Transthoracic echocardiography: a survey of current practice in the UK.

BACKGROUND: Echocardiography is one of the cornerstones of cardiovascular investigation. The escalating demands on echocardiography services necessitate close examination of how we organize our departments on a day-to-day basis, in order to provide a consistent, high-quality service. AIM: To evaluate current transthoracic echocardiography practice in the UK. DESIGN: National postal survey. METHODS: A questionnaire was sent to the chief cardiac physiologist (CP) of every hospital in the UK with echocardiographic facilities. RESULTS: Three hundred and thirty six echocardiographic departments were identified. One hundred and twenty six (37.5%) completed questionnaires were returned. In 87% of hospitals, CPs both performed and reported over 80% of echocardiograms. Fifty-seven percent of CPs and 22% of doctors performing echocardiography held an accreditation in echocardiography. Only 60% of hospitals had formal criteria that had to be met prior to an operator being allowed to report echocardiograms unsupervised. Fewer than half of hospitals regularly audited their echocardiography service. Both outpatient and inpatient waiting times for echocardiography were highly variable and frequently excessive. Fewer than half of hospitals used modern techniques for assessing diastolic function, mechanical dyssynchrony or severity of mitral regurgitation. CONCLUSION: In the UK, many transthoracic echocardiograms are performed and reported by operators without formally assessed competence. Fewer than half of hospitals regularly audited their service or used modern echocardiographic techniques. Services are likely to be improved by developing and instituting mandatory national guidelines.

Pericardiocentesis practice in the United Kingdom.

BACKGROUND: Pericardial effusions frequently present challenging clinical dilemmas. Whether or not to drain an effusion, and if so by what method, are two common decisions facing cardiologists. We performed a survey to evaluate pericardiocentesis practice in the United Kingdom (UK). METHODS: A total of 640 questionnaires were sent to all cardiologists in the UK Directory of Cardiology in March 2003. RESULTS: A total of 274 (43%) completed questionnaires were returned, 88% from consultants, equally distributed between tertiary referral centres and district general hospitals. More than 1500 procedures were performed, largely using a paraxiphoid approach (89%). Clinical tamponade was the commonest indication for pericardiocentesis (83%). However, the majority of respondents (69%) considered echocardiographic features alone an indication for pericardiocentesis, even in the absence of clinical tamponade. The commonest perceived indications for drainage were right ventricular diastolic collapse and right atrial collapse (69% and 33% of respondents respectively). For guidance, 82% use echocardiography, either alone or with fluoroscopy or the electrocardiogram (ECG) injury trace. 11% employ fluoroscopy alone or with the ECG injury trace. The remaining 11% stated that they would use the ECG injury trace alone or use no guidance. Using the ECG injury trace alone is said by the European Society of Cardiology (ESC) guidelines to offer an inadequate safeguard. Reported complications included ventricular puncture (n = 12, 0.8%) and hepatic damage (n = 4, 0.3%). CONCLUSION: Pericardiocentesis practice varies substantially in the UK. Many cardiologists would perform pericardiocentesis based on echocardiographic features alone. 11% of cardiologists use guidance that is considered inadequate by the ESC guidelines.