Hospital Physicians Research Articles

Exploring residents and supervisors' workplace learning needs during postgraduate medical education.

To identify the main enablers and challenges for workplace learning during postgraduate medical education among residents and their supervisors involved in training hospital specialists across different medical specialties and clinical teaching departments. A qualitative explorative study using semi-structured focus group interviews was employed. A purposeful sampling method was utilized to invite participants who were involved in postgraduate medical education for hospital specialist medicine at two universities. Hospital physicians in training, also called residents (n=876) and supervisors (n=66), were invited by email to participate. Three focus groups were organized: two with residents and one with supervisors. Due to the COVID-19 pandemic rules prohibiting real group meetings, these focus groups were online and asynchronous. The data was analyzed following an inductive thematic analysis. The following overarching themes were identified: 1) the dual learning path, which balances working in the hospital and formal courses, 2) feedback, where quality, quantity, and frequency are discussed, and 3) learning support, including residents' self-directed learning, supervisors' guidance, and ePortfolio support. Different enablers and challenges for postgraduate medical education were identified. These results can guide all stakeholders involved with workplace learning to develop a better understanding of how workplace learning can be optimized to improve the postgraduate medical education experience. Future studies could focus on confirming the results of this study in a broader, perhaps international setting and exploring strategies for aligning residencies to improve quality.

The Frequency and Risk Factors for COVID-19 Infection among Healthcare Workers in a Large-Scale University Teaching Hospital: A Case Control Study

Objective: This study aims to find out the frequency and risk factors responsible for COVID-19 infection among healthcare workers in a large-scale university teaching hospital. Methods: This case-control study was conducted on 185 healthcare workers sampled from the database of 1309 participants maintained at Dr. Ruth K. M. Pfau Civil Hospital, Karachi. Both the cases and controls were derived from the hospital’s database of COVID-19 Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR) and COVID-19 antibody tests performed on the said population. The participants included were physicians working in the hospital. They were grouped into cases and controls based on the positive diagnostic tests. We administered a simple structured questionnaire over the telephone and face to face for the interview. Statistical analyses were performed on IBM SPSS version 25. Results: The mean age of cases was significantly different than controls [cases (32.7±9.9) vs controls (38.8±10.6), p-value=0.002]. More cases 29/37 (78.3%) were working at a single setting compared to controls 54/148 (36.5%) (P-value <0.001). The use of Personal Protective Equipment (PPE), exposure to COVID-19 patients and experiencing symptoms also had statistical significance with the odds of infection (p-value <0.05). Conclusion: This study concludes that younger age, exposure to a known COVID-19 patient and longer duration of exposure among the hospital physicians is associated with positive COVID-19 results. Therefore, it is imperative that adequate measures be undertaken to limit the exposure to COVID-19 patients in this age group.

A Nationwide Survey on Malaysian Hospital Physicians’ Practices of Intravenous Potassium Chloride Supplementation and Opinions on Premixed Formulation in the Treatment of Hypokalaemia

This study aims to evaluate the Malaysian hospital physicians’ practices of intravenous potassium chloride in the treatment of hypokalaemia and their opinions on using premixed formulation. This was a nationwide online survey using a self-administered questionnaire. The survey link was sent to the practising hospital physicians in Malaysia through email (n = 1,455), Facebook Messenger (n = 2,734) and posted on Facebook as well. A total of 207 responses were received. The physicians were mostly males (63.8%), aged between 30 years old–39 years old (51.2%) and worked in the government sectors (76.8%). The most preferred dosage of potassium chloride for mild, moderate and severe hypokalaemia was 10 mmol (44.4%), 20 mmol (55.1%) and 30 mmol (37.7%), respectively. The mostly chosen infusion rate of potassium chloride for mild hypokalaemia was over 24 h (41.1%) while for both moderate and severe hypokalaemia were over 1 h–2 h (63.8% and 89.9%, respectively). The concentration of intravenous potassium chloride is the main factor (68.1%) which would influence the infusion route choice. Serum potassium monitoring of every 24 h was chosen by 52.7% of the respondents for mild hypokalaemia while every 1 h–2 h was mostly chosen for moderate and severe hypokalaemia (49.3% and 87.4%, respectively). Cardiac monitoring was mostly opted in severe hypokalaemic patients (70.0%). Majority of physicians agreed that a premixed formulation is easier to administer (64.7%) and safer for the patients (51.7%). In conclusion, there were variations in the prescribing practices among Malaysian physicians to treat hypokalaemia. Most physicians were in favour of premixed formulation.

