Archived: ECG on Demand

Updated 16 September 2019

ECG on Demand is located at Black Barn, Cornwells Farm, Sheephurst Lane, Marsden, Tonbridge, Kent TN12 9NS www.ecg-od.com. They operate 9am to 5pm Monday to Friday. They are registered to provide;

• Diagnostic and screening procedures
• Transport services triage and medical advice provided remotely.

The services are delivered by a team of four cardiac physiologists, IT and infrastructure lead, web designer, technical solutions specialist, compliance and administrator and overseen by a managing director and GMC registered medical director, leading on clinical governance.

The provider developed their own in- 12-lead ECG reporting software system, workflow management software system, quality assurance application and patient Apps. These are licenced to NHS and private sector primary and secondary care providers.

The service was inspected on 9 July 2019 by a CQC lead inspector. Members of the management and clinical team were interviewed by telephone on 10 July 2019 by a CQC GP specialist advisor.

Prior to the inspection we reviewed the providers website, spoke to the Director of ECG on Demand, reviewed information held on the service. We interviewed staff, conducted observations reviewed documents and received feedback from clients of ECG on Demand.

To get to the heart of patients’ experiences of care and treatment, we asked the following four questions:

• Is it safe?
• Is it effective?
• Is it responsive to people’s needs?
• Is it well-led?

Updated 16 September 2019

We carried out an announced comprehensive inspection at ECG on Demand on 9 July 2019 as part of our inspection and rating of independent healthcare services. Overall the practice is rated good with four outstanding qualities within the caring, responsive and well led domains. The practice was found to be outstanding in well led. We did not rate the caring domain as the provider does not have contact with patients or the public.

The Cardiology service provides remote interpretation of 12-lead ECG and ambulatory ECG Holter analysis (recording heart rate, rhythm and morphology over a period of time) at the point of care. These are conducted for medical centres, hospitals and GP practices in both the NHS and private sector.

This service is registered with CQC under the Health and Social Care Act 2008 in respect of all the services they provide. They operate from two locations in Kent and Bradford.

The principal cardiac physiologist is the registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Our key findings across all the areas we inspected were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents. All opportunities for learning from internal and external incidents were maximised.
• The practice used innovative and proactive methods to improve their assessments of data, working with colleagues and external specialists to identify, develop and embed best practice.
• The provider implemented suggestions for improvements and made changes to the way it delivered services, in response to feedback from staff, clients and external specialists.
• Staff told us they we treated with compassion, dignity and respect. Their professional opinion was valued and they were involved in the development and refinement of services.
• The provider had good facilities and issued, monitored and maintained the integrity of the recording equipment including training staff in its use.
• Information about how to complain was available and easy to understand. Complaints were welcomed, investigated and a detailed explanation provided in response including acknowledging improvements and actions taken.
• Clients reported receiving an excellent service, fast analysis of results and accessible and informed customer and staff support.
• The provider and their staff shared the same clear vision to improve the timeliness and accuracy of clinical assessments. There was a business plan, which was monitored and regularly reviewed and discussed with all staff. High standards were promoted and owned by all practice staff with evidence of team working across all roles.

We saw four areas of outstanding practice:

• The provider offered immediate real-time telephone access for any clinician who was concerned about either an ECG recording or the clinical wellbeing of a patient who was being assessed using this technology.
• The provider had developed a comprehensive continuous rolling Quality Improvement process. This provided the service with peer review and quality assurance of the cardiac physiologists who were responsible for first line reporting on each recording.
• The providers in-house developed decision assistance software has been continuously developed from feedback received from consultant cardiologists and cardiac physiologists.
• The provider had reduced the risk of mismatching test results to the wrong patient by harvesting patient identifiers (NHS Number) directly from the most commonly used primary care electronic patient record systems using its own in-house developed API enabled application. The provider had developed its own API enabled electronic record import tool that checked for a match on NHS number when attempting to attach an ECG report back into the patient record.

Dr Rosie Benneyworth BM BS BMedSci MRCGP
Chief Inspector of Primary Medical Services and Integrated Care