Joined-up North Wales vascular service cuts surgical waits

Improved teamwork and a North Wales-wide approach to scheduling surgery has seen significant improvements for patients with kidney failure.

Under the new service model for vascular patients, improved co-ordination between teams at North Wales’ three main hospitals has reduced the number of people waiting for arteriovenous fistula surgery.

By maximising resources and available theatre time, the number of patients waiting for surgery dropped from 116 to 41 between June 2019 and 2020.

The procedure joins a vein to an artery to create a fistula, which is the recommended way for dialysis patients to receive their medication.

Before the introduction of the new model of care for vascular services, surgical lists for patients needing arteriovenous fistula surgery were managed separately on each hospital site.

By combining resources across North Wales, patients are now accessing surgery faster thanks to shared resources.

Greater teamwork with colleagues in radiology and nephrology in the three main hospitals is also helping achieve greater outcomes for patients following surgery.

Mr Soroush Sohrabi, Clinical Director for Vascular Services, said: “By working as a team across North Wales, we’ve improved everyone’s access to the treatment they need.

“This achievement has been possible because of the coordinated efforts of our vascular surgeons, Vascular Access Specialist Nurses, theatre and nursing staff and our hard-working administrative staff.

“Really, we could have reduced the number of patients waiting even more had our work not been disrupted by COVID-19.

“We’re confident that going forward we can continue to improve care for patients across North Wales with the new service model.”

As well as improving the position on people waiting for surgery, the team have worked hard to continue to deliver services with as few interruptions as possible during the COVID-19 outbreak.

Vascular operating services continued at Glan Clwyd Hospital in one of five theatres which remained open, while day case arteriovenous fistula surgery continued at Ysbyty Gwynedd and Wrexham Maelor Hospital.

The work of Vascular Access Specialist Nurses at the three hospitals has also continued, supporting coordination of services across the three sites, assessing patients who require a simple fistula as well as providing follow-up care.

Jo Garzoni, Vascular Service Manager, said: “By optimising theatre capacity, we’ve been able to more efficiently manage our waiting list and ensure people get the treatments they need, quicker.

“People are now getting treatments when they need it, rather than being stuck on waiting lists which we had previously, due to not having dedicated theatre capacity to treat everyone who needs it.”

Mr Laszlo Papp, Consultant Vascular Surgeon and Lead for Vascular Access, said: “For patients, it’s much better to dialise from a fistula than a central line.

“Doing this presents a reduce risk of infection and follows guidelines set by the British Renal Society.

“This new way of providing access care and treatment as early as possible is improving the way patients are receiving dialysis across North Wales.”

Betsi Cadwaladr University Health Board has made a made a significant investment into securing the future of vascular services in North Wales.

Investment in staff has included the recruitment of eight vascular consultants, which has allowed a sustainable 24/7 on-call rota for patients in need of emergency care, which was not present under the previous service model.

A state-of-the-art £2.3 hybrid theatre to support complex vascular surgery for patients from across North Wales opened in 2019 at Glan Clwyd Hospital.