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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_3834_Библиотеки_им_академика_М_И_Перельмана
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21 One-Stop Vein Clinic: TheIdeal Option
https://t.me/med1917
231
2. Patients with complex medical conditions
requiring simple treatment
3. Patients with no, simple or complex medical
conditions requiring complex treatment
Varicose vein treatment is dependent on rst
determining whether they are of primary, secondary (e.g. following deep vein thrombosis) or
recurrent origin. Secondary and recurrent varicose veins often have a complicated pattern and
are notoriously more difcult to treat. On the
other hand, primary varicose veins are considered generally relatively less complex and easier
to manage. Hence, the latter often only require
simple interventions which are increasingly
being carried out as day cases using local anaesthesia. Utilisation of local anaesthetic provides
the advantage of allowing patients with complex
medical problems to be treated.
21.5.2 Streamlining Outpatients,
Diagnostics andTreatment
Another step is to ensure that there is enough
capacity for patients to be seen in the outpatient clinic, receive a varicose vein scan and be
treated. Good communication links between
all these departments is also essential to allow
a smooth and timely transfer of patients from
one department to another and avoiding
delays.
Patients found to be eligible candidates for
single-day treatment on their scans could receive
further counselling regarding the proposed intervention and will be consented for the procedure.
21.5.3 Improving Theatre Eciency
A ‘one-stop’ pathway is very reliant upon ensuring there are enough spare theatre slots to accommodate patients as well as quick patient turn
around. Patients could be added to an elective list
or to lists dedicated to those attending the ‘onestop’ clinic.
Elective lists do allow for the latter patients to
have their intended procedures and avoids the
loss of theatre space as elective patients are
already being operated on. However, depending
on the number of patients attending the ‘onestop’ clinic, there is a possibility that theatres
might overrun or even that patients may get cancelled. A quick turnaround, which might help
avoid this problem, could be facilitated by having staff familiar with the procedure scrub for
the varicose vein interventions.
Dedicated lists also pose a different type of
problem with possible under usage of theatres,
especially, if none or only a few of the ‘one-stop’
patients are suitable for same-day treatment.
21.5.4 Patient Recovery
Varicose vein interventions are increasingly being
carried out under local anaesthesia, simplifying
the recovery procedure. After spending an appropriate amount of complication-free time in the
recovery area, patients could be discharged with
instructions about what to expect over the following days and to return to activities as soon as they
felt able to.
21.5.5 Follow-Up
Routine follow-up, especially after an uncomplicated varicose vein procedure, is probably
unnecessary. Most complications, if they occur,
tend to happen within the rst 2 weeks of
treatment [20–22]. Around the time of their procedures, the complication rate is 5.1%, but this
increases to nearly 70% by 6weeks [23]. Most
of those complications, however, tend to be
minor, and it would be difcult to justify the
associated extra costs of such outpatient appointments. It has been argued that routinely following up patients after uncomplicated interventions
is neither necessary nor cost-effective and that
easier access to outpatient clinics might be more
appropriate for those developing complications
[24]. Provision of information leaets detailing
likely complications and time to improvement
could potentially avoid unnecessary follow-up
[24].
232
https://t.me/med1917
R. Bootun et al.
21.6 Benets andDrawbacks
ofaOne-Stop Vein Clinic
There are several potential advantages of organising a one-stop vein clinic. Along with the possibility of eliminating waiting times, it enables
abolishment of unnecessary outpatient appointments. Provision of same-day assessment and
treatment may lead to improved patient satisfaction and an earlier improvement in patient quality
of life. Another likely advantage is potential cost
savings made by avoiding the unnecessary
appointments.
However, a number of possible problems are
also evident. Patients invited to such a clinic may
not necessarily have varicose veins as the main
cause of their symptoms, or they may have more
complicated varicose veins disease than expected.
The lack of a ‘cooling off’ period to consider the
options available could be an issue, even though
this can be dealt with by providing patients with
information material prior to their appointments.
Another potential pitfall could be the inefcient
use of theatre facilities which could invalidate
any benets accrued from such a one-stop clinic.
Conclusion
Strategies to improve the efciency in the
health service are always welcome. A one-
stop approach to diagnosing and treating sim-
ple conditions is very attractive to all
concerned, and managing varicose veins in
this manner appears to be an ideal solution.
Both potential advantages and drawbacks
exist, and, hopefully, studies looking at the
feasibility and cost implications of this con-
cept being applied to varicose vein disease
would be able to elucidate the merits of such
an undertaking.
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