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Published on: May 15, 2020
Remodelling of vascular (surgical) services in the UK
J J Earnshaw1, D C Mitchell, M G Wyatt
1Department of Vascular Surgery, Gloucestershire Royal Hospital, Gloucester, UK. jjearnshaw@tiscali.co.uk
Insights
UK vascular services modernized by centralizing high-risk procedures in high-volume centers. This strategic change significantly reduced elective aortic aneurysm mortality rates, improving patient outcomes in vascular surgery.
Area of Science:
- Vascular Surgery
- Healthcare Management
- Public Health
Background:
- An aging UK population and increased patient expectations challenged existing vascular service delivery.
- Poor outcomes for low-volume, high-risk vascular interventions, like abdominal aortic aneurysm repair, were noted in the UK compared to Europe.
- National screening programs and the formalization of vascular surgery as a specialty presented new challenges.
Purpose of the Study:
- To detail the modernization of UK vascular services.
- To outline the implementation of a quality framework to drive structural changes.
- To assess the impact of centralizing vascular interventions in higher-volume centers.
Main Methods:
- Development of a quality framework agreed upon by vascular specialists.
- Structural reorganization to consolidate vascular interventions into fewer, higher-volume centers.
- Establishment of modern networks to support surrounding hospitals without on-site vascular inpatient services.
Main Results:
- Elective aortic aneurysm mortality rates have fallen nationally from 7.5% to 2.4%.
- Service remodeling has shown positive initial effects on patient outcomes.
- Centralization of services has led to improved efficiency and potentially better surgical results.
Conclusions:
- The modernization of UK vascular services through centralization and network development has yielded significant improvements.
- The quality framework effectively drove structural changes, leading to better outcomes for high-risk vascular interventions.
- Continued focus on high-volume centers and integrated network support is crucial for sustained enhancement of vascular care.
Abstract:
The last few years have seen major changes in the delivery of vascular services in the UK. An increasingly elderly population with greater expectations from their medical services has challenged established methods. It also became apparent that outcomes for low volume, high risk index vascular interventions such as abdominal aortic aneurysm repair were poor in the UK compared to the rest of Europe. Other ongoing challenges were the introduction of a national aortic aneurysm screening programme and the development of vascular surgery as a separate speciality. This article details the approach taken to modernise vascular services in the UK, using a quality framework agreed by vascular specialists, which drove the structural change to move vascular interventions into fewer, higher volume centres. The introduction of modern networks is designed to maintain services in surrounding hospitals without on site vascular inpatient services. The initial effects of this service remodelling are positive, with elective aortic aneurysm mortality rates falling nationally from 7.5 to 2.4 per cent.
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