Sussex Vascular Network

The Sussex Vascular Network will be working on an urgent / emergency only basis as outlined in the Vascular Society Document published 19^th March 2020.

https://www.vascularsociety.org.uk/_userfiles/pages/files/Newsletters/COVID%2019.pdf

All elective work, mainly Varicose Veins, portacaths etc, which are day cases are cancelled and will not be resumed until after the COVID crisis settles.

Most arterial work is urgent or emergency eg limb threatening.

AAA treatment below 7cm will be postponed and all symptomatic carotid patients unless crescendo TIA’s will be recommended for best medical therapy. Critical limb ischemia patients will be treated, but bypass surgery and IR to restore the circulation may not be possible at the height of the crisis, so primary amputation is more likely.

Diabetic foot infections will require debridement, after assessment by the vascular surgeon, and if appropriate will be done in the local hospital, however some will not be suitable for this, and they will require transfer to the arterial centre. Those having surgery in the local hospital will be looked after post op by the diabetic team with input from the vascular team, (Surgeons and VNS’s).

The degree to which vascular intervention is possible will depend on the COVID workload in each hospital but a scheme similar to the VASC-CON 5-1 progression adopted by some vascular centres in the USA is likely to be required with palliation only as VASC-CON 1. (see below)

Personnel: Inpatient

Consultants:

Con 1 )Consultant of the week (COW) – covering the vascular ward and all admissions 8am – 7pm Monday to Thursday

8am Friday to 8am Monday

Con 2) Overnight cover 7pm to 8am Monday to Thursday

Con 3) Theatre 6 cover 8am to 8pm

Professor Yusuf will provide IR/Surgical cover for ruptured AAA’s to have EVARs in line with the VS document

Registrars:

One registrar of the week providing ward cover 8-5

One theatre Registrar providing theatre cover 8-5

One on call registrar on call for a 8-8 24 hour period daily

SHO / CT:

One ward SHO

One morning or afternoon ward SHO (Which to be confirmed – vasc would prefer am)

One on call SHO

One SHO overnight

Vascular Nurse Specialists:

At present there are 9 across the network, they will be required to provide urgent vascular cover across the network, with a physical presence or by telephone to wards, medical staff and patients. There may need to be cross cover of Trusts due to sickness.

Outpatients:

Outpatient clinics will be held centrally and locally, a minimum of two clinics per Trust per week.

Consultant only Clinics – for urgent patients after triage completed locally. Patients who decline to attend will be telephoned and appropriate advice / action taken.

BSUH, sites where clinics can be held: RSCH, PRH, LVH, these  will be constantly reviewed with possible reductions as and when necessary

WSHT, clinics held at St Richards and Worthing

ESHT, clinics will be held in Conquest and Eastbourne

Triage will all be done locally

Routine appointments have already been cancelled and patients are being phoned.

Clinics will run as follows: 20 minute appointments then a 10 minute gap to reduce the risk of patients coming into contact with other patients. Patients will be asked to attend alone, if appropriate or with one relative. They will be asked to arrive no more than 5 minutes early for their appointment, many vascular patient fall into the high risk group. All patients will have their temperature taken on arrival and anyone with a temp above 37.8 will be discussed with the consultant for the clinic. They will either be sent home without review or sent to the appropriate area of A+E.

Ward:

Vascular Surgical Beds are all on Level 8 Tower at the RSCH, 37 beds managed by Christine Arthur. All vascular patients will accommodated on Level 8 Tower. This could include a maximum of 14 vascular COVID positive, non ventilated vascular patients, in rooms 2 and 3 and the side rooms

Vascular Assessment Unit:

Only urgent patients will be seen in the VAU: cover will be as follows:

RSCH, 9-5 Monday to Friday

Worthing Hospital 9-5 Monday to Friday

Eastbourne Hospital will be as required with patients being booked via a referral to a central number.

Patients will have their temperature taken on arrival and anyone with a temperature above 37.8 will not be scanned.

Non arterial centre work:

This will be urgent outpatient clinics and urgent ward referrals and if appropriate foot debridements and toe amputations locally  to minimise patients transferring to the arterial centre. Patients not appropriate for treatment in the Spokes will be transferred to the hub at RSCH as before.

Sickness:

This will be in line with trust policy via the online form to HR and Clare Ashenden.

Consultant sickness cover will be by the buddy system currently in place if possible or by agreement and swapping of duties by those well or recovered

VNS’s may be needed to cover other sites, either physically  or remotely. The VNS’s may be required to support Level 8 tower. This could include non arterial centre VNS’s

Staff who are not required clinically will be encouraged to follow the current government guidelines and remain at home, being ready to be called in if required to cover sickness or prepare for their on call duties.

Mike Brooks

Sussex Vascular Network Lead

USA vascular service escalating response to Covid19.  We are currently between stages 4 and 3

25.03.20

The service model is defined through the national service specification and the clinical model of care for Sussex is to be as described in the map below.

The Network has agreed a number of clinical pathways which lay out the pathway of care a patient should expect to follow. These pathways are based on national best practice and local service provision and will be under regular review through the Network.

• Ruptured AAA
• Portacath vascular access
• Renal vascular access
• Elective amputation
• Acute major amputation
• Carotid
• Chronic leg ischaemia
• Diabetic foot
• Active diabetic foot – hospital
• Active diabetic foot – primary care
• Elective AAA
• AAA screening
• Acute limb ischaemia

The purpose of the network clinical governance log is to maintain oversight of any network incidents, identify where patterns may be occurring and where improvements in the network pathways are required. The intention is not to replace already existing governance systems within trusts, but to assist in understanding and addressing network specific issues.

Please complete the proforma below to raise an incident on the log.

Submissions go to the Network Manager John-Paul.Crofton-Biwer@bsuh.nhs.uk