More Efforts Needed in the United Kingdom to Achieve Timely Surgery After TIA

Emma Hitt, PhD

August 05, 2010

August 5, 2010 — Patients in the United Kingdom are waiting longer than the recommended 14 days to receive vascular surgery after symptoms of stroke or transient ischemic attack (TIA), results of a new audit show, and renewed efforts are needed if the United Kingdom is to meet these standards, according to a related editorial in the July 31, 2010, of The Lancet.

The audit, published on July 22, 2010, found that only 3% of patients made the UK government's National Stroke Strategy guideline of 48 hours and approximately one-third of patients made the UK National Institute for Health and Clinical Excellence guideline of 14 days.

The findings are derived from the second round of the Audit of Vascular Surgical Services and Carotid Endarterectomy, commissioned by the Healthcare Quality Improvement Partnership and conducted by the Royal College of Physicians and the Vascular Society.

Currently, the average wait from symptom to surgery is 28 days and referral to surgery is 19 days," according to a written release from the Vascular Society of Great Britain and Ireland. "In practical terms, if patients undergo surgery within two weeks, experts predict that around 200 strokes could be prevented for every 1,000 operations," the release states.

According to the report, most delays relate to presentation and referral, with 18% of patients failing to present to a general physician or hospital and 40% not being referred on from primary care. In addition, 18% of patients missed the deadline because of the limited availability of staff or operating time and 9% because of a lack of imaging equipment.

"The persistence of delays in presentation and referral shows the continued importance of awareness campaigns," The Lancet editorial states. "Improved identification and urgent referral of patients at high risk will need to be coupled with further reorganization of services to ensure availability of specialist staff and facilities."

According to the editorial, a previous round of the audit, reported in 2008, showed that a third of people with symptoms of stroke or TIA were waiting longer than 12 weeks for surgery. These shortfalls were attributed to "poor public awareness of the symptoms and suboptimum organization of vascular services."

The current audit shows some improvement, with "reductions in delays at all stages of the process from presentation to surgery, but work remains to be done."

The study authors have disclosed no relevant financial relationships.

Lancet. 2010;376:304.

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