Quality standard
Quality statement 1: Referral to a vascular service
Quality statement 1: Referral to a vascular service
Quality statement
People with varicose veins that are causing symptoms or complications (including ulceration) are referred to a vascular service.
Rationale
If left untreated, varicose veins will continue to cause symptoms that affect quality of life, and may progress to bleeding, skin damage and ulceration. Referral to a vascular service is a first step to interventional treatment for varicose veins that can relieve symptoms, and slow disease progression and improve people's quality of life.
Quality measures
The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.
Structure
Evidence of local arrangements and written referral criteria to ensure that people with varicose veins that are causing symptoms or complications (including ulceration) are referred to a vascular service.
Data source: Local data collection.
Process
Proportion of people with varicose veins that are causing symptoms or complications (including ulceration) who are referred to a vascular service.
Numerator – the number in the denominator who are referred to a vascular service.
Denominator – the number of people who present with varicose veins that are causing symptoms or complications (including ulceration).
Data source: Local data collection.
What the quality statement means for different audiences
Service providers (such as GPs and vascular services) ensure that local referral pathways into vascular services are consistent with the evidence-based referral criteria in NICE's guideline on varicose veins, which include varicose veins that are causing symptoms or complications (including ulceration).
Healthcare professionals (such as GPs) follow local referral pathways into vascular services to ensure that people with varicose veins that are causing symptoms or complications (including ulceration) are referred to a vascular service.
Commissioners monitor activity across local referral pathways to ensure that the evidence-based referral criteria in NICE's guideline on varicose veins are being followed.
People with varicose veins that are causing symptoms (for example pain, aching, discomfort, swelling, heaviness and itching) or problems such as bleeding, eczema or leg ulcers are referred to a specialist vascular service (a team of healthcare professionals who have training and experience in diagnosing and treating varicose veins).
Source guidance
Varicose veins: diagnosis and management. NICE guideline CG168 (2013), recommendation 1.2.2 (key priority for implementation)
Definitions of terms used in this quality statement
Symptoms of varicose veins
Symptoms of varicose veins include troublesome lower limb symptoms (typically pain, aching, discomfort, swelling, heaviness and itching). The symptoms may be associated with primary or recurrent varicose veins. [Adapted from NICE's guideline on varicose veins, recommendation 1.2.2]
Complications of varicose veins
Complications of varicose veins are:
-
lower-limb skin changes, such as pigmentation or eczema, thought to be caused by chronic venous insufficiency
-
bleeding varicose veins
-
superficial vein thrombosis (characterised by the appearance of hard, painful veins) and suspected venous incompetence
-
a venous leg ulcer (a break in the skin below the knee that has not healed within 2 weeks) or a healed venous leg ulcer.
[Adapted from NICE's guideline on varicose veins, recommendation 1.2.2]
Vascular service
A vascular service is a team of healthcare professionals who have the skills to undertake a full clinical and duplex ultrasound assessment and provide a full range of treatment. [NICE's guideline on varicose veins, recommendation 1.2.1]