AI scribe and clinic software for vascular surgery clinics

The vascular note is built on numbers

A vascular note follows the clinic it comes from. In claudication clinic it records walking distance, risk factors, the femoral, popliteal and foot pulses and the ankle brachial pressure index. NICE sets out how the index is taken, at rest and supine where possible, with the systolic pressure in both arms and in the ankle arteries, the doppler signals documented, and the index for each leg calculated by dividing the highest ankle pressure by the highest arm pressure.⁴ It also warns against excluding peripheral arterial disease in people with diabetes on a normal or raised index alone.⁴ wai's template keeps a field for each leg and for the signal, so a figure said aloud lands in the right place.

In venous clinic NICE uses duplex ultrasound to confirm varicose veins and the extent of truncal reflux, and offers endothermal ablation first, then ultrasound-guided foam sclerotherapy, then surgery.¹ In aneurysm clinic NICE measures the inner-to-inner maximum anterior-posterior diameter on ultrasound and considers repair for an aneurysm that is symptomatic, that is larger than 4.0 cm and has grown by more than 1 cm in a year, or that is 5.5 cm or larger.² In carotid clinic NICE asks that imaging reports state which criteria were used, and refers symptomatic stenosis of 50% to 99% on the North American Symptomatic Carotid Endarterectomy Trial criteria, or 70% to 99% on the European Carotid Surgery Trial criteria, urgently for endarterectomy.⁵ The draft keeps the criteria beside the percentage.

wai suggests ICD-10 and SNOMED CT codes from the note, each shown with the line it rests on, for the surgeon to confirm. In the WHO edition of ICD-10 used in the UK and the Gulf, typical codes are I71.4 for an abdominal aortic aneurysm without mention of rupture, I70.2 for atherosclerosis of arteries of extremities, I83.9 for varicose veins of lower extremities without ulcer or inflammation, I87.2 for chronic venous insufficiency and I65.2 for occlusion and stenosis of carotid artery. ICD-10-CM in the US adds characters for site and side, so an infrarenal aneurysm becomes I71.43 and a right carotid stenosis I65.21. Procedure codes, OPCS-4 in the UK and CPT in the US, stay with the clinic's coder.

Letters that carry the figures

The Academy of Medical Royal Colleges recommends that most outpatient letters are written to the patient with a copy to the GP, and that this should be the default for an AI scribe.⁶ In vascular surgery the letter is often the only place the patient sees the number. An aneurysm letter states the diameter, the scan date, what the size band means and when the next scan is due, and tells the patient which symptoms need an emergency call. NICE notes that NHS screening data put the risk of rupture below 5.5 cm at 0.4% per year, and asks clinicians to avoid making people anxious about not being offered repair without implying that repair is always beneficial.²

Driving is a real line in a UK aneurysm letter. The DVLA lets a car or motorcycle driver with an aortic aneurysm under 6 cm drive without notifying it, requires notification from 6 cm to 6.4 cm, and bars driving at 6.5 cm or more, while a bus or lorry driver must notify any aneurysm and must not drive above 5.5 cm, in each case where there is no other disqualifying condition.¹⁰ The template asks which licence group applies, so the letter says the right thing.

Other letters come from the same visit. A reply to the GP after claudication clinic sets out the risk factor plan and the supervised exercise programme NICE offers to everyone with intermittent claudication, 2 hours a week for 3 months.⁴ A venous letter records the duplex findings and the agreed treatment. A referral for CT angiography or a cardiology opinion carries the questions for the specialist, as described in the referral letter, and results letters explain each scan. Every letter waits for the surgeon's signature and downloads as a PDF.

Warning symptoms in the patient's own language

wai works in 60 languages, among them English, Arabic, Spanish, French, Portuguese, Italian, Russian, Polish, Turkish, Urdu and Mandarin. English can be mixed in one consultation with Spanish, French, Portuguese, Russian, Italian, Dutch, German, Hindi or Japanese, and the other languages are captured in that language. The signed note is written in English for the record, or in another language the clinic chooses.

Vascular patients go home with instructions that matter, stopping smoking, taking a statin and an antiplatelet, walking to the point of pain, and knowing which symptoms mean an emergency. The patient summary can be translated into the patient's language beside the English letter, with crisis and emergency numbers kept exactly as written, so an aneurysm patient who speaks Urdu or Turkish reads the warning signs in the language he thinks in. See the multilingual AI scribe page for how capture and translation work.

