Community triage for lower limb vascular concerns: reducing the burden on hospitals

Source:
NICE Quality and Productivity Case Studies
Publisher:
Salford Royal NHS Foundation Trust
Publication date:
25 October 2016

Abstract

The Salford lower limb vascular assessment and triage service provides assessments, diagnosis and clinical management plans for patients with suspected non-acute peripheral arterial disease. Clinics are run 5 days a week with weekly evening clinics and monthly Saturday slots. Referrals are made by GPs using an e-referral system, and may also come from general podiatry, diabetes specialist nurses, district nurses, physiotherapy and the tissue viability service.

The service operates out of 3 gateway community centres, providing care closer to home. This is an improvement because previously patients were referred to the hospital vascular surgery team, but 80% did not need surgery and were subsequently referred to community exercise schemes. GPs now refer patients with symptoms of severe limb ischaemia straight to hospital, rather than to the community triage service. Those patients are seen quicker because the hospital appointments are freed up for serious cases.

The service is podiatry-led, working with patients to address their individual cardiovascular and limb risks and develops and agrees individual treatment plans. These may include referral to a community exercise and support scheme run by the local cardiac rehabilitation team, or the vascular surgery team at Central Manchester Foundation Trust hospital if appropriate.