An audit of Global Vascular Guidelines implementation at two large teaching hospitals in differing healthcare settings

Objective: The Global Vascular Guidelines on the Management of Chronic Limb-Threatening Ischemia provide a framework for assessment and management of patients with chronic limb-threatening ischaemia (CLTI). This audit describes compliance with Global Vascular Guidelines (GVG) standards across two teaching hospitals in different healthcare settings. Design: This is a prospective, cross-sectional, clinical audit conducted over a 1-month period. Methods: All new CLTI patients admitted or seen in the outpatient podiatry clinic at Guy’s and St Thomas’ Hospital (GSTT) and the National Hospital of Sri Lanka (NHSL) between 1 May 2024 and 31 May 2024 were included. Data were collected regarding clinical assessment, scoring system and imaging utilisation according to recommendations set out in the GVG. Statistical significance was analysed with Fisher’s exact test using SPSS. Results: 65 inpatients were included (GSTT: 38; NHSL: 27) and 49 outpatients (GSTT: 21; NHSL: 28). Among the inpatients, GVG-compliant medical history was recorded in 57 (88%) cases (GSTT: 32 (84%); NHSL: 25 (93%), p=0.311). GVG-compliant foot examination was completed in 10 (15%) patients (GSTT: 10 (26%); NHSL: 0 (0%), p=0.004). Use of non-invasive imaging was consistent between groups. Among the outpatients, GVG-compliant foot examinations were performed in all 21 outpatients at GSTT (100%) but in none of the 28 outpatients at NHSL (0%, p<0.001). Limb severity scoring systems were used for all outpatients seen at GSTT (21/21, 100%), whereas only 5 of 28 outpatients at NHSL (18%) had scoring systems documented (p<0.001). Non-invasive imaging utilisation was comparable between the two institutions for outpatients. Conclusions: Implementation of the GVG is challenging, with even large teaching hospital centres failing to meet all the recommendations for assessment of patients with CLTI. Commonly missing parameters relate to examination and scoring systems. Further work is needed to understand the barriers to implementation and address these. This was a single cycle audit and further work has not been conducted to recycle this audit.