Supervised echocardiography in internal medicine. An integrated model in a community hospital

Background: The management of patients admitted to an internal medicine ward frequently requires echocardiography, which may often be delayed because of overburdened specialist cardiologist services. The availability of appropriate echocardiography may be improved if internists first perform autonomous echocardiography on their cardiac patients. Our 5-year experience with such a model shows how it can exploit the complementary role of internists and cardiologists. Methods: We analysed data collected prospectively over 5 years, including patient characteristics, indications for investigation, time of execution, echocardiographic findings, incidence of technical failures and incomplete reports, and need for expert consultation, supervision, and review. Results: Out of 6035 admitted patients, 1943 (32%) had a primary cardiac discharge diagnosis and 1158 (19%) underwent transthoracic echocardiography (54% male, mean age 70.2+/-10.3 years). Heart failure, atrial fibrillation/flutter, and chest pain were the most frequent indications (19%, 14%, and 12% of cases, respectively). Technical failure occurred in 31 cases (2.7%) and incomplete information was provided in 127 cases (11%). Valvular and coronary heart diseases were the most frequent echocardiographic diagnoses (27% and 15%, respectively). Expert supervision, consultation, or review was required in 21 of the examinations (1.8%). Conclusion: Internists with training in echocardiography and adequate access to expert consultation can provide timely and clinically profitable echocardiographic information for the majority of their cardiac patients. The improved selection of their referrals allows cardiologists more time to devote themselves to detecting expertise-demanding pathology using special echocardiographic procedures. This integrated model can be applied in various clinical settings.