Providing an acute vascular service: two years experience in a district general hospital

Provision of acute vascular services is a topical subject for debate, but little has been documented on the total numbers of patients referred urgently to vascular surgeons. With the appointment in Exeter of a second consultant surgeon with a vascular interest, a thorough prospective audit was started of all vascular referrals seen outside the normal outpatient booking system. Between 1 February 1993 and 31 January 1995 a total of 877 such referrals were seen (446 in 1993-94 and 431 in 1994-95). The majority were inpatient referrals (38 percent) and patients seen urgently on the vascular surgical ward at the request of general practitioners (37 percent). The commonest presenting problems were limb ischaemia (42 percent), aortic aneurysms (11 percent) and diabetic foot complications (9 percent). The majority of patients were managed non-operatively. The commonest surgical procedure was amputation (in 8 percent), while 6 percent had grafts for aortic aneurysm, 4 percent grafts for ischaemia, 3 percent embolectomy, and 2 percent graft thrombectomy or revision. The two vascular surgeons were involved in out-of-hours operating substantially more than all but one of their general surgical colleagues, despite their reduced commitment to general surgical 'takes'. These figures document the substantial numbers of urgent referrals seen by vascular surgeons, many of which might well remain unrecorded in workload figures, because of the circumstances in which they are seen. We present the details of our arrangements for urgent vascular cover, and discuss the possible alternatives.