Introduction The SARS-COV-2 pandemic has led to the redistribution of NHS services. In our sector, CEA surgery moved to an NHS hospital where it had not previously been undertaken. To ensure safety a new standard operating procedure (SOP) was proposed. An audit was undertaken to evaluate the SOP, construct a pre-operative checklist, subsequently measure its effectiveness and identify improvements. Methods To ascertain key pre-operative steps to include in the checklist a questionnaire was completed by 9 SpR/Consultants. The form consisted of a ranking score from 0 (never done) to 10 (always done). Once the checklist was established the questionnaire was re-sent additionally asking for feedback on its impact on the service and suggestions for improvement. Using these results, the checklist was incorporated as a smart text to EPIC (electronic patient notes). Results The following key steps were identified: MDT decision, vascular review, imaging, anaesthetic review, relevant results (bloods, COVID swab and echo), theatre/bed booking, on-admission steps and post-op care. All 9 doctors felt the checklist improved the service in all domains, except bed availability and subsequent surgical delay, likely because this depended on HDU bed availability and need for on-the-day prioritisation. Conclusion The CEA surgery checklist is now an established part of the electronic patient record in the form of a simplified flowsheet with tick-boxes and space to insert results. This has ensured a standardised contemporary record of each patient's progress. All members of the team including new/temporary staff can follow this, ensuring a safe care pathway. Take-home message With the move of CEA surgery to an alternative London site it is important to establish a safe standard operating procedure. This has been facilitated by the use of a new pre-operative checklist ensuring a standardised contemporary record of each patient's progress.

Aim Stroke is the third leading cause of death in developed nations and the leading cause of long-term disability. Carotid artery stenosis accounts for 20 to 30% of ischaemic strokes. Carotid Endarterectomy, has proven highly effective in preventing the development of strokes, TIAs and reducing death among patients with symptomatic carotid artery stenosis of 50–99%. The most common complication of CEA is wound haematomas. This study evaluates a protocol driven haemostasis pathway aimed to address the findings of a recent QI project that identified a significantly high neck haematoma rate as well as a high return to theatre rate for the complication. Method A prospective cohort outcome study between June 2019 and June 2020 was conducted, with the introduction of this stepwise pathway introduced as a quality improvement measure. This was implemented at the end of successful patch closure, for each CEA. Results Post-CEA haematoma rates decreased from 7% to 3.6%. Return to theatre rates reduced from 6% to 0.9% with no increase in peri-operative stroke rates. Conclusion Our protocol appears to reduce post-CEA haematoma rates. Return to theatre rates had also dropped without an increase in peri-operative stroke rates despite using protamine and tranexemic acid when needed.