Venous Leg Ulcer Referral Waiting Times – a Clinical Quality Improvement Project

Objective
Venous leg ulceration (VLU) represents a significant burden on healthcare systems, affecting up to 1% of the Western population and 4% of the elderly. It causes significant impairment to patients’ physical health and psychological function, resulting in deteriorating quality of life. Previous studies have shown that delays to care results in further deterioration and worsens healing rates. There is evidence that VLU care has been affected by the COVID-19 pandemic, and this quality improvement project aimed to determine if waiting times following referral to a tertiary vascular centre for further investigation and management has been negatively impacted and identify methods to improve any identified delays.

Methods
Referral data from a tertiary vascular centre in London for a three month period (January to March 2022) was obtained. This data was screened to identify all referrals that were related to VLU. The date of referral and the dates for the first clinic or scan appointment were retrospectively collected from electronic health records. This data was analysed to determine the waiting times between referral and vascular outpatient review.

Results
From the 1,859 screen referrals, 70 VLU patients were identified (3.5% of all referrals). 68.5% of all referrals came from the community (e.g. general practice, tissue viability services) and the remaining 31.5% were internal referrals (e.g. emergency department, consultant to consultant). Three patients were excluded for either a missing referral or outpatient appointment date and two were duplicates. All remaining 65 patients were offered an appointment date. The mean time from referral to first scheduled appointment (either clinic or Duplex scan) was 80.2 ± 94.4 days (range 0 to 397). 20.0% (n=13) of patients had a >6-month waiting time before their first outpatient appointment. Shorter waiting times were seen for internal referrals when compared to those from the community.

Conclusions
This quality improvement project has retrospectively identified long waiting times between referral and outpatient vascular review in a tertiary vascular centre over a three month period from January to March 2022. This currently fails to meet national guidance of review within two weeks of referral. Strategies are currently being implemented, including the improvement of triaging staff awareness of the urgency for leg ulcer reviews, and the development of a dedicated leg ulcer clinic pathway for patients to increase capacity for more acute reviews. These strategies are aimed at improving the leg ulcer service and reduces these waiting times. This audit cycle loop will be closed after the measures above have been implemented, aiming to determine their impact on improving leg ulcer referral waiting times, and potentially further optimise these strategies.