Abstract
An audit of fractured neck of femur patients indicated that the delay in acquiring an echocardiogram was delaying surgery (time to echo 5.4 days ± 3.4SD (n=72), time to surgery 7.5 days ± 5.5SD (n=72)). This instigated a change in policy with the introduction of routine ‘targeted’ echocardiography performed by a cardiac technician at the patient’s bedside.
A re-audit has demonstrated an improvement in service (time to echo 1.0 days ± 0.7SD (n=96), time to surgery 2.9 days ± 1.9SD (n=118)). A targeted echocardiogram consists of an evaluation of left ventricular function expressed as normal, mild, moderate and severe (left ventricular ejection fraction > 50%, 40–50%, 30–40% and < 30%), the aortic valve (normal, non severe aortic stenosis, severe aortic stenosis, aortic regurgitation and aortic gradient). A targeted echo gives less information than a departmental echo where more parameters are measured, however the information provided is enough to guide the anaesthetists choice of anaesthesia and intraoperative anaesthetic management. Senior Echo technicians perform the investigation at the patients bedside on the trauma ward in the mornings of the working week using a portable machine. Each echocardiogram takes 2 to 5 minutes to perform. If obvious significant other pathology is seen, the patient is referred for a full departmental echocardiogram.
A total of 28.4 patient bed days per month were saved following this change in practice, assuming days waiting for echo preoperatively equate to extra days spent in hospital. The total cost saving per month was £4435, based on the cost of routine targeted echocardiography (£10), departmental echocardiography (£60) and bed cost (£155 per night).
Expedient surgery within this group of patients should not be compromised by delays in obtaining timely echocardiography. The cost of routine ‘targeted’ echocardiography is low and this change in practice can be justified in both clinical and economic terms.
Correspondence should be addressed to Editorial Secretary Mr ML Costa or Assistant Editorial Secretary Mr B.J. Ollivere at BOA, 35–43 Lincoln’s Inn Fields, London WC2A 3PE, England; Email: mattcosta@hotmail.com or ben@ollivere.co.uk
