Cardiology

Supporting information for GPs and health professionals

Direct Access Echocardiography and 24 hour Holter monitoring

Direct Access Echo and Direct Access Holter monitoring, via community diagnostic hub (CDH) at New QEII Hospital, Welwyn Garden City, is live to all GP’s able to request radiology tests from East and North Hertfordshire NHS Trust.

Requests which fit a pre-defined referral criteria (specified below) are made directly onto the ICE system by the GP.  All tests will generate a formal consultant cardiologist report including management advice.

No separate referral is required.  This is an alternative pathway to conventional e-RS referrals.  Please never refer to both in parallel – if in doubt please use advice and guidance (A&G) on e-RS to clarify which is more appropriate.

The consultant report is uploaded onto ICE (visible in general practice).  At this point if you require further clarification or advice this is available via A&G.

Referral criteria

Echocardiography:

• Suspected Heart Failure with BNP >400 (it is usually more appropriate for those with a BNP >2000 who have not previously been seen in a cardiology clinic to be referred directly for Rapid access heart failure clinic (includes echo and face to face consultation within two weeks)

• New murmur

• Hypertension (screening for LVH)

• Palpitations (with suspected structural cause)

• Family history of Cardiomyopathy or Sudden Cardiac Death

• The case has been discussed via advice and guidance and consultant suggests an echo

(If a case does not fit into the narrow referral criteria but it is felt CDH echo is more appropriate than conventional referral, GP should use A&G to discuss the case with a consultant cardiologist who may advise referral via the CDH pathway – please include the name of consultant cardiologist on your referral)

Holter monitoring:

• Symptomatic palpitations (for asymptomatic palpitations please discuss via A&G before using this pathway)

Excluded from CDH referrals

(Unless discussed and agreed via A&G in advance of referral)

• Exercise induced palpitations

• Palpitations with Syncope or presyncope

• Patients with High-Risk structural heart disease

• High Degree AV Block on resting ECG (2^nd or 3^rd degree AV block

• Bedbound Patients

• Paediatric Patients (0-18 years old)

Pathway overview

1. GP requests tests on ICE (search for CDH on ICE, which should display CDH echo and CDH Holter options)

• Patient is contacted by the hospital to arrange a date for their test (usually within 6 weeks)

• When the test has been performed a report stating ‘test performed awaiting consultant report’ appears on the ICE system (visible in general practice)

• Within two weeks of the patient being seen, a formal consultant report (in a similar form to a clinic letter) is uploaded as an addendum onto the ICE system and available to be viewed by GP

Vetting:

It is essential that all referrals either fit into the narrow referral criteria above OR have been discussed and approved by a consultant cardiologist via A&G.

NOTE: The quality of the consultant report is highly dependent on the amount of detail provided at point of request within the global clinical details box on ICE. The more relevant information the better the report the Trust can provide.

If any clarification of the service is required (ie suggested improvements, not management of an individual patient) please email [email protected]

For individual patient queries please use advice and guidance.