Prevalence of factors contributing to unplanned hospital readmission of older medical patients when assessed by patients, their significant others and healthcare professionals: a cross-sectional survey

Key summary pointsAimTo describe the prevalence of perceived factors contributing to the unplanned hospital readmission of medical patients aged 65 years and above.FindingsPerceived factors contributing to unplanned readmission relate to the patient’s illness and how it is managed. Patients and significant others as well as general practitioners and hospital physicians have low inter-rater agreement and different views on the contributing factors.MessageGeneral practitioners and significant others find it challenging to meet the needs, demands and expectations of patients who are discharged hastily and have not recovered.

Physicians' views on pharmacists' involvement in hospital deprescribing: A qualitative study on proton pump inhibitors.

Clinical pharmacists have a pivotal role in the management of the patient's medication. However, it is necessary to know how pharmacist-mediated deprescribing could be implemented in a hospital setting according to hospital physicians. To explore physicians' views on the involvement of hospital pharmacists in the deprescribing process using the example of PPIs. A qualitative study using two focus groups with hospital physicians was conducted to determine their attitudes regarding deprescribing initiated by the hospital pharmacist. The interviews were recorded and transcribed using the NVivo analysis software. A thematic analysis led to a categorization of all the verbatims. Hospital doctors are reluctant to deprescribe drugs initiated by a colleague and feel that it is the responsibility of the general practitioner (GP), who fails to do so due to lack of time. In this situation, the hospital pharmacist is in the best position to deprescribe because of his/her expertise in drug therapy. This should be a discussion between the hospital pharmacist, the hospital doctor, the GP and the patient. Deprescribing should always be adapted to the patient's context. Hospital physicians are open to a pharmacist-mediated, patient-centred approach to deprescribing as long as the GP is involved.

Study on the value of the prenatal-postnatal integrated management model in the screening, diagnosis, and treatment of fetal heart malformations.

With the development and widespread use of fetal ultrasound and magnetic resonance technology in recent years, approximately 75% of fetuses are diagnosed prenatally with congenital structural malformations, a serious birth defect that endangers the life and health of the newborn. In this study, we aimed to study and analyze the value of the prenatal-postnatal integrated management model in the screening, diagnosis and treatment of fetal heart malformations. All pregnant women who were to undergo delivery in our hospital between January 2018 and December 2021 were recruited as the first subjects in this study, and after excluding those who refused to participate in the study, a total of 3,238 cases were finally included as subjects of this study. All pregnant women were screened for fetal heart malformations using the prenatal-postnatal integrated management model. Maternal files were established for all cases of heart malformations, grading the fetuses according to their heart disease grade, observing and recording their deliveries, treatment results and follow-ups. After screening for heart malformations using the prenatal-postnatal integrated management model, 33 cases of heart malformations were identified, including 5 cases of Grade I (all delivered), 6 cases of Grade II (all delivered), 10 cases of Grade III (1 induced), and 12 cases of Grade IV (1 induced); 2 cases of ventricular septal defect healed spontaneously after delivery, and 18 infants were treated accordingly. The results of the later follow-up showed that 10 children had normalized their heart structure, 7 cases had slight alterations in the heart valves, and 1 case died. The prenatal-postnatal integrated management model is a multidisciplinary cooperation model with certain clinical value in the screening, diagnosis and treatment of fetal heart malformations, which is beneficial to comprehensively improve the ability of hospital physicians in the grading management of heart malformations, detecting fetal heart malformations early and predicting fetal changes after birth. It further reduces the incidence of serious birth defects, conforms to the development trend of the diagnosis and treatment of congenital heart diseases, enables to reduce child mortality with timely treatment, effectively improves the surgical prognosis of critical and complex congenital heart diseases, with a promising application prospect.

Pediatric Inpatient Leaders, Views Changed with COVID-19: A Call to Re-engage in Quality Improvement.

Pediatric Inpatient Leaders, Views Changed with COVID-19: A Call to Re-engage in Quality Improvement.

How German vascular surgeons and angiologists judge walking exercise for patients with PAD.

