An Audit Of Global Vascular Guidelines Implementation At Two Large Teaching Hospitals In Differing Healthcare Settings

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Introduction: The Global Vascular Guidelines (GVG) provide a framework for assessment and management of patients with Chronic Limb Threatening Ischaemia (CLTI) as laid out by Conte et al. (2019). This audit describes compliance with GVG standards across two teaching hospitals in different healthcare settings: UK (Higher Income Country) and Sri Lanka (Lower-Middle Income Country). Aim: Our aim was to identify key similarities, differences, and barriers to implementation of these guidelines. Methods: All new CLTI patients admitted or seen in outpatient podiatry clinic at Guy’s and St Thomas’ Hospital (GSTT) and National Hospital of Sri Lanka (NHSL) between 1/5/2024-31/5/2024 were included. Data were collected according to recommendations set out in the GVG. Statistical significance was analysed with Fisher’s Exact Test. Results: Sixty-five patients were included (GSTT: 38; NHSL: 27) and forty-nine outpatients (GSTT: 21; NHSL: 28). Among the Inpatients, GVG-compliant foot examination was poorly performed, (GSTT: 10 (26%); NHSL: 0 (0%), p = .004). Among the Outpatients, GVG-compliant foot examinations were performed in all 21 outpatients at GSTT but in none of the 28 outpatients at NHSL (0%, p < .001). Limb severity scoring systems were utilised for all outpatients seen at GSTT, whereas only 5 of 28 outpatients at NHSL (18%) had scoring systems documented (p < .001). Conclusion: Implementation of the GVG is challenging, with even large teaching hospital centres failing to meet all the recommendations for assessment of patients with CLTI. Further work is needed to understand the barriers to implementation and address these.

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