An innovative community based Cardiac Diagnostics Service prevents hospital
attendances
PG. Nolan1, O. Harrington2, J. Barton3, BD. MacNeill1, JJ. Crowley1, PJ. Nash1, K. Daly1
(1) University Hospital Galway, Galway, Ireland (2) Croi Rapid Cardiac Diagnostics, Galway, Ireland (3) Portiuncula Hospital, Galway, Ireland
Background
Background
Echocardiography Cardiac Ultrasound Primary tool for
diagnosis and follow-up Heart Failure Valvular Heart Disease Structural Heart Disease
Sudden Cardiac Death Paediatric to Geriatric
Service National Clinical
Programs Acute Medicine Heart Failure Acute Coronary
Syndrome
Background
Primary Care Physicians (GP's) have limited access to diagnostics Only 22% have open access
As part of the Community Heart Failure Program (ChaMP) Community based Echocardiography Service
commenced (Sept 2008) Croi, the West of Ireland Cardiac Foundation HSE West PCCC Cardiology Departments
University Hospital Galway Portiuncula Hospital
Eur Heart J 2000; 21: 1877–1887
Background
Now extended to include
Echocardiography 24hr-7 day Holter
monitoring Ambulatory BP
monitoring The only community
based Cardiac Diagnostics Service to GP’s in the Republic of Ireland.
Methods Sept 2008 - Sept 2012 3015 cardiac investigations were
performed by the service. 2249 patients underwent
echocardiography accredited Echocardiographer GE Vivid-i portable echo machine
Holter and Ambulatory BP monitor service commenced January 2011
570 patients underwent Holter monitoring 24hours to 7 days
196 had Ambulatory BP monitoring.
Referrals
47.1% of referrals were for reasons commonly seen in acute medicine Dyspnoea Cardiomegaly Palpitations suspected heart failure.
All patients had their test performed within 4 weeks of referral with urgent cases receiving highest priority
Results
47.8% of tests were reported as normal Echocardiography results
12.1% of patients had reduced LV function 5.8% mild dysfunction 2.9% moderate dysfunction 3.2% severe dysfunction.
33.3% of patients significant valvular disease
15.4% of cases at least moderate disease
Patient journey
Only 8% of tests required rapid direct referral to the Cardiology Outpatient Clinic
three cases attended the ED/MAU
92% of cases managed by GP's
Estimated savings
In absence of service OPD referral MAU/ED referral
GUH expects ED/MAU attendances - 22%
estimated direct cost of an ED attendance €162 OPD – 78%
estimated direct cost of an OPD attendance €167
Cost of an echocardiogram - €165
Estimated savings
Estimated cost of ED attendances 663 x €162 331 x €165 Total € 162021
Estimated cost of OPD attendances 2352 x €167 1176 x €165 Total €586824
Total saving
Challenges
Lack of perceived value in the normal test
Funding Peer-review and audit Increasing referral rate
Conclusion