268 Improve Clerking of Vascular Patients at Royal Devon and Exeter (RDE) Hospital Presenting with Acute Limb Ischaemia (ALI) Using Standardized Electronic Proforma

Abstract

Improve clerking of vascular patients at Royal Devon and Exeter (RDE) hospital presenting with acute limb ischaemia (ALI) using standardized electronic proforma.Analysis of clerking notes of patients presenting to vascular surgery with ALI over a 3-month period (March 2021 - May 2021) for documentation of vascular risk factors, smoking status, claudication, rest pain, exam findings, sensation, movement, ECG, ABPI and burgers test.A standardized electronic clerking proforma has been created using the ‘smart-phrase’ function in the ‘hyperspace Epic’ computer system at the RDE hospital.A poster has been put up in the doctor’s office and email sent out to all surgical doctors to encourage use of the new electronic clerking proforma for comprehensive initial assessment which would help vascular surgeons make early decisions especially when off-site.A total of 65 patients presented to vascular surgery during the 3-month period. Of these 20 patients presented with ‘acute limb ischaemia’. Documentation of rest pain (75%), pulses (Dorsalis paedis in 90%) and exam finding of cold feet (95%) was adequate. However, poor documentation of vascular risk factors such as previous stroke (20%) and atrial fibrillation (15%) was identified. ECG was performed on admission in only 35% patients. Examination like ABPI (10%) and Buerger's test (15%) were also inadequately documented.This audit shows inadequate clerking of vascular patients presenting with ALI. The second cycle will include further data collection post-implementation of the electronic proforma to analyse improvements in documentation of the above-mentioned factors at initial clerking.