Rotherham Doncaster and
South Humber
NHS Foundation Trust
To Practice Managers
Doncaster GP Practices
Dear Colleague
Rotherham, Doncaster and South Humber NHS Foundation Trust (RDASH) are new providers for a
rd
direct access 24 hour ECG test from 3 December 2012. The service is delivered by the Community
Cardiac Services team based at Cantley Health Centre. We will be offering this service across Doncaster
at various community locations to improve access and can offer home based tape service to patients
who have difficulty accessing clinics.
The aim of the service is to aid early diagnostics and avoid the need for unnecessary referral to
secondary care, or to support the shift of activity into a primary care setting.
This service will provide a direct access 24 hour ECG test with appropriate clinical interpretation for GPs
who wish to investigate patients at low risk of significant cardiac pathology, who have previously had a
12-lead ECG and for whom they wish to investigate further.
It is up to the GP to determine whether the patient has a level of risk which requires specialist
assessment.
Patients will be included in this diagnostic pathway by their GP if they report symptoms of:





Palpitations,
Irregularity,
Feelings of dizziness,
Light headedness,
“Fainting or falls” (note these patients require a careful assessment of risk of significant problems
warranting urgent specialist assessment.)
Guidance about risk stratification and the proposed pathway is included with the letter, in addition to a
referral form. Referrals can also be received by letter if the same information is included as on the
referral form.
Yours faithfully
Jo Partington
Cardiac Services Lead Nurse
The Pathway Step 1 – GP assessment
The GP should take a history and perform any necessary examination.
Other symptoms which raise clinical concern, should be discussed with an appropriate clinician to decide
if a 24 hour ECG would be helpful or not.
Before referral to a 24 hour ECG service please complete:
 a resting 12-lead ECG
 appropriate blood tests
LOW RISK
consider direct access 24 hour tape
(result reported to GP) or
community palpitations clinic
(arrhythmia nurse assessment plus
interpretation of 24 hour tape with guidance or
onward referral)
Patients who fulfil the following criteria should
initially be treated conservatively:




No history of sustained tachycardia or loss
of consciousness AND
Good exercise capacity AND
No family history of Sudden Cardiac Death
< 40 years AND
Normal cardiac examination AND
normal 12 lead ECG
HIGH RISK
refer to cardiologist as patients with the
following high risk factors are excluded from
this pathway:




Patients with symptomatic
ectopics
accompanied by significant chest pain or
shortness of breath or syncope and preexisting cardiac disease (prior MI, CABG,
adult congenital heart disease) or
significant congestive heart failure
Patients with no prior cardiac history and
an abnormal resting ECG (apart from 1st
degree heart block or RBBB)
Patients with a personal history of loss of
consciousness or a family history of
sudden death < 40 years
Patient with suspected a drug related
phenomenon (e.g. acquired long QT
syndrome)
The Pathway - Referral to the service
Referral details can be sent electronically over a secure NHS email to the RDASH Community Cardiac
services team or faxed to the service basepoint at Cantley Health Centre. The team will arrange an
appointment with the patient to attend for the fitting of a device. See accompanying referral form and
contact details for referral below. The tape result will be transferred electronically to Broomwell
Healthwatch http://www.broomwellhealthwatch.com/index.php using a secure NHS.net address, along
with the original referral form which will be faxed to their safe haven fax machine. The GP will receive an
analysed report back within 48 hours. The patient should be informed of the results by their registered
practice and managed as appropriate.
Referrals can be sent to:
Cardiac Services – 24 hour tape service
Cantley Health Centre
Middleham Road
Cantley
Doncaster
DN4 6EN
Tel 01302 379518
Fax number 01302 379546
Email: rdash.cardiac@nhs.net