THE VALUE OF ECHOCARIOGRAPHIC ASSESSMENT IN PATIENTS WITH HIP FRACTURES

An audit of fractured neck of femur patients indicated that the delay in acquiring an echocardiogram was delaying surgery (time to echo 5.4 days ± 3.4SD (n=72), time to surgery 7.5 days ± 5.5SD (n=72)). This instigated a change in policy with the introduction of routine ‘targeted’ echocardiography performed by a cardiac technician at the patient’s bedside. A re-audit has demonstrated an improvement in service (time to echo 1.0 days ± 0.7SD (n=96), time to surgery 2.9 days ± 1.9SD (n=118)). A targeted echocardiogram consists of an evaluation of left ventricular function expressed as normal, mild, moderate and severe (left ventricular ejection fraction >50%, 40–50%, 30–40% and A total of 28.4 patient bed days per month were saved following this change in practice, assuming days waiting for echo preoperatively equate to extra days spent in hospital. The total cost saving per month was £4435, based on the cost of routine targeted echocardiography (£10), departmental echocardiography (£60) and bed cost (£155 per night). Expedient surgery within this group of patients should not be compromised by delays in obtaining timely echocardiography. The cost of routine ‘targeted’ echocardiography is low and this change in practice can be justified in both clinical and economic terms.