The Centre at Bridgwater managed by Somerset Primary Care Trust provides unscheduled urgent care for almost 20.000 patients per year. With only an estimated 5 percent of patients requiring an ECG as part of their clinical assessment, the cardiac monitoring service at Broomwell HealthWatch offers non-cardiology clinicians expert support, enabling them to make more informed clinical decisions and provide robust risk management.
Broomwell's cardiac monitoring and response service has been used for over 600 patients at Bridgwater to date. It has proven to be a vital diagnostic aid for emergency nurse practitioners in both making informed clinical decisions and improving clinical outcomes. The ECG reporting service has also delivered clear cost benefits on a wider cross-Trust scale. It has reduced the number of patient referrals to the local acute hospital, freeing up beds and reducing some of the pressures on the ambulance service and local emergency departments.
Data from a recent 6-month pilot of telemedicine ECG tests by NHS North West, using Broomwell's handheld ECG device and monitoring service, showed 82 percent of patients did not need to go to hospital - neither A&E nor Outpatients - following the test. The report on the pilot projected savings of GBP46 million per year, 90.000 fewer A&E visits and 45.000 less hospital admissions across England.
Mike Paynter, nurse practitioner in emergency care at Bridgwater Community Hospital, stated: "There has been overwhelming support for the service amongst clinicians. Having access to fast, expert advice on sometimes complex cardiac issues is an invaluable aid; crucially it helps us to make informed clinical decisions in order to deliver optimal patient care. A large number of GPs within the area have expressed an interest in joining the service, they see it as an integral part of modern health care provision. I would like to see this type of service rolled out to all minor injury and urgent treatment centres across the country - it brings emergency department standards of diagnostic support into the community."
Bridgwater Community Hospital considered a number of ECG monitoring options in order to extend the services offered at its Urgent Treatment Centre, including faxing 12 lead ECGs to the local acute hospital. After a trial period they opted for the Broomwell monitoring and response service, as it is a dedicated service with leading cardiologists always on hand to give rapid, expert advice, usually within eight minutes of receiving the ECG.
The service has already proven effective in saving lives. Recently, when a patient attended having fallen and sustained a fractured wrist, the nurse practitioner identified a slow heart rate and performed a 12 lead ECG, which indicated a profound bradycardia with heart block. Broomwell's service confirmed the ECG as a complete heart block and the patient was transferred directly to the acute hospital's coronary care unit for pacing. Without this service and the astute observation of the nurse practitioner the heart block could possibly have been overlooked with potentially devastating outcomes.
Mike Paynter continued: "The obviously ill patients are relatively easy to manage, these receive prompt intervention and referral to the appropriate facility; more challenging are those patients with subtle signs and symptoms. This is where Broomwell's expert service is of most benefit. The ultimate clinical responsibility rests with the nurse practitioner managing the patient. All staff are acutely aware that a normal ECG does not exclude a developing myocardial event, and as such all chest pains and collapses are treated cautiously."
The service ties in well with the Department of Health's "chest pain awareness campaign". The early identification of cardiac risk factors and prompt expert cardiology advice on 12 lead ECGs provides a safe and effective clinical service to the local population.
Broomwell Healthwatch gives GPs and other health care professionals access to immediate, expert interpretation of ECGs by experienced cardiology-trained clinicians. 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, it is transmitted as a sound signal by landline telephone or by fax 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, Broomwell staff 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 e-mail or fax for inclusion in the patient record. Because constant communication with the patient's doctor, nurse or paramedic is maintained during the test, the quality of patient care is high.