Background: To determine the physician's perspective and perception on walking exercise as well as barriers in guideline-directed best medical treatment of patients with lower extremity peripheral arterial disease (PAD). Patients and methods: All members of the German Society for Vascular Surgery and Vascular Medicine and of the German Society for Angiology - Society for Vascular Medicine with valid email address were invited to participate in an electronic survey on walking exercise for treatment of intermittent claudication that was developed by the authors. Results: Amongst 3910 invited participants, 743 (19%) provided valid responses (33% females, 84% vascular surgery, 15% angiology). Thereof, 65% were employed by non-university hospitals, 16% by university institutions, and 18% by outpatient facilities. A mean of 14 minutes were spent per patient to counsel and educate, while only 53% responded they had enough time in everyday clinical practice. While 98% were aware of the beneficial impact of structured exercise training (SET) on pain free walking distance and 90% advise their patients to adhere to SET, only 44% provided useful guidance to patients to find local SET programmes and merely 42% knew how to prescribe SET as service that can be reimbursed by medical insurances. Approximately 35% knew a local SET programme and appropriate contact person. Health-related quality of life was assessed in a structured way by only 11%. Forty-seven percent responded that medical insurances should be responsible to implement and maintain SET programmes, while only 4% held hospital physicians responsible to achieve this task. Conclusions: This nationwide survey study amongst vascular specialists illustrates the current insufficient utilisation of SET as an evidence-based therapeutic cornerstone in patients with lower extremity PAD in Germany. The study also identified several barriers and flaws from the physician's perspectives which should be addressed collectively by all health care providers aiming to increase the SET use and eventually its' impact on patients with PAD.

A comparison of tertiary level NICU costs for infants born

Human milk-based fortifiers (HMBF) are more costly than bovine milk-based fortifiers (BMBF); but, the efficacy of human or bovine fortification for infants born <1250 g has yet to be fully elucidated. Our objective was to determine the effect of fortifier source on tertiary neonatal costs. Costs associated with tertiary neonatal care, including direct and indirect hospital expenditures, feed-related costs and physician billing were analysed retrospectively for participants of OptiMoM (NCT02137473), a blinded RCT comparing fortifier type for babies born <1250 g. A generalized linear model of cost according to fortifier type was created. Mean [95% confidence interval] daily costs per patient, adjusted for birth gestation and weight, was significantly greater in the human than the BMBF group ($3,452 [$3,186 - $3,740] Canadian dollars (CAD) versus $2,451 [$2,257 - $2,662] CAD) respectively, p < 0.0001). HMBF usage entails additional costs on NICU stay that should be considered with implementation.

Evaluating Outcomes and Time Delays of a Non-Trainee-Driven Hospitalist Procedure Service.

Ultrasound guidance has become standard of care in hospital medicine for invasive bedside procedures, especially central venous catheter placement. Despite ultrasound-guided bedside procedures having a high degree of success, only a few hospitalists perform them. This is because these are usually performed by radiologists or in the setting of trainee-run procedure teams. We sought to determine the impact of a non-trainee driven , hospitalist-run procedure service relative to time from consult to procedure. The University of Alabama at Birmingham Hospital (UAB), Department of Hospital Medicine, trained 8 non-trainee hospitalist physicians (from existing staff) to implement the ultrasound-guided procedure service. This study examines consult to procedure completion time since the implementation of the procedure service (2014 to 2020). Univariate analyses are used to analyze pre-implementation (2012-2014), pilot (2014-2016), and post-implementation data (2016-2018 initial, and 2018-2020 sustained). Results suggest a 50% reduction in time from consult to procedure completion when compared with the period before implementation of the nontrainee hospitalist procedure service. A hospitalist procedure service, which does not include trainees, results in less time lag from consult to procedure completion time, which could increase patient satisfaction and improve throughput. As such, this study has wide generalizability to community hospitals and other nonacademic medical centers that may not have trainees.

Pediatric pain knowledge and attitudes among health care professionals-A National Danish Survey.

To explore and compare Danish health-care professionals' attitudes and knowledge towards pain management of children. The cross-sectional study was carried out using the Pediatric Pain Knowledge and Attitudes Questionnaire. The questionnaire was distributed to all health care professionals caring for children in three hospital settings, including nurses and physicians in departments of pediatric, emergency, and anesthesia and medical laboratory technologists. The study was conducted in 2020 and 765 health care professionals participated. Within the six main categories included in the questionnaire, there were significant differences between nurses and physicians in three subcategories: view on the care of children in pain, using drugs to relieve pain, and the four mandatories. Comparing nurses with medical laboratory technicians, there were significant differences in the subcategory "view on the care of children in pain." Comparing types of clinical departments, there were significant differences in the subcategories' view on the care of children in pain, using drugs to relieve pain, and the four mandatories. Overall, we found that the participating health professionals did not have a uniform understanding of pain management and therefore might treat children differently. The present study highlights the need to align health care professionals' knowledge regarding pain assessment and management of children, as well as the need to develop and test interventions that support the use of knowledge in practice.

