Pre-operative checklist to improve pathway for carotid endarterectomy (CEA) patients: A single centre audit

ABSTRACT

Introduction: The SARS-COV-2 pandemic has led to The redistribution of NHS services. In our sector, CEA surgery moved to an NHS hospital where it had not previously been undertaken. To ensure safety a new standard operating procedure (SOp) was proposed. An audit was undertaken to evaluate The SOp, construct a pre-operative checklist, subsequently measure its effectiveness and identify improvements. Method(s) To ascertain key pre-operative steps to include in The checklist a questionnaire was completed by 9 SpR/Consultants. The form consisted of a ranking score from 0 (never done) to 10 (always done). Once The checklist was established The questionnaire was re-sent additionally asking for feedback On its impact On The service and suggestions for improvement. Using these results, The checklist was incorporated as a smart text to EpIC (electronic patient notes). Result(s) The following key steps were identified MDT decision, vascular review, imaging, anaesthetic review, relevant results (bloods, COVID swab and echo), theatre/bed booking, on-admission steps and post-op care. All 9 doctors felt The checklist improved The service in all domains, except bed availability and subsequent surgical delay, likely because this depended On HDU bed availability and need for on-the-day prioritisation. Conclusion(s) The CEA surgery checklist is now an established part of The electronic patient record in The form of a simplified flowsheet with tick-boxes and space to insert results. This has ensured a standardised contemporary record of each patient's progress. All members of The team including new/temporary staff can follow this, ensuring a safe care pathway. Take-home message With The move of CEA surgery to an alternative London site it is important to establish a safe standard operating procedure. This has been facilitated by The use of a new pre-operative checklist ensuring a standardised contemporary record of each patient's progress.