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Improving Access to Cardiology Services (Echo) Technician Led Clinics Evolution of the Echo Practitioner.

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Presentation on theme: "Improving Access to Cardiology Services (Echo) Technician Led Clinics Evolution of the Echo Practitioner."— Presentation transcript:

1 Improving Access to Cardiology Services (Echo) Technician Led Clinics Evolution of the Echo Practitioner

2 Why (Echo) Technician Led Clinics? Limited resources Very long wait lists for cardiology clinics Inefficient utilization of cardiology clinic times Limited funding More appropriate follow-up times (valve clinic) More timely access to echo More control over echo sessions Access to funding

3 Cardiology Audit July 2010

4 (Echo) Technician Led Clinics Tech Led PFO echo clinic Tech Led Contrast (bubble) echo clinic Tech Led Aortic Stenosis clinic Tech Led Exercise Stress Echoes Tech Led TOE service Tech Led GP access to echo Tech Led Valve Follow-Up clinic Tech Led paediatric echo service

5 (Echo) Technician Led Clinics Nelson Hospital Tech Led PFO echo clinic Tech Led Contrast (bubble) echo clinic Tech Led Aortic Stenosis clinic Tech Led Exercise Stress Echoes Tech Led TOE service Tech Led GP access to echo Tech Led Valve Follow-Up clinic Tech Led paediatric echo service

6 (Echo) Technician Led Clinics Tech Led PFO echo clinic Tech Led Contrast (bubble) echo clinic Tech Led Aortic Stenosis clinic Tech Led Exercise Stress Echoes Tech Led TOE service Tech Led GP access to echo Tech Led Valve Follow-Up clinic Tech Led paediatric echo service

7 Tech Led Exercise Stress Echoes 140 Exercise Stress Echoes annually One (afternoon) session per week One Echocardiographer One Physiology Technologist Cardiologist or Physician on the floor

8 Tech Led Exercise Stress Echoes Echo review session Exercise Stress Echo and ETT reported by Cardiologist and Echocardiographer* Echo findings verified Letter dictated

9 (Echo) Technician Led Clinics Tech Led PFO echo clinic Tech Led Contrast (bubble) echo clinic Tech Led Aortic Stenosis clinic Tech Led Exercise Stress Echoes Tech Led TOE service Tech Led GP access to echo Tech Led Valve Follow-Up clinic Tech Led paediatric echo service

10 Tech Led TOE service Central Regions Technical Advisory Service Scholarship 2009

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12 Tech Led TOE service Who should perform TOE studies? Who should perform TOE studies? Consultant cardiologists/anaesthetists/intensivists Specialist registrars in training Cardiac Technicians Dr N Bunce – St Georges Hospital, London

13 Tech Led TOE service Nelson Hospital No senior cardiology registrar No senior cardiology registrar Single TOE trained Cardiologist Single TOE trained Cardiologist Senior Echocardiographer assisted in TOEs Senior Echocardiographer assisted in TOEs last 16yrs Sign-off from Gastroenterologist, Cardiologists Sign-off from Gastroenterologist, Cardiologists Approx per annum Approx per annum

14 Tech Led TOE service Nelson Hospital Non-sedated TOEs. Safe (85% TOEs St Georges non-sedated) Non-sedated TOEs. Safe (85% TOEs St Georges non-sedated) Performed in Echo room Performed in Echo room RMO present RMO present Cardiologist on floor Cardiologist on floor Sedated TOEs performed in CCU Sedated TOEs performed in CCU

15 (Echo) Technician Led Clinics Tech Led PFO echo clinic Tech Led Contrast (bubble) echo clinic Tech Led Aortic Stenosis clinic Tech Led Exercise Stress Echoes Tech Led TOE service Tech Led GP access to echo Tech Led Valve Follow-Up clinic Tech Led paediatric echo service

16 Tech Led GP access to echo Why GP access to Echo? New A Fib guidelines New A Fib guidelines New NICE heart failure guidelines New NICE heart failure guidelines Free up cardiology OPD clinics Free up cardiology OPD clinics Faster access to results Faster access to results Empower GPs Empower GPs Greater control over echo sessions Greater control over echo sessions Meet a demand Meet a demand Access to appropriate funds Access to appropriate funds

17 Tech Led GP access to echo Initially thought access limited to 3 areas Murmurs (new) Murmurs (new) A Fib A Fib ? LV function ? LV function

18 Tech Led GP access to echo Access limited to 2 areas Murmurs (new) Murmurs (new) A Fib A Fib *

19 Tech Led GP access to echo Audit 2 month period Oct/Nov 09 likely referrals 14 likely GP referrals/month, estimate doubled to 28 likely referrals per month 14 likely GP referrals/month, estimate doubled to 28 likely referrals per month Jan-April 10 trial period with covering letter to GP with echo result Up to 10 per month, estimate likely to double Up to 10 per month, estimate likely to double May 10, GP education day. GPs notified Average 20 GP referrals per month Average 20 GP referrals per month

20 GP access to echo GP Educ. day GP educ. day

21 Tech Led GP access to echo Patient not seen by Cardiologist Limited to Murmurs (new) Murmurs (new) A Fib* A Fib* Echo reviewed at cardiology review session Letter dictated by cardiologist to accompany echo report

