GPs are diagnosing and treating complex medical conditions, such as heart disease, more than ever before. The shift from hospital-based care to medicine in the community allows patients to be managed locally, gives GPs an even greater role in medical management and is cost-effective.
With this complex role, the primary care team requires training, knowledge and diagnostic equipment that is reliable, accurate and easy to use.
Palpitations, syncope, chest discomfort and breathlessness are common presentations of cardiovascular disease and suspicion of arrhythmia, CHD, structural heart defects and heart failure require further investigation.
ECGs are easy to perform in the surgery and, if used correctly, can provide the clinician with a vast amount of information, that might reduce referral rates and streamline the patient pathway and improve patient experience.
For example, arrhythmias may be captured and documented on a 12-lead ECG. Paroxysmal arrhythmias, by definition, are often elusive. The ability to document the rhythm while the patient is experiencing palpitations can make a huge difference to their management. ECG documentation of AF is rewarded in the latest quality targets.
You should not wholly rely on the automated computer interpretation.
If you cannot safely interpret the ECG, there are courses available or, indeed, faxing them to your local cardiologist with a short covering letter can be invaluable. There are companies that will interpret the ECG for you at a cost.
It is clear that every general practice should have an ECG machine. The question is, which unit should you go for? The Welch Allyn CP100 is one of the latest and has a number of key features that make it a leading competitor.
Ease of use is vitally important. It took me less than five minutes to unpack the machine from its carry case, plug in the power cord and well-designed cable housing unit and obtain a reading.
Old ECG machines were often cumbersome when the paper needed replacing; this mess-free system uses thermal paper that takes a few seconds to install.
At a reasonable 5.3kg, the unit has a rechargeable battery, making it truly portable. The battery will last for 100 ECGs.
Patient information can be entered via the keyboard and will also be printed on the hard copy. Information such as clinical history and medication can also be entered, making life far easier when reporting ECGs without the patient's notes.
If there is a poor contact, the machine will indicate via its integrated LCD which lead is at fault, improving efficiency and reducing frustration.
The ECG leads can be presented in a number of different formats. Rhythm strips can also be taken. Multiple copies can be printed using the menu-driven software, rather than having to photocopy them.
If preferred, the ECGs can be downloaded to a secure digital memory card and then transferred to a PC. Using Welch Allyn's Cardioperfect software, the ECG can be analysed in more detail, measurements can be taken and the ECG can be emailed either as an ECG file or an image file.
ECGs can be attached to patients' records as image files at the touch of a button, eliminating the need for paper storage and allowing for the instant retrieval of the image when required.
Computer-generated ECG interpretation is optional. Other settings include the muscle and wandering baseline filters.
Welch Allyn has done well on this one. The CP100 is easy to use, provides clear and crisp images and allows the data to be stored in electronic format. Along with a three-year warranty, it comes with an array of features which help make life easier. This is a machine well worth considering.
- An independent review by Dr Raj Thakkar, a GP in Woodburn Green, Buckinghamshire
- Equipment supplied by Williams Medical Supplies