<h3>Introduction</h3> The Emergency Cardiology Service is a front line ANP led, consultant directed, protocol driven, clinical service focused on treating often high acuity patients with a wide range of general cardiac complaints early in their emergency department journey. Our service provides expert consult, diagnosis, and treatment, facilitating early discharge to outpatient ambulatory diagnostics/ANP led Rapid-access Virtual Clinic, or admission for inpatient diagnostics. In the 17 years prior to February 2021, patients determined to have a high pre-test probability of coronary disease based upon their typicality of symptoms, risk profile, ECG and biomarkers, would be discussed with the consultant cardiologist prior to an angiogram being ordered to ensure the test was justified. In 2020, the NMBI expanded the referring scope of practice for nurses referring for ionising radiation to include all medical radiological and other imaging procedures for nurses who had completed a comprehensive post graduate level 8 award, containing both academic and clinical components as set down by NMBI (NMBI, 2020) and contained within SI 256 of 2018. In order to enhance our service, we developed additional standard operating procedures (SOPs) [figure 1], [figure 2] which led to a memorandum of understanding on 6th February 2021 between the consultant cardiology group and radiology department, to allow our cardiology ANP group to refer for coronary angiogram, making our ANP service the first in Ireland to refer for coronary angiogram. <h3>Methodology</h3> A retrospective audit of referrals for coronary angiogram made by the ANP service to the consultant group from February 6th 2021 were audited to ensure adherence to our SOP and SI256 with regards to the principle of justification including: •Have a corresponding signature •Have evidence of prior thorough examination •Have a clear justification •Adhere to local and national protocols •Adhere to radiation safety policies. <h3>Results</h3> 67 in-patient and out-patient coronary angiogram requests were made on McKesson radiology or referred by letter to private rooms by the ANP service between 6th February to date. All coronary angiograms with deemed justified by the practitioner (consultant cardiologist) and subsequently completed. All ANP requests adhered to our SOP and met the standards in relation to the principle of justification set out in SI256. <h3>Conclusion</h3> Our initial experience of cardiology ANP as referrer for coronary angiogram is positive. We have demonstrated that working within our scope of practice framework and standard operating procedures has ensured that all referrals were considered justified by the consultants who ultimately performed the tests. <h3>Implications</h3> Cardiology ANP referral for coronary angiogram has the potential to safely streamline the management of patients across the country provided there is consultant support, adequate training/education and standard operating procedures are in place prior to commencement.