22 (Echo) Technician Led Clinics Tech Led PFO echo clinic Tech Led Contrast (bubble) echo clinic Tech Led Aortic Stenosis clinic Tech Led Exercise Stress Echoes Tech Led TOE service Tech Led GP access to echo Tech Led Valve Follow-Up clinic Tech Led paediatric echo service

23 ECHOCARDIOGRAPHER TECHNICIAN LED VALVE FOLLOW-UP CLINIC (VALVE CLINIC) 1 st prize Affiliates section

24 EchoValve Follow Up Patient Cardiologist OPD Follow up organised Results/letter to GP Results/letter to notes Tech Led Valve Follow-Up clinic Traditional Patient-flow

25 EchoValve Follow Up Patient Cardiologist OPD Follow up organised Results/letter to GP Results/letter to notes Valve Follow Up Patient Valve Clinic Echo QOL B/P ECG Follow up organised Results to GP Results to notes Echo review Traditional Patient-flow vs Valve Clinic

26 Referral to Valve Clinic Initial enrolment into Valve Clinic made by the Cardiologist Assymptomatic mild, moderate and moderately-severe valve disease Aortic Stenosis Mitral Regurgitation Aortic Regurgitation Mitral Stenosis Tissue valve replacement

27 Valve Clinic Patient aware that they will not see the Cardiologist Echocardiogram Short QOL questionnaire B/PECG

28 Change in symptoms Presyncope/syncope yes/no Increased SOB yes/no Chest pain yes/no Palpitations yes/no

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30 Echo review session Review Echo, ECG, B/P, QOL Valve Clinic with reviewed follow-up interval Valve Clinic Patient symptoms/Echo unchanged Cardiologist OPD Clinic visit +/- Echo Patient symptoms/Echo changed Patient Symptoms unchanged Echo changed

31 Valve Clinic Follow Up Criteria Aortic Stenosis Mild Stenosis3-5 year Valve Clinic followup Moderate Stenosis1-2 year Valve Clinic followup Mod-severe Stenosis Needs cardiology OP review6 month Echo/Cardiologist followup Severe Stenosis Needs cardiology OP review3-6 month (assymptomatic) Echo/Cardiologist followup

32 Valve Clinic Follow Up Criteria Mitral Regurgitation (MR) Mild MR5 year Valve Clinic followup Mild-moderate MR3 year Valve Clinic followup Moderate MR2 year Valve Clinic followup Moderately-severe MR1 year Valve Clinic followup Severe MR Needs cardiology OP review3-6 month Echo/Cardiologist followup Tissue Valve Replacements Baseline post Op Echo, then 3x biannual Valve Clinic follow up, then yearly

33 Valve Clinic Follow Up Criteria Patients remain in active follow-up in the Valve Clinic until the age of years Valve lesion being followed Severity of valve lesion Patients discharged back to their GP

34 Valve Clinic Results Audited: feasibility, safety and efficiency

35 Valve Clinic Results Feasible Absolutely feasible Absolutely feasible Echoes are not extra echoes Echoes are not extra echoes Altered patient journey Altered patient journey Extra tests: ECG, B/P, QOL Extra tests: ECG, B/P, QOL

36 Valve Clinic Results Safe. No patient was admitted or seen acutely during the period between Valve Clinic visits

37 Valve Clinic Results Efficient Makes better use of Echo clinic times Makes better use of Echo clinic times Makes better use of Cardiologist clinic times Makes better use of Cardiologist clinic times Fits department ethos on clinical efficiencies Fits department ethos on clinical efficiencies

38 Valve Clinic Results Nov 06 to Sept 10: 715 pt visits

39 Valve Clinic Results Nov 06 to Sept 10: 715 pt visits

40 Valve Clinic Results Nov 06 to Sept 10: 715 pt visits <20% of patients disease progressed to warrant formal Cardiologist outpatient review >80% of patients entered into the valve clinic remain in active follow-up in the valve clinic

41 Valve Clinic Hugely reduced impact on Cardiologist clinic times Reduced patient waiting times More timely follow up of chronic valve conditions More control over echo sessions Appropriate access to appropriate funding Proven to be a safe process in which to follow-up valve lesions

42 Conclusion Within the framework of tight clinical governance the Echocardiographer Technician Led Valve Follow-up Clinic has improved patient care. Patient waiting times have reduced allowing tight, timely follow up of chronic conditions. In addition consultant clinic time has now been targeted towards the higher risk patients.

43 Valve Clinic Requirements/Tech Led Clinics Competent Echocardiographer/s Technically and clinically* Technically and clinically* Echo database (no notes dept) 100% support from Cardiologists Understanding of Cardiology Department funding streams

44 (Echo) Technician Led Clinics Tech Led PFO echo clinic Tech Led Contrast (bubble) echo clinic Tech Led Aortic Stenosis clinic Tech Led Exercise Stress Echoes Tech Led TOE service Tech Led GP access to echo Tech Led Valve Follow-Up clinic Tech Led paediatric echo service

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