National Vascular Registry (NVR)

National Vascular Registry update October 2022

This update is long overdue, the last version was dated 2015. Much has changed.

I should start by thanking the NVR committee for their support over the last year since I became the IR clinical lead. There is a clear determination to ensure that NVR is run for the benefit of patients with vascular disease and for all clinicians treating those patients. Both the VS and the BSIR are integral to that process.

The NVR is part of National Clinical Audit and Patient Outcomes Programme (NCAPOP) which comprises around 40 national clinical audits of a wide range of medical, surgical and mental health conditions.

It is funded by HQIP in 3-5 year cycles. Data is collected for AAA, Carotid interventions and lower limb PAD and has been collected in current form since 2013. It remains one of the most comprehensive audits of vascular treatments across the globe.

The NVR is run by a small team at the clinical effectiveness unit of the Royal College of Surgeons of England. Headed by David Cromwell and Sam Waton with statisticians and clinical fellows. There are two clinical leads – Arun Pherwani, representing the Vascular Society and myself, representing the BSIR

The current HQIP contract expires Dec 2022. The existing team have just been re-commissioned after competitive tender by HQIP (September 2022) for another three years.

NVR activity 2021-2022  

VSQIP | Vascular Services Quality Improvement Programme

• Annual publication of unit and operator outcomes for AAA and carotid interventions – In 2021, due to the effect of COVID and reduction in activity, HQIP agreed that operator level outcomes should not be published but were available to individuals. Unit level data was published and available on the website. This will continue for the 2022 release. For the first time IRs will receive their AAA mortality data and will also receive some basic unit level data from the lower limb datasets.
• NVR annual report, currently with HQIP for final approval. To be published 10^th November 2022
• NVR short report on COVID-19, May 2021 update due early 2023
• Medical Devices - Developing and implementing implantable medical device capture for aortic aneurysm repair, June 2021
• 2022 AAA devices update with HQIP for approval publication Dec 2022
• PAD QIF – End of Phase 1 of PAD QIF. Phase 2 of QIF will be reviewing the effect of the CQUIN in 2022-23. PAD QIF fellow #3 funded by CF/RCS England to be appointed
• CQUIN – the successful CLTI CQUIN for 2022-2023 aims to drive improvements in the treatment of inpatient CLTI. All acute trusts in England are participating and the CQUIN is worth between £500,000-£1,000,000 for most trusts. The NVR is part of the monitoring process, this is shared with regional specialist commissioning teams. The initial data shows the national average proportion treated within 5 days is now 60%. There are 7 providers not meeting the minimum 40% threshold. 

With more available on the website

Making the NVR more relevant to the IR community

Outcome Data - For many years IRs have escaped scrutiny of outcomes and activity but the Paterson Inquiry Report has made it clear that this type of information should become a normal part of the appraisal process. It is likely that the National Consultant Information Programme NCIP – Getting It Right First Time – GIRFT will become part of our lives. As mentioned above, the NVR is beginning the process of sending outcome data to individual IRs. This will mirror the process for our vascular surgery colleagues and will feed into the NCIP platform.

Lower limb datasets - these are in the process of being revised by a panel of IRs and VSs. This process should improve the relevance and granularity of the dataset. I believe it should be possible to make data entry more straightforward and less time consuming, although judge me on the end result rather than these words.

Case ascertainment is improving but sits at just over 50%. We have a long way to go.

Medical Devices – In response to the “Cumberlege Independent Medicines and Medical Devices Safety review” NHSe has created the Medical Devices Safety Programme (MDSP) GIRFT to harness technology to improve medical devices safety – Getting It Right First Time – GIRFT. This programme will use existing registries to gather medical device outcome data at an individual patient level. The NVR will be the platform to collect data on vascular devices. AAA devices have been used to pilot the process and this will be extended to the lower limb dataset in the near future. I am almost certain that this process will be mandatory in the future.

IR NVR Fellowship – as I reported last year, we are trying to secure funding for an interventional radiology fellow within the NVR. This will be part funded by the Circulation Foundation (CF), BSIR and we are still waiting to hear whether the RCR will fund the remaining portion.

