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FOI Request

Disclosure ID
FOI/02865
Request Date
December 14, 2018
Subject
Cardiac Pathways
Description
  1. Any care pathways for the investigation and management of patients with symptomatic palpitations and/or syncope referred to cardiac services in your trust by GPs. Of particular interest is the role and positioning of diagnostic investigations such as cardiac rhythm monitoring, cardiac imaging and cardiovascular performance assessment.
  2. Details of both national and locally negotiated tariff arrangements applied to this service:
  3. Does the GP have direct access to the cardiac monitoring service?
  4. Is the patient seen by a cardiologist before having the monitor attached?
  5. If not, who undertakes the process (e.g. technician, nurse etc)
  6. What is the first pass monitoring technology (e.g. 24hr, 48hr, 7-day event triggered etc
  7. What happens after the first pass monitoring – are all seen by a cardiologist or is there a pre-appointment triage process?
  8. What other tests are ordered (e.g. 12-lead ECG, Echo etc), at which stage in the pathway and for which patients?
  9. What determines who is selected for 2nd pass monitoring and what technology is used for this?
  10. What determines who is discharged back to the GP?
  11. What is the current tariff for 24 hr, 48 hr, 7-day Holter Monitoring:
  12. What is the tariff for referral to community cardiology investigation clinics;
  13. What is the tariff for direct referrals for GPs for 24hr, 48 hr and 7-day Holter Monitoring;

 

Response
  1. Palpitations seen in Electophysiology clinics;

    Nurse led Blackout clinic Pathway for syncope

  2. We apply National Tariffs to these patients
  3. Yes: ECG & BP holter monitoring.
  4. No
  5. For GP open access holters the request are validated by a cardiac physiologist. The patient attends holter clinic and an assistant Cardiac Physiologist fits the monitor. The patient returns their monitor after 24 hours and this is analysed by a cardiac physiologist. Unless there are any urgent findings the report is sent directly to the referring GP.
  6. Depends upon symptoms, but usually 24hr holter.
  7. No
  8. Blackout clinic follow protocols to determine relevant diagnostics.
  9. Blackout clinic patients are discussed with cardiologists of the day.
  10. Protocol Department
  11. Outpatient tariffs applied:

    Electrocardiogram monitoring or stress testing – £126.26

    Electrocardiogram monitoring or stress testing, for Congenital Heart Disease – £149.87

  12. We do not refer to community cardiology investigation clinics
  13. Outpatient tariffs applied:

    Electrocardiogram monitoring or stress testing – £126.26

    Electrocardiogram monitoring or stress testing, for Congenital Heart Disease – £149.87

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