hospital queues

Aseth

I got a paper from my doctor to the ECG. He didn't tell me what hospital I can do it(meaning anywhere where suits me).
Does anyone know which hospital may have/tends to have the shortest waiting time?

DrIndy

Depends on where you live. ECG's take less than 5 minutes so waits are normally short.

Vorsprung

Strange that GP practices don't have an ECG machine to be honest.

Thephantomsmask

Give the hospital a ring and find out when their cardiology clinics are on and avoid like the plague as there will usually be a queue those days. Normally though a wait is about 10 to 15 min when a department isn't heaving.

bigjimthefirst wrote: »

Strange that GP practices don't have an ECG machine to be honest.

That can do more harm than good to be honest. One of the hospitals I worked in had several GP's in the area doing their own ecg's. Out of 40+ new patient ecg's I would do on clinic mornings at least 4 or 5 would be patients who had an ecg as part of a routine health check up and denied any symptoms, that the GP said there "might" be an abnormality. Out pops a perfectly normal ecg and the patient is discharged from clinic by the cardiologist. It clogs up the system needlessly.

drzhivago

bigjimthefirst wrote: »

Strange that GP practices don't have an ECG machine to be honest.

Agree with you there jim

drzhivago

Thephantomsmask wrote: »

Give the hospital a ring and find out when their cardiology clinics are on and avoid like the plague as there will usually be a queue those days. Normally though a wait is about 10 to 15 min when a department isn't heaving.

That can do more harm than good to be honest. One of the hospitals I worked in had several GP's in the area doing their own ecg's. Out of 40+ new patient ecg's I would do on clinic mornings at least 4 or 5 would be patients who had an ecg as part of a routine health check up and denied any symptoms, that the GP said there "might" be an abnormality. Out pops a perfectly normal ecg and the patient is discharged from clinic by the cardiologist. It clogs up the system needlessly.

disagree with you there now to be honest
The GP is a general practitioner and most have the skill to read ECG, the problem lies with some of the machines they have not the doctor.

Many machines sold to G practices have interpreting software set to a very sensitive level. This is to ensure that something is not missed. If an ECG done in a practice like that is read by the machine as saying there is an abnormality the GP faces a dilemma, is this a true positive or false positive, even if the patient doesnt have gross symptoms some MI's can be very mild or even silent in Type 2 Diabetics or the elderly

The appropriate course of action is to refer to the specialists if unsure.

consider this another way
Patient comes to cardiology clinic, they have PACS system for radiology, pull up recent xrays and see an abnormality in the shoulder region, they send to the orthopedic clinic for patient to be told its a normal variant of the A-C joint, humeral head etc etc

Is that a reason not to have PACS in a cardiology clinic.

Thephantomsmask

I fully agree that ecg's in the primary care setting can be of great benefit to certain patients and there are many GP's out there that are competent in interpretation, it's the ones who aren't that cause knock on effects for other services. My own GP started offering ecgs recently but not before the whole practice took a refresher course. The computer algorithms used are the same across all manufacturers and are known to be woefully inadequate, hence why rarely anyone bothers to use them in hospitals, it's like expecting an automatic BP machine from Boots to do work to the same standard as a trained operator using a sphyg. If someone is relying purely on a computer to do their interpretation for them without making sure they have a reasonable level of competence in interpretation of common results and troubleshooting artifact then they should either make the effort to get their training up to scratch or not do the test. That applies to any healthcare provider performing any test. While the example I gave is isolated, approx 10% of new referrals from the same group of GPs being overtly normal does raise questions as to waste of resources.

Vorsprung

An apparently abnormal ECG does not require a full referral to a Cardiology clinic, even more so in someone who's asymptomatic. As an intern I often print out an apparently abnormal ECG on someone during the day. There is absolutely no problem with me dropping down to the Cardiology Regs' office with it and asking them to have a quick look, and more often that not it turns out to be fine. Both Cardiology and I would rather that than a full referral.

In my place we have a GP rapid access clinic run by a reg - has turned out to be fairly useful for an abnormal ECG scenario.

drzhivago

Thephantomsmask wrote: »

That applies to any healthcare provider performing any test. While the example I gave is isolated, approx 10% of new referrals from the same group of GPs being overtly normal does raise questions as to waste of resources.

