Kirklees - 12 Lead ECG remote interpretation service

The clinical objective of the service is to provide service users access to ECG testing, interpretation and reporting within a primary care setting to ensure prompt diagnosis and condition management.

• The 12 Lead ECG remote interpretation service will be provided by the chosen provider
• The test equipment will be supplied to all GP practices (64) and any branch surgeries requesting them (17) and will be maintained by the service provider
• The ECG tests will be performed by a health care professional in GP surgeries
• Relevant and suitable training in ECG test delivery will be given by the service provider to the practice nurses conducting such testing, circa 160 total
• GPs will perform the initial interpretation of all ECG readings in-practice
• Relevant and suitable training in ECG interpretation will be given by the service provider to GPs carrying out such activity, circa 200 total
• Readings of concern needing more specialist attention will be transmitted to the service provider via an effective, reliable system for swift interpretation and reporting by trained and accredited clinicians at the provider’s remote location
• Interpretation will take account of context, i.e. service user condition, history and medications
• All ECG interpretations will be reported within a timescale determined by clinical need and the ordering clinician, according to a range of options offered by the provider
• In cases in which the ECG reading indicates that a service user is in need of immediate medical attention, the interpreting clinician will contact the ordering clinician as soon as practicably possible and within 30 minutes of receipt of the ECG reading
• Written reports will include an image of the reading and be sent securely in a format compatible with SystmOne and Emis
• The provider will have a system in place to provide the service during General Practice extended hours (earliest 7.00am – latest 9.30pm)

Population to be covered

The service should be available for service users 18 years old and above presenting with:

• Tachycardia
• Bradycardia
• Irregular pulse
• Heart Murmur (significant Aortic Stenosis unlikely with a normal ECG)
• Breathlessness (combined with Full Blood Count and chest x-ray as appropriate)
• Chest pain (not acute)
• Hypertension (as work up of primary prevention)
• Palpitations
• Syncope (even single episodes)
• Family history of Sudden Cardiac Death
• Current palpitation (if not decompensated)
• OR in any circumstances when deemed clinically appropriate

A standard 12-lead ECG should be offered to:

• Adults when atrial fibrillation is suspected (follow NICE's clinical guideline [CG180] on atrial fibrillation)
• People aged 18 and over if they have experienced a blackout (NICE's clinical guideline [CG109] on transient loss of consciousness)
• Adults with recent onset chest pain, in certain instances (NICE's clinical guideline [CG95] on chest pain of recent onset).

For service users presenting with acute chest pain typical of an Acute Coronary Syndrome, practices should contact emergency services (999) immediately.

NICE Clinical Guideline 95 (http://guidance.nice.org.uk/CG95) recommends provision of an ECG within practices for those with chest pain (query acute coronary syndrome), which should be sent to hospital in advance of the service user; however conducting the ECG test should not delay the transfer to hospital.