Authors (including presenting author) :
WONG ST, LAI WS, TSANG YY, CHIU TF
Affiliation :
Vascular nurse clinic, Department of Surgery, Princess Margaret Hospital
Introduction :
Peripheral vascular disease (PVD) is recognized as a prevalent problem among elderly in Hong Kong. In 2021-2022, there are 192 new cases referred to Princess Margaret Hospital for PVD management. With the growing service demand, the average waiting time for non-urgent cases is 386 days. Delaying PVD diagnosis and management until its complications become greatly impacts patient's clinical outcomes including ulcer formation and limb loss.
Traditional nurse clinic provides patient education and basic non-invasive examinations- Ankle-brachial index (ABI) measurement. However, ABI only provides moderate predicted value in the diagnosis of PVD without providing detailed and precise vascular conditions. ABI measurement may also give a false negative result in patients with non-compressible arteries. As a result, some patients may require few more follow ups to arrange other diagnostic tests and review results.
Duplex examination is considered a non-invasive and reliable diagnostic tool for PVD, informing revascularization decisions and localizing sites of arterial occlusion. Nurses with training in ultrasonography can help in performing arterial duplex examinations for PVD patients.
In the vascular nurse clinic of Princess Margaret Hospital, trained vascular nurses provide concomitant ABI and duplex examination together with health education as a bundled service for all new cases of PVD prior to 1st doctor's consultation.
Objectives :
The objectives of the study are to evaluate the impact of integrating duplex examination in vascular nurse clinic bundled service for PVD patient on: 1) waiting time for first follow up , and 2) accuracy in making PVD diagnosis
Methodology :
A retrospective study was conducted for patients newly referred to vascular nurse clinic for PVD from 1/1/2022 to 31/12/2022. Case triage was done by surgeons, doctor clinic and nurse clinic follow-up were arranged subsequently. Nurse clinic visits were arranged pirior to 1st doctor consultations as bundled service. ABI examination, arterial duplex examination and health education were done in each nurse clinic consultation. The waiting time for 1st doctor and 1st nurse clinic visit were retrieved from OPAS for analysis. The results of ABI and arterial duplex examinations performed in vascular nurse clinic were compared with each other.
Result & Outcome :
A total number of 192 new PVD patients attended vascular nurse clinic from 1/1/2022 to 31/12/2022. All patients received bundled service in nurse clinic prior to 1st doctor consultation. With bundled service, the average waiting time for 1st follow up reduced from 386 days to 241 days (non-urgent case); from 53 days to 42 days (semi-urgent case); from 13 days to 10 days (urgent case).
100% of new PVD patients had completed ABI measurement and duplex examination, and the results were available prior to their 1st doctor clinic appointment. 3% of patients with normal ABI results were found significant arterial stenosis in duplex examination and diagnosed as PVD.
Adopting duplex ultrasound examinations in vascular nurse clinic provides more reliable and precise investigation results compared with traditional ABI measurement. It allows doctors to formulate treatment plan promptly during the first doctor clinic visit.
The vascular nurse clinic bundled service prior to doctor clinic visits shortens the waiting time for patients to receive care by healthcare providers, allowing early detection, intervention and education.
Therefore, the implementation of duplex examination as an integral part of the assessment in
vascular nurse in highly recommended.
