Subspecialty Nurses as Essential Ingredient for Modern Vascular Service

Like most developed countries with an ageing population, the incidence of patients vascular disease in Hong Kong is predicted to increase rapidly next few decades. Coronary, cerebrovascular and peripheral arterial diseases are usual end result systemic atherosclerosis, caused by longer life expectancy, high-lipid diet increasing prevalence diabetes mellitus. The aetiology management many (eg, chronic venous ulcers, ischaemic foot post-operative regimental surveillance) complex require a dedicated multi-disciplinary team approach achieve maintain good-quality service. This often consists surgeons, cardiologists, renal physician, diabetologists, orthopaedic surgeons specialist nurses. concept nurses not new. In Western countries, there already well-established organisations, such as United Kingdom Society Vascular Nurses or States for Nursing, that officially recognise honour nursing distinct specialty. These societies offer necessary guidelines clinical practice, education, research professional networking. There also multiple frequent journals courses. role nurse extends far beyond simple dressings unhealed ulcers wounds. They form bridge between patient (usually ongoing recurrent disease) surgeons. As workload increases, it no realistic practical endovascular see every monitoring follow-up. Diabetic instance, disabling patient, difficult manage frequently recur. progress worsening sepsis significant proportion present infection requiring major lower limb amputations. Nurse-led dressing clinics would be ideal continuity care these patients, their knowledge they will alert if doubts about current plans. able document (by documenting ulcer size photographs, instance) apply appropriate required. addition, perform examination procedures, use hand-held Doppler machine, performing bed-side debridement assisting vacuum-assisted closure devices. With help nurses, possible provide consistency inpatient outpatient treatment, facilitate interdisciplinary coordination communication, improve overall efficacy efficiency care.1 It has been shown following surgery, service can reduce length stay hospital without adversely affecting morbidity mortality.2 Likewise, requires nurse-led programme, local cleaning, application compression bandages repeated assessment. coordinate effectively other members arrange admission follow-up imaging appointments. Increasingly more aortic aneurysms being managed aneurysm repair. long-term time-coordinated computed tomography duplex scans surveillance sac size, presence endoleak stent graft patency. nurse, departmental database scan dates specialists worrying symptoms signs. Last but least, innovative case model highly recommended demands, complexity needs thereby enhancing professionalism. clinic mainly aimed at stable providing them comprehensive suffering from asymptomatic carotid stenosis <70%, abdominal <5 cm varicose veins; Figure 1A–C). complementary OPD aim assess, monitor educate on risk factor control, lifestyle modification identification alarming symptoms. Patients different classifications opt conservative surgical management. Education therapy control given. establishment may waiting time physician's enhance patients’ background disease. Queen Mary Hospital started February 2021, our doctor's clinic, same floor outpatient's building. decrease while patients. Examples criteria referral frequency Table 1. number new referrals, within hospital, increased steadily seen nurses’ over past months (Figure 2). At institution, we conduct regional annual courses future introduce aspects elective emergency surgery 1D). Short lectures procedures given senior followed visits suite hands-on session simulators, which give experience open devices how deploy stent). familiarise well inspire attract talents subspecialty surgery. Looking forward, develop standardised practice making guidelines, pathways protocols, expert advice consultancy services specialty across clusters. design own curriculum deliver advanced education specialty, university community level, staff competence transferring specialised skills knowledge. hoped eventually evidence-based conducted all centres findings incorporated into practice. No conflict interests declared; funding received.