional link' above to access the full-text.
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