The Greater Manchester and Cheshire Cardiac Network have successfully piloted a new telemedicine ECG service from Broomwell HealthWatch to provide expert cardiology reporting for patients and will now roll the system out to a total of almost 150 practices.
The system allows 12-lead ECGs to be carried out in the GP practice by a doctor or nurse and transmit the results to a Broohwell's cardiac centre, providing GPs with expert cardiology advice.
The Greater Manchester and Cheshire Cardiac Network is responsible for the cardiac care of 3.2m people in the region. The network has already piloted the system in 48 surgeries in the region, and will now be rolled out to a further 96 surgeries.
Broomwell’s hand-held 12-lead ECG machine is used by a nurse, clinician or paramedic in the same way as a conventional machine. When the ECG is complete, the data is transmitted as a sound signal by landline telephone in just 45 seconds to Broomwell’s monitoring centre, where it is displayed on screen for interpretation by experienced clinicians.
Based on the high-quality ECG trace, staff at Broomwell's monitoring centre give an immediate verbal interpretation by phone so that action can be taken quickly, if needed. A full written ECG report is also sent to the GP surgery by email or fax for inclusion in the patient record.
Prestwich-based GP, Dr Jonathan Lieberman, had been using the system for a couple of years and championed his PCT to take part in the pilot.
He told EHI Primary Care: “The system is great for use in diagnosing patients with chest pain symptoms. Normally, we would refer patients to the local hospital outpatients departments for an ECG to look for any signs of cardiac illness. Now I can do a test there and then in the surgery and get a telephone call to tell me the extent of the cardiac problem and if the patient needs to go to hospital or not. It’s incredibly useful.”
Dr Lieberman added: “It is a very good screening tool and is also useful for treating patients who need regular ECG tests such as those with high blood pressure. It helps save expenses for the NHS and boosts patient confidence in knowing they do not have to unnecessarily visit the hospital.”
The cardiac monitoring and response service is so far in place at four primary care trusts across the area – the North and Central districts of Manchester PCT, Stockport PCT and Bury PCT – and since its launch in September 2006 has already been used with over 1,300 patients.
A key benefit of the service to patients is that because it is carried out locally by their GP it removes the need to travel elsewhere for diagnosis. Before the introduction of the service the process used to be that a patient had to travel to an acute hospital for an ECG and then wait for about two weeks for the results to get back to their GP. But now GPs have the results in minutes, meaning they can detect any problems at an earlier stage, and provide timely and preventative care.
Karen Greenwood, service improvement manager at the GMC Cardiac Network said: “The service has delivered clear cost savings and freed up acute and emergency healthcare resources. Carrying out 1,300 ECGs within the primary care setting has helped ease the burden on local acute hospitals.
“By providing cardiac monitoring, diagnosis and care at GP level, we’ve succeeded in dramatically reducing the number of out patient secondary care referrals. Patients get early diagnosis and care ensuring NHS resources are used most effectively.”
Patients in the area can also use arrhythmia recognition watches as part of the service.
These devices enable patients with suspected irregular heart palpitations to record and transmit a record of them when they occur. The interpretation service provides GPs with a clinical aid to diagnose whether the heart palpitations are indeed arrhythmia or not allowing appropriate care to be delivered.
However, Dr Lieberman says that although there are great benefits to the service, funding limitations mean that it can’t always be used with patients in the GP surgeries.
“I’d like every ECG to be done in this way. The problem is I can’t always spend my time waiting for the confirmation e-mail and going through the information with patients, as a GP, I’m often stretched for time. Similarly nurses do not work every day, and when they do, they are often very busy and cannot perform all the ECG’s that are necessary.
“More funding is needed to allow nurses to have more time to do these. PCT’s should see this as a great way of using their resources, saving the NHS money and getting the most out of practice based technology. It’s hard to be able to offer one patient the use of the service, whilst having to refer another patient due to a busy appointment list.”
Following the success of the initial one year pilot, the service is now being rolled out to a further four PCTs within the GMC network, covering 96 surgeries – Heywood, Middleton & Rochdale, Oldham, Eastern & Central Cheshire and Salford, extending the benefits to a wider patient base.
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