PO-0033 Referrals For Echocardiograms In A District General Hospital – Are We On The Pulse?

Abstract

<h3>Background and aims</h3> Echocardiograms are a major resource for diagnosing congenital and acquired heart disease. Paediatricians with special expertise in Paediatric Cardiology are now at the forefront of the paediatric cardiac care service. The aim of this audit was to report on the quality of referrals – investigating the indications for referral, documentation of symptoms and signs. <h3>Methods</h3> The medical notes of 46 children who attended outpatient echocardiogram clinic were retrospectively reviewed (April to June 2012). We looked at indications for referral, documentation of symptoms and signs in the initial referral letters. <h3>Results</h3> 41 out of 46 children attended the clinics, of which 39 sets of notes were available to be reviewed. 22 were new and 17 were follow-ups. The main indications for referral were presence of murmur, family history, congenital heart disease, syndromes and Kawasaki Disease. 16 children were referred because of murmur, 12 of whom were asymptomatic. Half did not comment on grade, position or radiation of the murmur. One-third did not have documentation of femoral pulses, signs of heart failure (crackles on auscultation, hepatomegaly, oedema). <h3>Conclusions</h3> Indications for referral to echocardiogram clinic were appropriate. However, the quality of documentation of basic examination findings was poor. This audit starts a discussion regarding setting the standard for quality of referrals to echocardiogram clinic, and highlights deficiencies in documentation. Recommendations include a standardised pro forma and an emphasis during general practice study days.