Final thoughts – there are many reasons to enter data into the NVR – improving patient outcomes, operator outcome data, CQUIN money for your trust etc, but I suspect many of us do not realise it is already mandatory:

“ 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.”

Dr Robin Williams

Consultant Interventional Radiologist

NVR Short Report Aortic Devices - June 2021

Click HERE to view the NVR Short Report Aortic Devices - June 2021

Userguide on how to enter devices on the NVR.

Click HERE to view / download the userguide on how to enter devices on the NVR.

NVR eNewsletter - Issue 2021 (5): 10 June 2021

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National Vascular Registry: A National Prospective Audit

Issue 2021 (5) 10 June 2021

NVR aortic devices short report

The NVR has published a report today that describes the results of an initiative to implement the capture of implantable medical devices used in procedures to repair aortic aneurysms. The results in this report are based on an extract of activity taken from the NVR IT system in March 2021, and covered the period from January 2020 to February 2021. It contains information on: · The process undertaken by the NVR team to incorporate devices on the NVR IT system, including the ability to scan barcodes directly into the NVR. · The number of aortic procedures containing device information. · Aortic morphology of patients undergoing procedures. · The type of device and components used during the procedures   We have also updated the userguide on how to enter devices on the NVR. The updated guide indicates what should be entered for the product number and lot/batch number for each manufacturer. Some example device labels and barcodes are also shown for guidance. Please continue to let us know if you find issues when entering devices on the NVR.

NVR Data Submission Deadlines

Just a reminder that the final data submission deadlines for AAA and CEA procedures up until the end of December 2020 is next Friday 18th June. We are currently in discussions with the VSGBI about how to proceed with our consultant level analysis for 2021. We may well not publish any consultant level outcomes in the public domain in 2021, but this will have to be approved by HQIP and NHS England first.

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NVR Short Report on COVID-19 – May 2021 Update

In this short report, VSQIP present preliminary results on the impact that the Covid-19 pandemic has had on the provision of NHS vascular care in the UK and its potential impact on short-term surgical outcomes.
The analysis covered:

1. patients who had a repair procedure for abdominal aortic aneurysm (AAA)
2. patients who had carotid endarterectomy, and
3. patients with peripheral arterial disease (PAD) who had either lower limb revascularisation (endovascular / bypass surgery) or major amputation.

The results in this report are based on data extracted from the NVR data collection system on 28 January 2021, which covered patients whose operation was performed in 2019 and 2020.

This report is an update on the one we published in November 2020, to include the time period from August to October 2020.

Click here to view the report 

National Vascular Registry (NVR) Report November 2020

National Vascular Registry (NVR) Report November 2020

NVR Short Report Covid-19

NVR Short Report Covid-19

Update March 2015

The NVR has been altered as of January 2015 so as to include more information about peripheral angioplasty. The project board of the NVR have worked with BSIR to make a number of changes to the dataset. This now records disease extent and severity and procedure success. 
Outputs can be produced including a summary of procedures by operator and funnel plots of mortality. The next step will be to look at outputs of success and complication rates for angioplasty.
Work continues to improve the speed of the website.

In 2014 submission rates for angioplasty have been <15%, but we hope that these will improve in 2015. The BSIR audit sub-committee aims to reduce the time required for data entry and to encourage trusts to provide our members with time and administrative support for this activity.

It is important that if you are the second operator for an EVAR procedure that this is reflected in the NVR dataset. This is easy to check.

Fiona Miller,  Audit & Registries Committee Chair

NVR Newsletter

Data Capture Paper Tool for NVR

Please find attached a paper consent and data collection tool that you may find helpful in data collection for peripheral angiographic procedures for the NVR. While this document does not circumvent the requirement for eventual electronic data submission, we hope that IRs will find it useful to collect data immediately after a procedure. Ideally some administrative support should be made available by trusts to enable data entry direct from the document without the need for the IR to do this personally.

The BSIR is progressing a number of other projects that may eventually assist in electronic data entry.

Yours faithfully

Chris Hammond

Chair: BSIR R&A Committee