Authors (including presenting author) :
Lee SF, Wong KC, Ng MW, Mau TY, Ng LK, Lam KC, Lee KL, Lau YK
Affiliation :
Cardiac Diagnostic Laboratory, EDU, Ruttonjee & Tang Shiu Kin Hospitals
Introduction :
Echocardiography (Echo) is a common and important core investigation for patients with various cardiovascular disorders nowadays. The demand is huge and ever rising, eg. Despite over 50,000 elective echo performed annually in the Hospital Authority (HA), the mean waiting time is still over 50 weeks. Moreover, as there is no formal Echocardiography training center in Hong Kong, the standard and practice may vary widely in local hospitals. The training program on Echocardiography for Nurses from HA (Central Committee on Cardiac Service)selected Ruttonjee & Tang Shiu Kin Hospitals (RTSKH)and Prince of Wales Hospital as the Echo training center. The training team included Cardiologists and two principal nurse trainers and started training from 2016.
Objectives :
To provide better support and sustainability to echo patient service and to reduce waiting time, we expanded the role of nurses in providing echo service through dedicated and continuous training.
Methodology :
The training program on Echocardiography for Nurses included 1) Intensive supervised hands-on echocardiography training for HA nurses; 2) Organize echo conference and workshops with live demonstration: a. biannual Echo Hong Kong meeting, b. annual conference and workshop for critical care trainees, ER physicians and anaesthetists respectively; 3) Ongoing 6 week preceptorship program for small group hands-on echo training in cardiac laboratory; 4) Regular training for cardiology fellows, physicians and cardiac nurses to perform trans-thoracic echocardiography (TTE) including image acquisition, interpretation and preliminary report writing. Besides, the cardiac nurses will regularly assist in exercise/ phamachological stress echocardiogram and trans-esophageal echocardiogram (TEE). In addition, the cardiac nurses provide other non-invasive cardiac service like Holter and telemetry analysis, event recording, ambulatory BP monitoring, treadmill test and pacemaker nurse led clinic.
Result & Outcome :
With such intensive and diversified training, 10 nurses were trained to perform echo in 7 HA hospitals. From the non-invasive cardiac diagnostic laboratory of RTSKH, it increased the volume of echo service and halt the progressive increase in waiting time. The number of elective echo performed in RTSKH increased from 1892 in 2013, 2324 in 2014, 2323 in 2015, 2327 in 2016 to 3208 in 2017. This 41% increase in elective volume served was achieved with a simultaneous reduction of elective waiting time, from 33 weeks in 2014 to 26 weeks in 2018. 2 cardiac nurses performed 60% of the elective echo. Cardiologist time in performing elective echo was spared, allowing them to perform other duties, including urgent and emergency bedside echo. The number of such bedside echo was estimated to be 1500 annually. This has contributed significantly in the reduction of elective waiting time when echo was performed more timely during patient acute hospitalization. Through enhancing and training cardiac nurses to perform elective echo and assist in stress echo, TEE and other non-invasive cardiac investigations, more patients can be served timely and elective waiting time reduced despite increasing demand on echo services. Nurses can play a significant contributory role in providing the core echocardiogram and non-invasive cardiology services, as well as in the organised training of related services to improve their quality.
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