Missing points from British report

Letters to the Editor (The Guardian)
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Editor: I was delighted to see that you were able to simultaneously present several viewpoints on the provision of vascular surgery on P.E.I.. I have a great deal of respect for Drs. Ken Grant and Jerry O’Hanley. Unfortunately, in order to accommodate both pieces, some of my key points were removed. Here are the missing points which I had abstracted from the British report.  

1. It is no longer acceptable for emergency vascular care to be provided by generalist surgeons and radiologists who do not have a specialized elective vascular practice; they may, however, be involved in the triage of patients in hospitals with no vascular service before referral to a vascular unit.

2. The arterial centre should develop an on-call roster no more onerous than one in six to provide 24/7 vascular care to network patients. The referral population serviced should be greater than 800,000. The referral centre should have a dedicated angiography suite, spiral CT and MRA, a vascular laboratory and a ward specifically for vascular patients.

3. There is evidence that, even with travel times of more than one hour, transfer to a specialized vascular unit improves patient outcomes. Patient survival after a ruptured aortic aneurysm is between five and 15 per cent if they stay in a hospital with no vascular surgeon, compared to 35 to 65 per cent if transferred to a vascular service. This advantage persists even with up to fur hours of hypotension (shock.)

According to the British Society for Vascular Surgery, there is good evidence that patients with vascular disease who would benefit from surgery have better outcomes if their care is delivered in a specialized center. Such programs are extremely resource-intensive in their need for staff, support services, equipment, a large enough patient base, dedicated operating rooms and in-patient beds, much of which we are lacking. We have had limited success in providing 24/7 coverage in other specialties having fewer than three specialists.

Desmond Colohan,

MD, FRCPC, MHSc.,

Charlottetown

Organizations: British Society for Vascular Surgery

Geographic location: Charlottetown

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