title: Patient flow to carotid endarterectomy: hastening the patient journey.
abstract: BACKGROUND
  Early carotid endarterectomy (CEA) after stroke or transient ischaemic attack is the proposed standard of care to prevent recurrent ischaemic events in selected patients. The aim of this study was to investigate if this standard is achieved in a tertiary vascular unit.
  
  
  METHODS
  This was a clinical audit. CEAs performed from 1 January 2006 to 31 December 2008 at Christchurch hospital were identified. The value stream from initial presentation to surgery was mapped in two phases (phase 1; 2006-2007 and phase 2; 2008). Patients who had carotid intervention for asymptomatic carotid lesions were excluded.
  
  
  RESULTS
  The relevant patient journey was documented in 81 patients (55 phase 1; 26 phase 2). Median time from initial presentation to carotid ultrasound was 5 days in phase 1 and 6 days in phase 2. Time from presentation to vascular surgery review was 22 days in phase 1 and 13 days in phase 2. Time from presentation to CEA significantly reduced from 83 to 32 days between phases (P < 0.005).
  
  
  CONCLUSIONS
  There has been a significant decrease in time from presentation to operation between phase 1 and 2. The most significant change is reduced delay between vascular surgery review and CEA. There has been no improvement in urgency of referral for imaging or surgical review. This part of the patient journey is a target for improvement.
authors.affiliation: University of Otago, Christchurch School of Medicine, Christchurch, New Zealand.
authors.forename: Manar
authors.initials: M
authors.lastname: Khashram
authors.forename: Justin A
authors.initials: JA
authors.lastname: Roake
authors.forename: David R
authors.initials: DR
authors.lastname: Lewis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002339:Carotid Arteries / Q000000981:diagnostic imaging*; D016894:Endarterectomy, Carotid / Q000592:standards*; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000209:etiology / Q000601:surgery*; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D012017:Referral and Consultation; D020521:Stroke / Q000209:etiology / Q000601:surgery*; D013997:Time Factors; D014463:Ultrasonography