Data collection for study: August 2024 Publication date: November 2025
Aim
To explore current care pathways for patients with acute limb ischaemia (ALI); identify remediable clinical and organisational factors that can improve the delivery and quality of required care.
Participation
All acute hospital providers in England, Wales, Northern Ireland and Jersey where patients with ALI might be admitted will be expected to participate in the study.
Patients will be identified for the study in vascular centres (“hub hospitals”) then tracked through their pathway of care. Data will be collected from all identified healthcare providers in the pathway. In addition to the vascular centre / “hub hospitals” we will collect data from referring / “spoke” hospitals, as well as GP practices.
Data Collection Patient identification spreadsheet
The patient identification spreadsheet will be sent out to vascular specialist centres. A local contact, either the NCEPOD local reporter or a specific study contact will be asked to identify all patients admitted as an emergency to their hospital during the study time period, with the included ICD10 and OPCS codes. For this group the admission details will be checked at the hospital to remove as many patients as possible from the data pool who did not have ALI. A patient identification spreadsheet will then be returned to NCEPOD identifying patients suitable to sample for inclusion in the study.
The spreadsheet will include the following data fields: NHS number, hospital number, date of birth, date of admission, source of admission, primary ICD10 code, all ICD10 codes, all OPCS codes, discharge destination, date of discharge, clinician code and specialty, the details of the transferring hospital (if applicable) and the primary care details.
Study Contact
Because there is no specific code for ALI, we will need a ‘study contact’ in each vascular centre to facilitate the identification of patients for the study. We will be asking Local Reporters to nominate a study contact. Vascular surgeons and interventional radiologists are best placed to carry out this role. We will ask that once the initial sample of patients likely to include those with ALI is identified by our Local Reporter, through ICD10 coding, the study contact will review the list of patients identified and confirm which have ALI. We will also ask that the study contact support the Local Reporter in collecting the required data (questionnaires and case notes). If you are interested in being a study contact, please contact ALI@ncepod.org.uk and we will put you in touch with your Local Reporter.
Clinician questionnaire
Two clinician questionnaires will be used to collect clinical data for this study:
1) Clinician questionnaire: hospital-based
2) Clinician questionnaire: primary care
Clinician questionnaires- hospital-based
The clinician questionnaires (hospital-based) will be sent to the NCEPOD Local Reporter for dissemination via the online questionnaire system. Reminder letters will be sent at six weeks and ten weeks where the data is outstanding. Up to 15 patients per hospital will be sampled for inclusion in the study.
Vascular centres / “Hub” hospitals
This questionnaire will be assigned to the named vascular surgeon and will have questions on the admission process, initial investigations and decision making (if applicable), and treatment provided.
Referring / “Spoke” hospitals
LRs in “spoke” hospitals will be asked to assign this questionnaire to the either the named consultant in the Emergency Department or the admitting consultant (e.g. in the Acute Admissions Unit (or equivalent)). It will have questions on the arrival to hospital, initial investigations, any treatment provided and referral/ transfer process.
Primary care clinician questionnaire
This will be short to encourage submission. The primary care clinician questionnaire will be sent for those patients identified as being referred for the admission by the GP. The questionnaire will be sent directly to the GP for completion either as a hard copy questionnaire or via the online questionnaire system. Reminder letters will be sent at six weeks and ten weeks where the data is outstanding.
Case note extracts for review
Case notes will be requested for all patients included in the case review aspect of the study. A full list of required extracts will be provided.
Case Review
We will be recruiting a multidisciplinary panel of case reviewers to assess the case notes and questionnaires and provide their opinion on what went well and what did not go well in the care provided for each patient. The reviewer group will comprise vascular surgeons, physicians (general, cardiologists, diabetologists, geriatricians) emergency medicine physicians, interventional radiologists, vascular nurses, anaesthetists, intensivists and general practitioners. We will be asking Local Reporters to circulate an advertisement for this role.
Organisational questionnaire
Data collected will include information around the organisation of services, the use of protocols, training, networks of care, transfer arrangements, the availability of staff and facilities, emergency surgery access, information for patients and families and follow-up arrangements. Questionnaires will be sent to all hospitals participating in the study via the online questionnaire system.
Please see the study protocol for more information.
This page will be updated regularly so please check for further information. Any other queries relating to this study should be also addressed to ALI@ncepod.org.uk.