Imagine that you start to experience unfamiliar chest pains. What would you do? Like most people, you're likely to call or visit your GP surgery and ask for an emergency appointment. The problem is, a majority of surgeries are not equipped to perform any meaningful cardiac diagnostic tests, such as an ECG: instead, you're likely to be referred to a hospital for tests in several days' time.
Now think about the impact this has. You remain anxious and concerned while waiting for your appointment. You may have to travel miles to the hospital or clinic for the test, taking more time off work to do so, perhaps at considerable inconvenience via public transport. You continue to be stressed while waiting for the test results.
This is obviously far from ideal. But anxiety, waiting and inconvenience is the reality for most people with symptoms of chest pain. The complexity of this diagnostic pathway for patients also makes it a costly reality for the NHS.
But why do so many patients have to start on this pathway from primary to secondary care at all, just for simple tests? After all, while symptoms of chest pain could indicate heart problems, they are also just as likely to have other, non life-threatening causes.
Wouldn't it make more sense to be able to assess the patient's cardiac health in a primary care setting, before involving secondary care providers or emergency services? This could mean enormous cost and resource savings for the NHS, easing the burden on already stretched resources; not to mention the benefits to patients.
Immediacy of diagnosis reduces anxiety and tension for patients (and at the same time, makes savings in the economy as a whole: so many working days are otherwise lost to unnecessary health appointments). What's more, identifying and addressing problems at an earlier stage - without several days' wait for a test and its results - means patients receive more timely and preventative support, ensuring optimal care.
Calling up expert help
The most common method of diagnosing cardiac conditions is the ECG. However, as mentioned earlier, most GP surgeries don't have access to ECG machines, or the in-house skills and experience required for accurate interpretation of ECG traces.
This is where a telemedical ECG approach has proven tremendously successful, with take-up by Trusts and practices growing rapidly. A cardiac telemedical service enables a GP or practice nurse to record a full 12-lead ECG using a handheld unit, and then transmit the ECG trace via telephone to a 24-hour monitoring centre staffed by expert cardiac clinicians. When the trace is interpreted (within 2 to 3 minutes), the clinician give the GP or nurse an immediate verbal evaluation, followed by a written report.
In effect, this approach imports the same kind of cardiac expertise found in hospitals into a GP surgery, enabling a full on-the-spot ECG test and assessment for patients and cutting out waiting times for outpatient appointments or hospital diagnostic tests.
Evidence matters
A long-term project, started in 2007 by the Greater Manchester & Cheshire Cardiac and Stroke Network (GMCCSN) has proven the benefits of the telemedical ECG equipment and service both to patients and to the NHS. It has drastically reduced unnecessary outpatient appointments, freeing up secondary healthcare resources, and quickly generating significant, ongoing savings. The service is used by over 150 GP practices in nine PCTs across the GMCCSN, as well as in many in other parts of the country.
The latest results from practices using the service showed that over 90% of patients did not need any referrals to hospital. Even when the telemedical ECG service was used on symptomatic patients, 90% of these did not require a referral, and could be treated in a primary care setting.
It's here that the savings possible with the telemedical service are realised: a single average hospital outpatient appointment costs £155, and a single hospital-based diagnostic test (ECG) is £46 - not including the cost to patients in terms of anxiety, time and travel. The costs of the telemedical ECG service are a fraction of this.
So the benefits are evident. Cardiac telemedicine in GP surgeries realises very significant ongoing cost savings by reducing secondary care referrals and reliance on hospital-based testing. This not only cuts waiting lists, but also gives patients easier, faster access to diagnoses for worrying symptoms of chest-pain, reducing anxiety and inconvenience.
The work done by the GMCCSN also shows how easily this service can be brought into the mainstream of cardiac care pathways across a large population. This helps Trusts ease the burden that cardiac care places on their A&E and outpatients departments - all the while keeping the patients' best interests at heart.