Requesting Adult Transthoracic Echocardiograms with Bubble Study

Transcription

1 Requesting Adult Transthoracic Echocardiograms with Bubble Study Type: Clinical Guideline Register No: Status: Public Developed in response to: Contributes to CQC Core Outcome The need to prevent inappropriate requests for adult Echocardiograms with Bubble Studies. The need to maximise the efficiency of the echocardiogram service 4 Consulted With Post/Committee/Group Date Dr Duncan Coles, Dr Gerald Clesham, Dr Reto Gamma; Dr George Zachariah Consultant Cardiologists Consultant Physician 04/11/ /11/2014 Professionally Approved By Dr Duncan Coles 04/11/2014 Version Number 2.0 Issuing Directorate Cardiology Ratified by: DRAG Chairmans Action Ratified on: 14th November 2014 Trust Executive Board Date December 2014 Implementation Date 20th November 2014 Next Review Date November 2017 Author/Contact for Information Kathryn Watson. Chief Cardiac Physiologist Policy to be followed by (target staff) All health professionals that may request echocardiograms Distribution Method Intranet & Website Related Trust Policies (to be read in conjunction with) Requesting Echocardiograms, Infection Prevention/Control Policies, Document Review History Version No Authored/Reviewed by Review Date 1.0 Kathryn Watson 27/10/ K Watson/Dr Coles/Dr Clesham/Dr Gamma/Dr Zachariah 04/11/2014 1

2 Index 1 Purpose 2 Equality and Diversity 3 Scope 4. Infection Prevention 5 Staff and Training 6 Inpatient Requests 7 Considerations for requesting an Adult Transthoracic Echo (TTE) with Bubble Study 8 Definitive criteria for an Adult Transthoracic Echo (TTE) with Bubble Study referral 9. Clinical Indications for an Adult Transthoracic Echo (TTE) with Bubble Study 10 Non compliant requests 11 Audit 12. Policy Breaches 13 References 2

3 1. Purpose 1.1 To act as guidance about the process of requesting Transthoracic Echocardiograms (TTE) with Bubble Study and which staff may request them. 1.2 To prevent inappropriate requests for TTE with Bubble Study in order to reduce the waiting time 1.3 To maximise the efficiency of the echocardiography service. 2. Equality and Diversity 2.1 MEHT is committed to the provision of a service that is fair, accessible and meets the needs of all individuals. In accordance with this, the TTE and Bubble Study referral guidelines are based on clinical factors and will not be affected by race and ethnic origin, disability, gender, culture, religion or belief, sexual orientation or age. 3. Scope 3.1 TTE with Bubble Study will be carried out on patients who meet the definitive criteria and clinical indications as outlined in sections 8 and TTE with Bubble Study will be performed by: a qualified cardiac physiologist with proven training in echo and a qualified cardiac doctor trained in performing TTE with Bubble Study a student cardiac physiologist under supervision of a qualified cardiac physiologist with a qualified cardiac doctor trained in performing TTE with Bubble Study. 3.3 In some circumstances the TTE with Bubble Study may be performed by a physician who is trained in echocardiography under the supervision of a qualified cardiac physiologist or by a physician specialising in cardiology who has echocardiography experience. 4. Infection Prevention 4.1 All staff performing TTE with Bubble Study will follow the Trusts Hand Hygiene Policy. The echo probe will be cleaned after each use with a suitable disinfectant wipe. Disposable couch paper will be changed between each patient. 5. Staff and Training 5.1 The Stroke and Cardiac teams were all involved in the production of this document and are therefore aware of the referral guidelines for this test. It will be their responsibility to ensure their staff are aware of the guidelines. 5.2 For other staff, training regarding the requesting of TTE with Bubble Study will be provided via distribution of this policy. 6. Inpatient Requests 6.1 An inpatient TTE with Bubble Study will only be performed as directed by stroke and cardiac consultants if the referral meets the criteria and clinical indications. This 3

4 diagnostic test is predominantly for outpatients as it is a routine test and not performed in an emergency situation 7. Considerations for requesting an Adult TTE with Bubble Study 7.1 Firstly check that a TTE with Bubble Study has not recently been performed. If the report cannot be located in the patient notes it can be accessed via TOMCAT or from the cardiac (echocardiography) department, location A Ensure that the reason for the request is clearly stated and include all relevant clinical details. All requests will be screened. Ambiguous requests or those which fall outside the accepted guidelines will be returned with a cover note explaining why the request was rejected. If a bleep number has been stated then the requester will be informed by telephone also. 7.3 Remember practicalities. Body habitus and significant respiratory disease make transthoracic echocardiogram (TTE) technically difficult. This may result in the study not being performed or it maybe an inconclusive study. 7.4 All request forms must be completed fully with Consultant name, requesting Doctors name and bleep number. 7.5 TTE with bubble study should not be used for monitoring chronic conditions or where the data obtained has no immediate impact on patient management. 8. Definitive Criteria for an Adult TTE with Bubble Study Referral 8.1 Patient must be years old (discretion of Consultants). This is due to the prevalence of Patent Foramen Ovale (PFO) findings within this age group and to conform to criteria set for consideration for PFO closure 8.2 Patient must have been seen by a stroke/cardiac consultant who has made the decision to refer 8.3 Only referrals sent by stroke/cardiac doctors will be accepted 8.4 A full Transthoracic Echo must have been performed prior to the study 8.5 Transthoracic images must be of adequate quality to clearly view chambers and septum 8.6 Patient must have had an abnormal MRI scan 8.7 Patient must be a potential candidate for Patent Foramen Ovale (PFO)/Atrial Septal Defect (ASD) closure if results warrant this 9. Clinical Indications for an Adult TTE with Bubble Study 9.1 Recent crytogenic (ischaemic) stroke when exclusion of other potential causes of cerebral embolism has been achieved (i.e. thrombus, MI) 9.2 Previous septal defect closure when suspecting residual flow 4

5 10. Non-compliant requests 10.1 All requests will be screened for compliance with the criteria/indications listed in sections 8/ All non-compliant requests with be discussed with a Cardiologist before returning to requester Non-compliant requests rejected by the Cardiologist will be returned to the requesting consultant with a cover note informing them of the reason for refusal A list and copy of all returned request forms will be kept in the Cardiac Department for audit purposes 11. Audits 11.1 All TTE with Bubble Study requests will be audited for compliance with this policy. Any inappropriate requests will be labelled not indicated and returned to the referring consultant. All inappropriate requests will be discussed with a Cardiologist before returning to the referring consultant. A record of any such requests will be logged in the Cardiac Department. 12. Policy Breaches 12.1 Any breaches of this procedure that lead to harm to a patient, of any kind, must be recorded promptly on a risk event form (Datix) 13. References Di Tullio, M R (2010) Patent Foramen Ovale: Echocardiographic Detection and Clinical Relevance in Stroke. Journal of American Society of Echocardiography. 23: Nair, S V et. Al (2010) An Audit of Cardiac Physiologist Led Bubble Contrast Transthoracic Echocardiography. European Journal of Echocardiography Supplements 11 (supplement 2), ii106. National Institute for Health and Clinical Effectiveness (2010). Percutaneous Closure of Patent Foramen Ovale for recurrent migraine. IPG NHS Commissioning Board (2013). Clinical Commissioning Policy Statement: Patient Foramen Ovale (PFO) Closure. 5