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

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.

Outcome

a) Progression of venous leg disease.

Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

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 clinical guideline 168, 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 (CCGs and NHS England) monitor activity across local referral pathways to ensure that the evidence-based referral criteria in NICE clinical guideline 168 are being followed.

What the quality statement means for patients and carers

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

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 clinical guideline 168, 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 clinical guideline 168, 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 clinical guideline 168, recommendation 1.2.1]