慢性威胁性肢体缺血（CLTI）是一种与下肢丧失和死亡风险显著相关的疾病，其风险随治疗延迟增加。指南建议紧急转诊和评估，但在CLTI患者的每个阶段都存在延迟的问题。本研究采用定性方法探究医院临床医生对现有CLTI路径的经验和认知。进行了定性访谈研究。通过有目的抽样从英国血管外科单位中选择了13名涉及评估被转诊至医院的疑似CLTI患者的医生进行半结构化访谈。临床医生包括足病学家、血管专科护士和医生。从批判现实主义的立场对数据进行了反思性主题分析。所识别的单一的总体主题是追求速度的需求。还识别了四个相关的基础主题：1.血管外科与肿瘤和其他专科相比较低下，并且CLTI是一个具有挑战性的诊断，是其下面的一个子主题。2.某些患者比其他患者更不平等，其下面有糖尿病与非糖尿病、中心与外围、虚弱与非虚弱等子主题。3.在国家医疗服务体系中的生活是艰难的，其下面有资源不足和我们都承受压力的子主题。4.非外科医生可以提供帮助。丰富的访谈数据产生的基础主题描述了延迟转诊、评估和管理CLTI的障碍，以及足病学家和血管专科护士等非外科角色作为减少延迟的潜在解决方案的实用性。追求速度的总体主题突显了参与CLTI评估的临床医生对延迟管理产生的不良后果的意义。未来针对CLTI路径的改进项目应考虑到这些发现。 ©2023. Podiatry学院和Australasian Podiatry Council.

Chronic limb-threatening ischaemia (CLTI) is a condition associated with significant risks of lower limb loss and mortality, which increase with delays in management. Guidance recommends urgent referral and assessment, but delays are evident at every stage of the CLTI patient pathway. This study uses qualitative methods to explore hospital clinicians' experiences and perceptions of the existing CLTI pathway.A qualitative interview study was conducted. Semi-structured interviews were undertaken with 13 clinicians involved in the assessment of patients referred to hospital with suspected CLTI, identified via purposive sampling from English vascular surgery units. Clinicians included podiatrists, vascular specialist nurses and doctors. Reflexive thematic analysis was performed on the data from a critical realist position.The need for speed was the single overarching theme identified. Four linked underlying themes were also identified; 1. Vascular surgery as the poor relation (compared to cancer and other specialties), with a sub-theme of CLTI being a challenging diagnosis. 2. Some patients are more equal than others, with sub-themes of diabetes vs. non-diabetes, hub vs. spoke and frailty vs. non-frail. 3. Life in the National Health Service (NHS) is tough, with sub-themes of lack of resource and we're all under pressure. 4. Non-surgeons can help.The underlying themes generated from the rich interview data describe barriers to timely referral, assessment and management of CLTI, as well as the utility of non-surgical roles such as podiatrists and vascular specialist nurses as a potential solution for delays. The overarching theme of the need for speed highlights the meaning given to adverse consequences of delays in management of CLTI by clinicians involved in its assessment. Future improvement projects aimed at the CLTI pathway should take these findings into account.© 2023. The College of Podiatry and the Australasian Podiatry Council.