Indications for Echocardiography by tdc38363

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									                                                         Referral Protocol for a community-based Echocardiography Service




Indications for Echocardiography


The Primary Care Echo Service is mainly centred around the detection of left ventricular systolic dysfunction, as well as
cardiomyopathies and potential valve lesions.

It is not intended for patients who are acutely ill. They need to be managed in the usual way and admitted to hospital
where appropriate.


Patients who will benefit from referral to the primary care echo service include:

    •    Those with suspected heart failure or at high risk of developing it, who have not yet had an echo scan
    •    The screening of those with established ischaemic heart disease, i.e. a past history of:
              -   myocardial infarction,
              -   atrial fibrillation or
              -   re-vascularisation, who have not had and echo scan
    •    Murmurs of unknown cause
    •    Patients who are being investigated for shortness of breath who have an abnormal ECG
    •    Screening relatives of patients with cardiomyopathies


Patients to be excluded are those:

    •    Who are acutely ill
    •    Under the age of 18
    •    Previous valve or reconstructive surgery
    •    Any known congenital disease




Echovision contact telephone numbers
Patient line all enquiries: 01767 677507
Fax Number for all Echo requests: 01767 677173




             Echovision: Rosewood House, Meadow Road, Great Gransden, Sandy Bedfordshire, SG19 3BD
                                                          Referral Protocol for a community-based Echocardiography Service




Community-based Echocardiography Service Referral Protocol


1.   All Echocardiography requests are to be made on dedicated Echocardiography request forms.

2.   The referrer/GP practice to fax echo request form through to Echovision (details below) providing:

              •    the patient’s name
              •    address and contact telephone number
              •    date of birth
              •    medical history
              •    current medication
              •    results of recent ECG
              •    Other relevant information such as BNP, chest X-ray results

3.   Echovision will validate the request and then contact the patient by telephone to agree the appointment time
     and location. Where the patient does not have a telephone we will send the patient a ‘ring for appointment’
     letter.

4.   Echovision will arrange for the patient to be scanned at the next available echo session in the locality.

5.   Confirmation of the appointment, together with an Echo patient guide and a map will then be posted to the
     patient.

6.   The patient is requested to arrive 15 minutes prior to the appointment time.

7.   Once the scan is complete, a Specialist Cardiac report will be undertaken which will then be returned to the
     referring GP or practice. This report will contain patient management recommendations, based on the echo
     scan results.


Echovision contact telephone numbers
Patient line all enquiries: 01767 677507
Fax Number for all Echo requests: 01767 677173




             Echovision: Rosewood House, Meadow Road, Great Gransden, Sandy Bedfordshire, SG19 3BD
FAX Referral To: 01767 677 173
Telephone number: 01767 677 507
Echovision Ltd, Rosewood House, Meadow Road, Great Gransden, Sandy, Beds,SG19 3BD

Request Form for: Echocardiogram Study                         …………………………...Primary Care Trust
Date of Referral:                                              Community based Echocardiography Service

Patient:                                                       GP:
DoB:                               ( Patients must be > 18 )   Surgery:
NHS no:

Address:


                                                               Tel:
Tel no:                                                        Fax:
                                                               Email:

Cardiac History:                    Date                                    Comments / Details
  Myocardial infarction
  Atrial fibrillation
  Hypertension
  CABG / PTCA / Stent
  Angina                                          .

Other History:                      Date                                    Comments / Details
   COPD
   Diabetes
   Thyroid
   Other

Current Repeat Medication:




Investigations:             Date                                               Results
   Hb
   Cholesterol
   Fasting glucose
   TSH
   ECG
   CXR
   BNP

Symptoms:                                                                 Comments / Details
  SOB – moderate exercise
  SOB – minimal exercise
  SOB – at rest
  PND
  Orthopnoea
  SOA
  Murmur

Past Medical History:



Other relevant information:




                          For routine referrals please fax to 01767 677 173

								
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