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Hospital clinicians’ perceptions and experiences of care pathways for chronic limb-threatening ischaemia: a qualitative study

BACKGROUND: Chronic limb-threatening ischaemia (CLTI) is a condition associated with significant risks of lower limb loss and mortality, which increase with delays in management. Guidance recommends urgent referral and assessment, but delays are evident at every stage of the CLTI patient pathway. Th...

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Autores principales: Atkins, Eleanor, Kellar, Ian, Birmpili, Panagiota, Boyle, Jonathan R., Pherwani, Arun D., Chetter, Ian, Cromwell, David A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10507819/
https://www.ncbi.nlm.nih.gov/pubmed/37726754
http://dx.doi.org/10.1186/s13047-023-00664-6
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author Atkins, Eleanor
Kellar, Ian
Birmpili, Panagiota
Boyle, Jonathan R.
Pherwani, Arun D.
Chetter, Ian
Cromwell, David A.
author_facet Atkins, Eleanor
Kellar, Ian
Birmpili, Panagiota
Boyle, Jonathan R.
Pherwani, Arun D.
Chetter, Ian
Cromwell, David A.
author_sort Atkins, Eleanor
collection PubMed
description BACKGROUND: Chronic limb-threatening ischaemia (CLTI) is a condition associated with significant risks of lower limb loss and mortality, which increase with delays in management. Guidance recommends urgent referral and assessment, but delays are evident at every stage of the CLTI patient pathway. This study uses qualitative methods to explore hospital clinicians’ experiences and perceptions of the existing CLTI pathway. METHODS: A qualitative interview study was conducted. Semi-structured interviews were undertaken with 13 clinicians involved in the assessment of patients referred to hospital with suspected CLTI, identified via purposive sampling from English vascular surgery units. Clinicians included podiatrists, vascular specialist nurses and doctors. Reflexive thematic analysis was performed on the data from a critical realist position. RESULTS: The need for speed was the single overarching theme identified. Four linked underlying themes were also identified; 1. Vascular surgery as the poor relation (compared to cancer and other specialties), with a sub-theme of CLTI being a challenging diagnosis. 2. Some patients are more equal than others, with sub-themes of diabetes vs. non-diabetes, hub vs. spoke and frailty vs. non-frail. 3. Life in the National Health Service (NHS) is tough, with sub-themes of lack of resource and we’re all under pressure. 4. Non-surgeons can help. CONCLUSIONS: The underlying themes generated from the rich interview data describe barriers to timely referral, assessment and management of CLTI, as well as the utility of non-surgical roles such as podiatrists and vascular specialist nurses as a potential solution for delays. The overarching theme of the need for speed highlights the meaning given to adverse consequences of delays in management of CLTI by clinicians involved in its assessment. Future improvement projects aimed at the CLTI pathway should take these findings into account. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13047-023-00664-6.
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spelling pubmed-105078192023-09-20 Hospital clinicians’ perceptions and experiences of care pathways for chronic limb-threatening ischaemia: a qualitative study Atkins, Eleanor Kellar, Ian Birmpili, Panagiota Boyle, Jonathan R. Pherwani, Arun D. Chetter, Ian Cromwell, David A. J Foot Ankle Res Research BACKGROUND: Chronic limb-threatening ischaemia (CLTI) is a condition associated with significant risks of lower limb loss and mortality, which increase with delays in management. Guidance recommends urgent referral and assessment, but delays are evident at every stage of the CLTI patient pathway. This study uses qualitative methods to explore hospital clinicians’ experiences and perceptions of the existing CLTI pathway. METHODS: A qualitative interview study was conducted. Semi-structured interviews were undertaken with 13 clinicians involved in the assessment of patients referred to hospital with suspected CLTI, identified via purposive sampling from English vascular surgery units. Clinicians included podiatrists, vascular specialist nurses and doctors. Reflexive thematic analysis was performed on the data from a critical realist position. RESULTS: The need for speed was the single overarching theme identified. Four linked underlying themes were also identified; 1. Vascular surgery as the poor relation (compared to cancer and other specialties), with a sub-theme of CLTI being a challenging diagnosis. 2. Some patients are more equal than others, with sub-themes of diabetes vs. non-diabetes, hub vs. spoke and frailty vs. non-frail. 3. Life in the National Health Service (NHS) is tough, with sub-themes of lack of resource and we’re all under pressure. 4. Non-surgeons can help. CONCLUSIONS: The underlying themes generated from the rich interview data describe barriers to timely referral, assessment and management of CLTI, as well as the utility of non-surgical roles such as podiatrists and vascular specialist nurses as a potential solution for delays. The overarching theme of the need for speed highlights the meaning given to adverse consequences of delays in management of CLTI by clinicians involved in its assessment. Future improvement projects aimed at the CLTI pathway should take these findings into account. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13047-023-00664-6. BioMed Central 2023-09-19 /pmc/articles/PMC10507819/ /pubmed/37726754 http://dx.doi.org/10.1186/s13047-023-00664-6 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Atkins, Eleanor
Kellar, Ian
Birmpili, Panagiota
Boyle, Jonathan R.
Pherwani, Arun D.
Chetter, Ian
Cromwell, David A.
Hospital clinicians’ perceptions and experiences of care pathways for chronic limb-threatening ischaemia: a qualitative study
title Hospital clinicians’ perceptions and experiences of care pathways for chronic limb-threatening ischaemia: a qualitative study
title_full Hospital clinicians’ perceptions and experiences of care pathways for chronic limb-threatening ischaemia: a qualitative study
title_fullStr Hospital clinicians’ perceptions and experiences of care pathways for chronic limb-threatening ischaemia: a qualitative study
title_full_unstemmed Hospital clinicians’ perceptions and experiences of care pathways for chronic limb-threatening ischaemia: a qualitative study
title_short Hospital clinicians’ perceptions and experiences of care pathways for chronic limb-threatening ischaemia: a qualitative study
title_sort hospital clinicians’ perceptions and experiences of care pathways for chronic limb-threatening ischaemia: a qualitative study
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10507819/
https://www.ncbi.nlm.nih.gov/pubmed/37726754
http://dx.doi.org/10.1186/s13047-023-00664-6
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