National carotid interventions audit

Following some exploratory work based at St George's, University of London, the project is now housed within the Clinical Effectiveness and Evaluation Unit of the Royal College of Physicians of London, in collaboration with the Vascular Society of Great Britain & Ireland (VSGBI) and the original team at St George's.

A password-protected web-based tool is used to continuously collect data on carotid interventions performed between December 2005 and September 2009. To protect the identity of the patients, surgeons and contributing hospitals, anonymous codes are used. Appropriate linkages with relevant databases, such as Hospital Episodes Statistics will be possible to inform variations between self-reported data and centrally collected data. This project is particularly exciting because of the integration of the project with the Vascular Society's National Vascular Database, which is ongoing.

Initially the project focused on patients who are undergoing Carotid endarterectomy (CEA). However plans are being considered to expand the dataset to include patients who undergo carotid angioplasty/stenting. Both endarterectomy and angioplasty/stenting are valuable in the prevention of stroke in appropriate patients and in some cases will have one of the two procedures as an alternative to the other one. All hospitals in the UK that offer both or either of these procedures are eligible to participate in the audit. Data for more than 5500 carotid endarterectomy cases were submitted for the first round, published in September 2008 and more are being submitted for the current. Recent work in academic literature has demonstrated that speed is of the essence when performing carotid endarterectomy after a cerebrovasular event to reduce the chance of further events.

Aims of the audit

• Demonstrate variation in provision of carotid interventions
• Demonstrate variation in timeliness with which investigation and treatment is carried out
• Assess outcome of carotid interventions (death and gross disability at routine follow-up)
• Drive improvement where variation is demonstrated
• Encourage ongoing participation in comparative audit of vascular surgery by engaging the professional involved

The audit provides reports for contributing consultants, trusts and SHAs. The reports are bench-marked against national results enabling comparison of routine practice with regard to carotid interventions with prioritised findings and recommendations for improvement. Comparisons are also made against relevant Hospital Episodes Statistics data (e.g. admissions). There is potential to compare against relevant registries in the future to further inform current practice and the developments therein.

The audit hopes to provoke action to ensure that timely and appropriate carotid intervention is provided to all suitable patients, resulting in reduced rates of death and disability from stroke.

Project management

The audit is led by a multidisciplinary Steering Group on which professional organisations and patients are represented: The Vascular Society, Royal College of Physicians/ Stroke Intercollegiate Working Party, British Association of Stroke Physicians/British Geriatrics Society, Association of British Neurologists (ABN), The Society for Vascular Technology, Healthcare Quality Improvement Partnership (HQIP) Patient representatives, Society of Vascular Nurses, Royal College of General Practitioners, Royal College of Anaesthetists/Association of Anaesthetists of Great Britain and Ireland, British Society of Interventional Radiologists. They were involved in the design of the audit, including wording of the questions. Day to day running (data collection, collation and analysis) takes place within the CEEu of the Royal College of Physicians.

Participation (Round 1)

England: Trusts (77%), Surgeons (62%), Cases submitted, compared to HES data for the same period (67%)
Wales: Trusts (44%), Surgeons (47%), Cases submitted, compared to HES data for the same period (44%)

The Royal College of Physicians