Improving Clinic Letters in Vascular Surgery

Hypothesis

Clinic letters are:

  1. Not completely compliant with NICE guidance
  2. Don’t explain things in language patients understand
  3. Dictated and therefore; expensive, time-consuming to produce, and contain mistakes

Initial audit of vascular clinic letters compared to NICE guidance CG147 for peripheral arterial disease (T Gatenby, S Grant 2015):

  • 100% compliance with a history being taken, pulses examined and ABPI performed.
  • Only 20% of obese patients were advised to lose weight, 38% of smokers got a cessation clinic referral, and only 4% got an information leaflet

Currently vascular clinic dictations are sent to the Philippines for typing, at an average cost of £4 per letter, with an average of one notable mistake per two letters!

Solution

  1. Easy to use NICE guidance compliant spreadsheet for use by clinician in clinic
  2. Simple, & cost free, mail merge function for secretaries to create personalised patient letter
  3. Succinct patient information leaflet to give to patients (not shown: a4, easy to understand, initial print run of 500 done)

Step 1

The clinician fills in the 28 click-box spreadsheet, with headings for each point of the NICE CG147 guidance, clicking options from a dropdown menu for each, with 3 opportunities for free-text.

Step 2

Secretaries use the one-click Microsoft® ‘mailmerge’ to merge the spreadsheet collected clinic details for the patient, with a template word document (first sample below), which creates the clinic letter (second sample below, full letter far right).

Template Word Document

Clinic Letter