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Audit and QI

Audit and Quality Improvement

Find out more about the Audit and Quality Improvement Committee .

Organisational data

UK Audit of Vascular Surgical Services & Carotid Endarterectomy 2009

Outcomes data

National Vascular Regsitry (NVR)

The NVR was formed in January 2013 by the amalgamation of the National Vascular Database (NVD) and the UK Carotid Interventions Audit projects.

The NVR is a national clinical audit commissioned by the Health Quality Improvement Partnership (HQIP) to measure the quality of care for patients who undergo vascular surgery in NHS hospitals in England, Wales, Scotland and Northern Ireland. 

The NVR is part of the National Clinical Audit and Patient Outcomes Programme (NCAPOP).NCAPOP is a closely linked set of centrally-funded national clinical audits that collect data on compliance with evidence based standards, and provide local trusts with benchmarked reports on the compliance and performance. The NVR uses structure, process and outcome indicators to measure the quality of care received by patients undergoing vascular surgery.

The NHS standard contract requires that English NHS organisations providing care must participate in all relevant NCAPOP audits and enquiries. If providers do not participate in relevant NCAPOP audits, they will be in breach of their contract with their commissioner; therefore any non-participation would need to be agreed with the commissioner and CQC as the regulator.


The VS runs the NVR with the Clinical Effectiveness Unit of the Royal College of Surgeons of England. Some key programme staff are listed below:

  • Prof Arun Pherwani, Audit and Quality Improvement Committee Interim Chair
  • Rob Williams, BSIR Representative
  • Prof David Cromwell,
  • Sam Waton,

NVR Reports



Clinical Effectiveness Unit

Royal College of Surgeons of England, 38-43 Lincoln's Inn Fields, London WC2A 3PE.

National Consultant Information Portal (NCIP)

A founding principle of NCIP is that it is a resource for the profession and led by the profession. The programme’s consultant Clinical Lead is Professor Norman Williams. NCIP works in partnership with GIRFT, specialty associations and sub-specialty associations to develop content in the portal.

Vascular leads

  • Jon Boyle
  • Arun Pherwani

NCIP has the support of the Academy of Medical Royal Colleges (AoMC), the Royal College of Surgeons (RCS Eng.) and the Federation of Surgical Specialty Associations (FSSA) as a tool that can support consultant learning and development.

NCIP provides access to rich objective activity and outcomes data. It is a single point of access to locally and nationally benchmarked NHS surgical data. The ambition is to develop NCIP into a single repository covering the whole practice of a consultant, across the NHS and private sector. This makes this data accessible for Consultants, Medical Directors, Responsible Officers and specialty Clinical Leads.

Data sources

The primary data source is Hospital Episode Statistics (HES), content is pseudonymised at individual level and refreshed every quarter.

The NCIP content development team is also working on incorporation of trust theatre data, clinical audit and registries’ data to enhance the data tool.


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Outcome Registries Platform (ORP)

The NHS England Outcomes and Registries Programme was established in 2022 to develop a single, unified registry solution – the Outcome Registries Platform. The platform consolidates existing implantable device-level registries and implements new outcome registry data collections to address data and vigilance gaps, enabling the prevention of patient safety issues and adverse outcomes.

The ORP addresses the need for a more consistent approach to assure safety and satisfactory outcomes, and fulfils the recommendations of the Independent Medicine and Medical Device Safety Review (IMMDS) (2020) and Paterson Inquiry (2020).

The Medical Device Outcome Registry (MDOR) will significantly improve the quality of data available to improve patient safety and outcomes in high-risk medical device procedures.


Vascunet is the European vascular registries collaboration.



Quality Improvement

Transient ischaemic attack (TIA) and stroke

The Vascular Society has been running national vascular audit since the late 1990’s. Our quality improvement work began with funding support from the Health Quality Improvement Partnership (HQIP) in 2005. We initiated a UK wide carotid interventions audit aimed at improving care for patients needing surgery following transient ischaemic attack (TIA) or minor stroke. This work was undertaken in partnership with the Royal College of Physicians in London. Through several reporting cycles we have shown a reduction in waiting times for surgery coupled with low adverse (stroke and death) outcomes.

Abdominal aortic aneurysm (AAA) repair

In 2005 NCEPOD identified a high mortality rate after surgery to repair Abdominal Aortic Aneurysm (AAA). In 2008 a Vascunet report on European vascular surgery showed the UK to be on outlier with the worst death rates after elective (non-emergency) AAA repair at 7.5%. This provoked the development of our AAA QI programme, supported by grant funding from The Health Foundation. A national programme involving patients, surgeons, anaesthetists, radiologists, nurses and hospital managers was undertaken to define a national pathway of care and best practice for both care delivery and communication between health providers and patients. We were able to report improved outcomes across the UK in 2012, with an overall death rate of 2.4%. This has now further reduced to 1.7%.

Peripheral arterial disease (PAD)

In 2018, Professor Mike Horrocks published the GIRFT Vascular surgery national report. This report highlighted the variation and delays in the management of people with peripheral arterial disease. This led to the implementation by the VS of a quality improvement framework focussing on the timeliness of intervention - lower limb angioplasty or lower limb bypass - for people with critical limb threatening ischaemia (CLTI).

The targets recommended by the PAD QIF are inpatient revascularisation within 5 days and outpatient revascularisation within 14 days. These were deliberately challening targets. The inpatient target has been adopted by NHS England as a CQUIN for 2022/23 and 2023/24.

Procedure Volumes

There is a significant body of work published by the Audit and Quality Improvement committee linking procedure volumes to outcomes in vascular surgery. The relationship has been best defined for open abdominal aortic aneurysm repair and carotid endarteretomy.

It is accepted by NHS commissioners and most healthcare professionals that complex interventions should only be performed by vascular MDTs with adequate case volumes and specialist expertise. 

Analysis (2012) of UK AAA repair in quartiles from the low volume units (mean 10 cases per year) through to the high-volume units (mean 150 cases per year) showed a consistent reduction in mortality across the quartiles from 4.4% to 1.9%. In an analysis by the international consortium of vascular registries a minimum of 13 open AAA repairs was identified as a minimum.

The Vascular Society. Outcomes after Elective Repair of Infra-renal Abdominal Aortic Aneurysm (2012).

Scali ST, et al. Optimal threshold for the volume-outcome relationship after open AAA repair in the endovascular era: Analysis of the international consortium of vascular registries. EJVEVS 2021; 61(5): 747-55.

Recommended case volumes for arterial centres:

  • 60 aortic
  • 13 open intact AAA repairs per year, averaged over 3 years, should also be a minimum. 
  • 35 carotid