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
- Use the software to save ECG recording to patient’s record, and task requesting clinician to review
- Inform the patient they will be contacted if there is an abnormal result
- Task the requesting clinician to review
- If the requesting clinician is not available, the duty doctor should be tasked
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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
- Hand the ECG to the on-site paramedic or duty doctor to interpret
Interpreting the ECG
Paramedic or Duty Doctor
ECG is normal (or no significant abnormalities):
- Record in the patients notes, alongside the appropriate SNOMED Code
- Pass to clinical admin for scanning
ECG is normal, but still symptomatic:
- Record in the patient notes, alongside the appropriate SNOMED Code
- Refer for further observations (e.g. 24hr monitoring)
- Contact the patient, and ensure the patient is safety netted, and follow-up arranged
- Pass to clinical admin for scanning
ECG is abnormal:
- Record in the patients notes, alongside the appropriate SNOMED Code
- Alert the Duty Doctor, and referring clinician, and action accordingly
- Contact the patient, and ensure the patient is safety netted
- Pass to clinical admin for scanning
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