Best practice for assessment of patients with varicose veins.

BACKGROUND: Varicose veins are a significant health problem which attract much medicolegal attention. Recent publications have suggested "best practice" regarding assessment of patients with varicose veins. A retrospective audit was performed comparing clinical practice in a New Zealand teaching hospital with suggested standards.

METHODS: Clinic letters from 80 patients awaiting varicose vein surgery were reviewed. Data were collated regarding presenting problem, relevant medical history, clinical findings on examination, further investigations, and outcome.

RESULTS: Presenting complaint was noted for 99% of patients but actual symptoms were only recorded for 41%. The degree of disability caused by varicose veins was documented for 33% and patient concerns in 4%. Half of the patients presented with leg ulcers but ankle-brachial indices (ABPIs) were only recorded in 26% of clinic letters. Duplex scanning was recommended prior to surgery for 69% of patients and hand held Doppler assessment of venous disease was recorded in 61% cases. Clinic letters did not specify the nature and extent of disease in 6% of cases, and although every patient was recommended for surgery, the exact procedure was specified in only 24%. Details of surgical risks and complications were only present in 20% of letters, and only 21% of patients received a printed information sheet.

CONCLUSIONS: The quality of the data recorded in the clinic letters of fell below suggested standards for assessment of patients with varicose veins. Improving the documentation of patient assessment will allow better communication between providers of healthcare and make clinical errors less likely.