Page last updated at 08:08 GMT, Monday, 14 April 2008 09:08 UK

'Patients get an instant result'

By Emma Wilkinson
Health reporter, BBC News

Handheld ECG device
GPs send the test to cardiac specialists over the phone

A patient suffering chest pains is a common problem faced by GPs.

It can be a sign of a serious, life-threatening heart attack.

However, in many people, the symptoms will be caused by some other, less worrying, condition.

The only way to get a proper diagnosis is with an Electrocardiograph (ECG) - a machine which monitors the patients heart rhythms, which means a time-consuming trip to hospital.

But a pilot in Greater Manchester and Cheshire of hand-held ECG monitors in GP surgeries has cut the need for hospital referral by 60%.

GPs get an instant read-out but more importantly they can get immediate expert advice from the hospital over the phone.

The technology is simple - they simply hold the device next to the phone line and cardiac nurses at the other end of the line interpret the readings and advise whether the patient needs hospital treatment.

Before you would have sent them to casualty where they would have had to wait for four hours
Dr Jonathan Lieberman

In the first year of testing the technology, almost 2,000 patients avoided a trip to the local accident and emergency department.

Dr Jonathan Lieberman, a GP in Manchester who has been using the hand-held device in his surgery said he sees at least one patient a week who needs an ECG and who previously would have been referred.

"Before you would have sent them to casualty where they would have had to wait for four hours.

"Often you don't think it is a heart attack but you can have that confirmed there and then.

"It means you're not having to waste time.

Patients love it - they don't have to go traipsing off to hospital."

However, if an ECG is negative in a patient with chest pains, they are likely to need further tests for doctors to identify the cause.

Routine tests

The technology also means GPs can carry out routine ECGs in people with long-term heart conditions.

Karen Gibbons, service improvement manager for Greater Manchester and Cheshire Cardiac and Stroke Network, said in other parts of the country there were waits of several weeks for ECG reports to get back to GPs after patients had the test.

"They turn up at the GP and get an instant answer which negates the need for a second GP appointment as well as negating the need for a referral to secondary care," she said

Although the government is keen on this kind of telemedicine as a way of giving patients in rural areas better access to specialists, the results from Manchester show it can be just as useful in the inner city, she added.

"The service has great potential and has demonstrated that if used on a national level it could generate huge savings for the NHS every year."

If rolled out across the country, the service could prevent 432,000 referrals to hospital every year, pilot results suggest.

Results from use of the technology in a separate study in Lancashire and South Cumbria SHA last year predicted that cuts in referrals to A+E could save the 46m per year.

The service is now deployed across 10 PCTs in Greater Manchester with 150 GP practices using the technology.

The British Heart Foundation said the pilot showed telemedicine could be useful for doctors in helping interpret ECGs.

But BHF cardiac nurse, Judy O'Sullivan, pointed out the results did not look at whether patients did better.

"We would like to see a more robust randomised controlled trial, which looks at patient outcome before we can say for certain that this tool leads to better health results for patients with heart disease."

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