Clinic software for vascular surgery clinics, built around surveillance

Surveillance is the admin that matters most. NICE asks vascular services to use the same surveillance frequency as the NHS screening programme,² which offers yearly scans for a small aneurysm of 3 to 4.4 cm and 3-monthly scans for a medium one of 4.5 to 5.4 cm.³ wai's proactive care sends the recall for each scan at the interval the surgeon signed, and a person approves each message before it goes. After repair, the after-visit companion tracks the surveillance imaging the surgeon set until each scan is done.

Calls, email, web forms and WhatsApp messages land in one thread per patient, and replies are drafted in the clinic's voice for a person to approve. Patients request appointments through booking links that read each surgeon's calendar in Google, Outlook or Apple, cancellations are offered to the waitlist, and reminders go out. Deposits, invoices and payment links go through the clinic's own Stripe account, and insured patients get insurer invoices.

Before each visit the surgeon sees a sourced brief of the patient, so the diameters from earlier scans sit in one place, each traced to the letter or result it came from. In the UK, lipid and renal bloods are ordered through TDL with results back to the record, and private prescriptions for a statin or an antiplatelet are issued and signed through SignatureRx. Each result reaches the patient with the surgeon's own comment and a plain explanation. The full set is on the clinic management software page.

One aneurysm surveillance visit, start to finish

Take a 72-year-old retired teacher, a former smoker treated for high blood pressure, referred after screening found an abdominal aortic aneurysm. The clinic ultrasound today measures 4.8 cm inner to inner. The surgeon explains what the aneurysm is, that the risk of rupture at this size is low, that repair is not recommended now and that he will be scanned every three months. She reviews his blood pressure medicines, recommends a statin, asks about leg pain on walking and examines his pulses. He drives a car and asks whether he must tell the DVLA.

The draft holds the history, the risk factors, the pulses, the diameter with the measurement method, the size band, the interval, the medicine plan and his driving question. The safety-netting check flags that the letter has no instruction for sudden severe abdominal or back pain, which she had mentioned only in passing, and she adds the line telling him to call 999. She corrects one figure. The draft took 4.7 cm from the screening letter he quoted, and she changes it to 4.8 cm from today's scan, with the date. She confirms ICD-10 I71.4 and signs.

The letter goes to him with a copy to his GP. It tells him that as a car driver with an aneurysm under 6 cm and no other disqualifying condition he need not notify the DVLA. The front desk sets the recall for his next scan in three months, sends the booking link and the reminder, and orders his lipid profile through TDL. When the result comes back it reaches him with the surgeon's comment, and his diameters line up in the brief for the next visit.

The evidence behind wai's method

The note is one part of the day the evidence measures. In a randomised trial of 238 outpatient physicians across 14 specialties at UCLA Health, the ambient scribe with a significant effect cut the time spent writing each note by about 41 seconds, against 18 seconds in usual care.⁷ wai is built on that finding, so it takes on the letters, the recalls, the booking and the follow-up as well as the note.

Vascular guidance is exact about what a record must say. NICE asks that every carotid imaging report state which criteria were used to measure stenosis,⁵ and measures aneurysms by one stated method so that surveillance figures can be compared.² A template with a field for each figure, its method and its date holds that standard in every letter.

A draft stays a draft until the surgeon signs it. wai holds every note and letter until the clinician signs it, and every reply until a person at the clinic sends it. In a systematic review of 33 studies, 76% found at least one outcome better when patient and physician shared a language other than English.⁸

Measured in a working clinic. At The Wellness in London, which runs on wai every day, every clinician has 15 hours a week back, as published in the customer story.⁹

Where to start

Start with one surgeon's aneurysm surveillance clinic. In the first week, build the letter template with fields for diameter, method, scan date, size band, interval and licence group, and run it for every visit. Measure the time from the end of clinic to signed letters, and count corrections to figures and dates. The guides to AI scribe accuracy and hallucination rates show what to look for.

In the second week, add the venous and claudication templates and turn on surveillance recalls at the front desk. Cardiac work-up before repair often sits with colleagues, and the cardiology guide covers their side. Other specialties are on the specialties page, and plans are on the pricing page.

Frequently asked questions