Assessment of drug-related problems at the emergency department in older patients living with frailty: pharmacist-led medication reviews within a geriatric care team

BackgroundOlder patients are vulnerable to experiencing drug related problems (DRPs), which may result in emergency department (ED) visits. However, it is not standard practice to conduct medications reviews during ED visit. The aim of this study was to assess the number of DRPs in older patients living with frailty at the ED, identified through pharmacist-led medication reviews within a geriatric care team, and to determine the acceptance rate of pharmacists’ recommendations among hospital physicians and general practitioners or elderly care specialists.MethodsA retrospective observational study was performed in patients ≥ 70 years living with frailty at the ED at Tergooi Medical Center. Pharmacist-led medication reviews were conducted to identify and classify DRPs as part of a larger geriatric assessment. The acceptance rate of given recommendations was determined during follow-up.ResultsA total of 356 ED visits were included. The mean (standard deviation, SD) age of patients was 83 (6.8) years. About 76% of patients had at least one DRP. In total, 548 DRPs were identified with a mean of 1.5 DRP (SD 1.3) per patient. The acceptance rate of medication recommendations in admitted patients was 55%, and 32% among general practitioners/elderly care specialists in discharged patients.ConclusionsPharmacist-led medication reviews as part of a geriatric care team identified DRPs in 76% of older patients living with frailty at the ED. The acceptance rate was substantially higher in admitted patients compared to discharged patients.

Hospital Physicians' Stethoscopes: Bacterial Contamination After a Simple Cleaning Protocol.

Stethoscope surfaces become contaminated with bacteria due to inconsistent cleaning practices,​ as​​ ​​​​cleaning frequency and practical clean​s​ing approaches are not well-established. We investigated bacterial contamination of stethoscopes at baseline, after simple cleaning, and after examining one patient. We surveyed 30 hospital providers on stethoscope cleaning practices and then measured bacterial contamination of stethoscope diaphragm surfaces before cleaning, after cleaning with alcohol-based hand sanitizer,and after use in examining one patient. Only 20% of providers reported cleaning stethoscopes regularly. Before cleaning, 50% of stethoscopes were contaminated with bacteria, compared with 0% after cleaning (p<0.001) and 36.7%after examining one patient (p=0.002). Among providers who reported not cleaning stethoscopes regularly, 58% had bacterial-contaminated stethoscopes compared with 17% who did report cleaning regularly (p=0.068). Hospital providers' stethoscopes had a high probability of bacterial contamination at baseline and after examining one patient. We recommend decontamination with alcohol-based hand sanitizer immediately before each patient examination.

Zum Stand der intersektoralen Behandlung in der HNO-Heilkunde in Deutschland – Ergebnisse einer Umfrage*

