The BMJ Awards 2020: Stroke and cardiovascular team of the year

Venous leg ulcer project

A team at the vascular surgery department at Guy’s and St Thomas’ Hospital, London, noted that patients with chronic venous leg ulcers were being treated without any coordinated care plan.

“We identified that a lot of patients in the community had significant debilitating leg ulcers that weren’t getting better and there was no proper investigation of their underlying disease,” says Oscar Johnson, vascular research fellow. Data showed that at 12 months venous leg ulcers were healed in only 21% of patients.

A coordinated streamlined care pathway for patients with leg ulcers was developed—the first in the UK. General practices, ulcer clinics, and tissue viability clinics could refer patients directly on to the pathway. Once referred, the patients were assessed in a clinical nurse led clinic, appropriate investigations were arranged, and a management plan for treatment of any underlying disease was formulated.

An audit of 110 patients who went through the pathway in the first year showed that 80% of venous leg ulcers were healed at 12 months, with 11% partially healing, and only 9% not healed. “The impact on patients’ quality of life has been huge,” says Johnson.

A five year economic outlook for the 700 patients in the boroughs of Lambeth and Southwark showed the pathway would save £15.5m (€17.8m; $19.8m) compared with current best care. Following its success, a similar pathway is now being rolled out in Cambridge and Oxford.

A disruptive collaboration

An audit of the acute medical unit at West Middlesex Hospital revealed that 40% of patients admitted with chest pain had stable angina. Many of these patients were referred, unnecessarily, to cardiology or were …