cardiology diagnostics Tests 1

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cardiology diagnostics Tests 1

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Cardiology
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Cardiology
Cardiology
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Cardiology
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Workload Cardiology diagnostic tests requested
from acute admissions elective
admissions OPD clinics open access clinics GP
requests for diagnostic tests etc Location of
tests Departmental AE Ward based OPD Communi
ty based
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Workload Cardiology diagnostic tests Virtually
all admissions (elective or emergency) will have
at least one test Many OPD patients will have at
least an ECG Sequential tests in many Batch
testing especially by speciality Workload will
increase as underprovision of services
resolves demand increases ageing
population expanding knowledge/treatments gu
ideline adherence contract driven
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Redesigning Diagnostic Services

• Timing of diagnostic investigations
• Support workers
• Voice recognition software
• Bundling of tests pre OPD
• Workforce
• Open access and community echo

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Timings of Investigations

• ECG clinic and wards
• Echo with and without support worker

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ECG timing clinic room v ECG room
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ECG - clinic

• Average time to do an ECG was 5.42mins (range
  3.07 to 10.06 mins)
• Significantly less (for cardiac physiologist)
  when done in clinic room rather than department

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ECG - clinic

• Worse in winter
• 88 per day (2min 3hrs, 3min 4hrs)
• Extrapolation to other tests

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ECG in-patients

• Average time to do an ECG was 5.42mins
• Time to provide ward based ECGs leaving
  department with machine

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ECG timing on wards
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WARD ECG
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Ward ECG

• Using lifts takes time
• By locating a machine on each floor significant
  improvements can be made to the service
• Finding a location which is safe and secure
• Quantity of machines available
• Should all ECG machines be property of the
  department rather than ward/area. Department
  could then be responsible for consumables
• Applicable to other tests/areas

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Redesigning Diagnostic Services

• Timing of diagnostic investigations
• Support workers
• Reporting methods
• Bundling of tests pre OPD
• Workforce
• Open access and community echo

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Echocardiography

• Support worker has helped the smooth flow through
  the department.
• Reduction in waiting time from 9 months to 4
  weeks

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Redesigning Diagnostic Services

• Timing of diagnostic investigations
• Support workers
• Reporting methods
• Bundling of tests pre OPD
• Workforce
• Open access and community echo

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Echocardiography
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Echocardiography

• Significant proportion of time allowed per scan
  is taken up by non-scanning activities especially
  reporting
• Voice recognition software - reduce reporting
  times
• Reporting outside of clinic room

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Redesigning Diagnostic Services

• Timing of diagnostic investigations
• Support workers
• Voice recognition software
• Bundling of tests pre OPD
• Workforce
• Open access and community echo

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Pre OPD investigations

• Referral letter to cardiology defines appropriate
  diagnostic testing needed pre out-patient visit
• Healthcare scientists can triage both referrals
  and diagnostics
• Applicable to all common non-invasive tests
  including ETTs
• Bundled

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Process Map cardiology
OPD conventional v pre OPD testing pathway Seen
by doctor (arrow)
Letter to Test
Test to clinic
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Redesigning Diagnostic Services

• Timing of diagnostic investigations
• Support workers
• Voice recognition software
• Bundling of tests pre OPD
• Workforce
• Open access and community echo

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Workforce

• Support workers
• Secretarial support
• Staff retention
• Staff return to working
• Expansion of working day

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Workforce
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Redesigning Diagnostic Services

• Timing of diagnostic investigations
• Support workers
• Voice recognition software
• Bundling of tests pre OPD
• Workforce
• Open access and community echo

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Review of LV function according to source of
outpatient referral (A) PCT (B) SOH
A
Normal LV function Mild LVSD Moderate
LVSD Severe LVSD
B
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Review of valvular disease according to source of
referral (A) PCT (B) SOH
PCT
SOH
No valvular disease Mild valvular
disease Moderate valvular disease Severe
valvular disease
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Primary care testing

• Which tests
• Same staff
• Alternative staff
• Community based clinics

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