The German Healthcare System is currently subject of significant structural changes. Due to politic influences it is obvious that more and more even complex diagnostic and therapeutic procedures will be performed in an office setting or as day treatments. This is due to the high rate of hospital treatments in Germany compared to other OECD countries. A revision of the healthcare system will include both, ambulatory and hospital treatments, which will only be possible with some new structures for this "intersectoral" treatment. Currently there are no data available on the status, possibilities and structure of the "intersectoral" treatment in ENT in Germany. To get an overview on the possibilities for an "intersectoral" treatment in ENT in Germany a survey was conducted. Each chariman of an ENT clinic/Department and all ENT specialists in private practice were contacted and got a questionnaire. The evaluation was performed differently for chairmen of an ENT department, ENT specialists in private practice without and with a ward for inpatients in hospitals. 4,548 questionnaires were mailed. Out of them 493 were filled and came back (10.8%). The return rate in the group of ENT Department chairmen was with 52.9% even higher. "Intersectoral" for physicians in hospitals means that they are usually working with a personal authorization by the local Association of Statutory Health Insurance Physicians, ENT specialists in private practice usually with a ward for inpatient authorization in a hospital. Appropriate structures for an intersectoral organization of patients´s treatment are currently missing. Both, ENT Department chairmen and ENT specialists in private practice declared the current remuneration system for ambulatory and day surgery as completely inaedequate and is urgently to be revised. Beside this, ENT Department chairmen declared problems with the emergency care of patients with complications operated on outside the hospital, problems with the continuing education of residents and with information transfer. They request that hospital specialists should be allowed to work in the contractual medical care of outpatients without a restriction. ENT specialists in private practice mentioned positively the good cooperation possibilities with hospital physicians, knowledge sharing, and wide ranges of indications in the ENT Departments. Negative points could be possible worse information sharing when there is no distinct contact person in the ENT Departments, a possible competitive situation between ENT Departments and specialists in private practice, and sometimes long waiting times for the patients. The German health care system is currently facing a radical reform with the overcoming of traditional rigid and inflexible sectors in outpatient care and inpatient hospital care. To achieve this, the intersectoral patient treatment should play the key role. "Intersectoral" means that the whole process of patient care from diagnosis to therapy is closely interlinked and can also be managed by the same physicians, no matter whether they are working as spcialists in an ENT-Department in a hospital or in private practice. However, currently there are no appropriate structures available to achieve this goal. Beside creating structural conditions for intersectoral treatment the current remuneration system for outpatient procedures and dayclinic treatments must be renewed in a way to cover all the costs. Further conditions are the development of good cooperation models between ENT Departments and specialists in private practice, and the possibility for hospital ENT physicians to work in the contractual medical care of outpatients without a restriction. Intersectoral patient care must take the quality management, the continuing education of residents and the patient safety under consideration.

Impact of Burnout on Self-Reported Patient Care among Resident Physicians in Suez Canal University Hospitals

: Emotional exhaustion (EE), depersonalization (DP), as well as a diminished sense of personal accomplishment (PA) was identified as the three subscales defining the burnout syndrome, all of which contribute to a person's inefficiency on the job. More than half of all physicians experience severe burnout.

Barriers and facilitators to improving patient safety learning systems: a systematic review of qualitative studies and meta-synthesis

BackgroundThe implementation and continuous improvement of patient safety learning systems (PSLS) is a principal strategy for mitigating preventable harm to patients. Although substantial efforts have sought to improve these systems,...

Comparison of Abbreviation Usage Practices in Two Philippine Tertiary Hospitals and Perceived Effects on Medical Training

Objectives. To (1) compare abbreviation usage practices in the Doctors’ Orders and History Sheet in two tertiary hospitals in Cebu City, namely, Cebu Velez General Hospital (CVGH) and Vicente Sotto Memorial Medical Center (VSMMC); (2) determine why medical students and physicians use abbreviations and (3) determine the perceived effects on medical student training.&#x0D; Methods. This is a descriptive cross-sectional study utilizing medical chart reviews as well as group and key informant interviews. Stratified Random Sampling with Proportionate Allocation was used to select 100 charts each from CVGH and VSMMC. Purposive sampling was done for key informants.&#x0D; Results. All patients' clinical history, physical examination and doctors’ orders in all departments of both hospitals contained abbreviations. First initialization was the most common form, e.g. BP (blood pressure). Non-universally-accepted abbreviations were common, e.g. HFD (heredofamilial disease). Potentially dangerous abbreviations were noted, e.g. d/c, D/C. Abbreviations were used to maintain patient-doctor confidentiality, save space and time, and for convenience. Perceived effects on medical training included speeding up of task performance.&#x0D; Conclusions. Use of abbreviations in medical charts among medical students and physicians in both private and public tertiary hospitals in the Philippines is a prevalent practice. While such has its perceived benefits, it also poses potential danger to patients because not all abbreviations are understood and used the same way. Medical schools and their training hospitals must initiate moves to standardize the use of abbreviations in medical education and promote awareness of their potential dangers.&#x0D; The authors suggest that potential dangers/benefits of abbreviations be formally introduced in medical school as a separate topic.

Public views on healthcare workers' burnout before and during COVID-19: A comparative study.

