Summary: The process for arranging an ECG, then interpreting and recording in patient’s record once completed.
Who’s it for: Welcomes Team, GPs and Paramedics (all sites) & Practice Nurses (Knights Hill only)
Arranging an ECG
All sites should refer to a local hospital for ECGs, with the exception of Knight’s Hill (see below) 👇
- Lambeth & Southwark → GSTT Echocardiography or KCH Echocardiography
- Lewisham → UHL Cardiology
Knight’s Hill
ECGs can be done by the Practice Nurse
✅ ECGs are suggested for:
- Hypertension (Checking for Left Ventricular Hypertrophy)
- Palpitations
- Bradycardia or Tachycardia (<60 or >100)
- Non-cardiac chest pain, for completeness
- Checking for AF in a patient with irregular pulse
- Prior to ordering an Echo
❌ We cannot do ECGs for:
- Children <16yrs
- Cardiac chest pain → see Medical Emergency Protocol
- Suspected typical angina, refer to:
- Lambeth & Southwark → GSTT Rapid Access Chest Pain Clinic
- Lewisham → UHL Cardiology
Equipment & Process
Practice Nurse
- Ensure contact details for the patient are up to date, and a chaperone is present if requested (see Chaperones)
- Prepare the machine, ensuring the lead sequence is standard, and is ready for a new recording
- Explain the procedure, obtaining verbal consent
- Ask patient to undress, to expose chest
- Apply electrodes to patient’s skin, cleaning first if visibly dirty
- Ask the patient to remain still, and record
- Print the ECG, and hand to Clinical Admin (if team on site) or Welcomes team (if no Clinical Admin on site) to scan (following process below)
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Processing ECGs
When the patient is referred for a 12-Lead ECG at their local hospital, they will be provided with an unreported print-out of their ECG. We are responsible for interpreting and recording the results.
Patient hands in an ECG
Welcomes Team
- Explain that the ECG will be reviewed by a clinician, and they will be contacted if any action is required
- If no Clinical Admin team on site (Deptford, LMC, Maddock Way, Surrey Docks) → scan ECG and send to generic email, move email to Admin folder
- If Clinical Admin team on site (Penrose, Knights Hill, Nightingale, Kingfisher) → hand ECG to Clinical Admin team to scan
Upload ECG to patient record
Clinical Admin
- If ECG has been handed to you → scan ECG and send to generic email
- Upload ECG to patient’s record and send task to In-House Paramedics Team asking them to review (should be done same day / within 24 hours)
Review the ECG
Paramedic
Check tasks, review and action as appropriate:
- Normal or no significant abnormalities → record in the patients notes using appropriate code
- Abnormalities detected → complete necessary follow-up actions as required (e.g. arrange AMBP, 24 ECG holter) and text the patient to inform them of next steps
- Red flags or severely abnormal findings → call the patient and advise A&E
💬 Send Accurx: ‘Normal ECG’
If unsure of next steps, task to referring clinician to review (do not book an appointment — they may not feel it’s necessary and will decide when they review the ECG themselves)
💬 Send Accurx: ‘Abnormal ECG (low risk)’ or ‘Abnormal ECG (medium risk)’ or ‘Abnormal ECG needing AMBP’