Consider this which becomes more relevant the further up the reg food chain you get, if 100% of the people you see have pathology for the particular clinic or service you run/attend/work for then there are people with pathology whom you are not seeing and the referral criteria are too tight

As a reg in multiple services I have always offered a very open door/phone service to GPS as that is what the tertiary care centre is there for

There is no point being stupid on the phone and refusing to see etc etc, ultimately your colleague is looking for your help, often they will have the patient in the room with them when they phone so what is the point giving them the 3rd degree, I usually ask them if they are free to talk unhindered and if they would like to fax in a request for a clinic that week or the next and I will return the call at the end of their clinic when they have more time to speak.

The corollary is there will be times when you need the GP to do something for you in relation to a patient from a clinic whose bloods were not back and who doesnt have a contact number now that the bloods are grossly abnormal. You will find a much more cordial response if you have offered the same

If we want to talk about waste of resources we as hospital docs should not be casting stones here.

Gps manage many conditions without the need for the multitudes of investigations that us hospital docs rely on

drzhivago

bigjimthefirst wrote: »

An apparently abnormal ECG does not require a full referral to a Cardiology clinic, even more so in someone who's asymptomatic. As an intern I often print out an apparently abnormal ECG on someone during the day. There is absolutely no problem with me dropping down to the Cardiology Regs' office with it and asking them to have a quick look, and more often that not it turns out to be fine. Both Cardiology and I would rather that than a full referral.

In my place we have a GP rapid access clinic run by a reg - has turned out to be fairly useful for an abnormal ECG scenario.

Slightly diferent scenario at the top theer Jim, at least you can collate your ECGS and walk round to the cardiac reg, GP doesnt have the luxury

I do agree that rapid access ECG clinic with good cardiac technician is great as they will often go further if the ECG is abnormal before the reg gets there, works best in smaller units with really tight group of staff

Vorsprung

drzhivago wrote: »

Slightly diferent scenario at the top theer Jim, at least you can collate your ECGS and walk round to the cardiac reg, GP doesnt have the luxury

I do agree that rapid access ECG clinic with good cardiac technician is great as they will often go further if the ECG is abnormal before the reg gets there, works best in smaller units with really tight group of staff

No but the general idea is the same, in that a GP can send someone in for a quick check with the reg in the rapid access clinic, much like what I would be doing by dropping down myself.

Thephantomsmask

drzhivago wrote: »

Slightly diferent scenario at the top theer Jim, at least you can collate your ECGS and walk round to the cardiac reg, GP doesnt have the luxury

I do agree that rapid access ECG clinic with good cardiac technician is great as they will often go further if the ECG is abnormal before the reg gets there, works best in smaller units with really tight group of staff

GP's and small district hospitals can fax ecg's, many departments, including this particular one I mentioned, offer it. It means have a rate ruler handy for intervals as the paper quality is crap but it saves unnecessary referrals. Also, I never once implied that patients should be turned away, once their referred on the become the responsibility of that service. My point is that somebody who cannot say outright what textbook normal is shouldn't be a offering a test, it's not that hard to create a "word picture" of rate, rhythm, intervals, axis etc and make a check point of whether each is within limits instead of relying on an inaccurate computer algorithm. The first step to learning what's abnormal is knowing what is normal. Again, there are many GPs competent at interpretation as they've made the effort to develop their skills. I highly doubt that however that doctors doing ecgs on patients with no clinical presentation or family history, part of a routine health check as most of these patients related to me, have a higher rate of capture of cardiac disorders than GPs who don't perform ecgs and refer based on patient history, especially if merely relying on computer algorithms.

Ostrom

Aseth wrote: »

I got a paper from my doctor to the ECG. He didn't tell me what hospital I can do it(meaning anywhere where suits me).
Does anyone know which hospital may have/tends to have the shortest waiting time?

I go to James' for mine, no waiting. Go straight to diagnostics (beside x-ray reception) and its usually no more than fifteen minutes wait

AmcD

Aseth you didn't say where you are based.
Connolly Hospital in Blanchardstown do ECGs for GP patients who have a doctor's letter Monday-Friday between 9 and 10 am. This may not be helpful if you live in Tipperary.