Understanding burnout among nurses and physicians may mobilize public support for increasing budgets, personnel, and trust in both routine and pandemic times. The study aimed to examine public views of nurse and physician burnout both before and 1 year after the COVID-19 outbreak. This study was conducted in two phases in a pre-post design. The general public (a random sample) responded to a structured questionnaire with 1-2 open-ended questions: (a) before the COVID-19 pandemic, in 2019 during routine life (n=504) and (b) 1 year after the COVID-19 outbreak, in 2021 (n=500). Quantitative and qualitative data on public perceptions of nurse and physician burnout, its sources and consequences, were collected. The public view was that hospital physicians and even more so hospital nurses suffer from higher burnout than those working in the community, and that this worsened during the pandemic. Three themes related to caregiver burnout were identified: (a) work overload, (b) lack of sensitivity, empathy, and motivation, and (c) impaired ability to provide quality care. The public is aware of the experiences of caregivers both in times of routine and in emergency. Healthcare management must influence public opinion in order to receive support for organizational steps. Healthcare leaders should leverage public support in order to receive backing for organizational moves aimed at improving work conditions and, in turn, the quality of care and patient outcomes.

Perceptions, attitudes, and practices of a Belgian teaching hospital's physicians, pharmacists, and nurses regarding antibiotic use and resistance: survey towards targeted actions for Antimicrobial Stewardship

ObjectivesThis study aimed to identify barriers to the proper use of antibiotics by healthcare professionals and to help the hospital Antimicrobial Stewardship develop suitable actions for the staff.MethodsIn a Belgian teaching hospital, a survey was conducted among physicians, pharmacists, and nurses involved in antibiotherapy. Questions from the 2019 European Center for Disease Prevention and Control (ECDC) survey were analyzed based on components of the COM-B model (capabilities, opportunities, and motivations). First, collected data were reviewed with the Ethnos software to analyze the different COM-B model components. For statistical analyses, responses were grouped into three clear-cut answers in a Fisher’s exact test.ResultsOverall, 400 staff members were included. We found that our professions, combined, have a good perception of antibiotic resistance (97.8%). For capabilities, however, only 77.2% state that they have sufficient knowledge, with 91.3%, 71.5%, and 63.0% for physicians, nurses, and pharmacists, respectively. For opportunities (access to resources, information, and training), it is observed that 72.2% report having easy access to the guidelines they need to manage infections. In comparison, for 64.2% of the respondents, this information changed their opinion on the useless or inappropriate prescription, administration, and delivery of antibiotics. For 55.0%, this information has enabled them to change their practices. Finally, for motivations, 92.8% of respondents state that they know about the link between their practices and the emergence and spread of antibiotic resistance. However, only 65.0% of participants say they have a role in managing antibiotic resistance. We found that 5 out of 8 questions are significantly dependent on the profession: 2 inquiries related to capability, 1 to opportunity, and 2 to motivation.ConclusionWe found that responses to the ECDC questionnaire are related to the profession. While some topics are universal/cross-functional, others must be explicitly tailored to each professional category. Information is useless if not accessible. Communication and provision of documents are thus paramount.

Echocardiography in telemedicine: a possible solution for containing waiting lists in cardiology

The length of waiting lists in Italy for outpatient cardiology investigations provided by the National Health System is a serious dysfunction. The shortage of physicians in hospitals makes it difficult to solve this problem by drawing on internal resources. The waiting list at Valduce Hospital in Como for outpatient echocardiographic examinations was 12 months at the beginning of 2018. Therefore, we experimented a new way to deal with this inefficiency. Starting in February 2018, we have undertaken in Valduce Hospital a partnership between the Department of Cardiology and an external startup (Ecocardioservice LLC) which guarantees for outpatients on-site performance by sonographers of echocardiographic examinations that are subsequently reported remotely via telemedicine by experienced cardiologists. From February 12, 2018 to July 7, 2022, 20 782 examinations were carried out by this mode. The waiting list was reduced from 12 months to 15-20 days. A new diagnosis or a significant change in pre-existing pathology were detected in 3466 patients well in advance of previous timelines. In 5640 patients we found a known stable pathology. Of the 8926 patients with pathologic examination, 3706 patients were taken over by the Cardiology Department for subsequent investigations, possible hospitalization and, when necessary, interventional or cardiac surgical procedures on an elective basis in 2636 cases (71%) and on an urgent basis in 1070 cases (29%). In our experience, a system in which echocardiograms are performed on-site by sonographers and then reported in telecardiology by cardiologists outside the facility makes it possible to meet the demands of the local area and free up internal resources. This organization allowed to bring outpatients waiting lists for echocardiography back within acceptable limits and to intercept early a significant proportion of patients with need for further investigations or procedures.