{
  "abstract": "Introduction Direct access TTE (Transthoracic Echocardiogram) requesting and interpretation at primary care level is intended to improve access, thereby reducing waiting times and pressure on cardiology clinics, but only works if referrals align with triage criteria and reports translate into clear clinical actions. BSE (British Society of Echocardiography) has clear guidance for primary care detailing when TTE is indicated, highlights low yield scenarios and reinforces BNP/NT-pro-BNP (Brain Natriuretic Peptide) based pathways for suspected heart failure. It also has valve specific guidance for surveillance intervals and criteria for urgent referrals. We evaluated primary care awareness about BSE TTE triage/referral/follow-up guidance and quantified confidence in requesting, triaging and interpreting direct access TTE reports to identify actionable targets for service improvement.Methods An anonymised cross-sectional survey based on the BSE GP (General Practitioner) feedback template was conducted. Survey was distributed to all GP practices using our regional direct access TTE pathway over a one-month period. Responses were analysed using descriptive statistics.Results 50 responses were recorded ( figure 1), all GPs (32 with ≥ 10 years experience). Amongst them, only 27/50 (54%) fully understood the value of TTE in patient assessment (with 23/50 [46%] somewhat understanding). Usefulness of checking BNP/NT-pro-BNP was generally recognised, though 15/50 (30%) did not fully understand its role in heart failure triage. Awareness about available BSE resources was overall quite low. Only 2/50 (4%) were fully aware of the BSE ‘Clinical Indications and Triage of Echocardiography Outpatient requests’ poster; whilst 30/50 (60%) remained unaware and 12/50 (24%) just partly aware. Similarly, only 8/50 (16%) were aware of the clinical conditions in the BSE triage document where a TTE had low clinical yield with 12/50 (24%) being partly aware and 30/50 (60%) completely unaware. Further, only 20/50 (50%) felt confident explaining a rejected TTE request to patients, and just 13/50 (26%) always understood the terminology used in TTE reports. On a scale of 1-10, their confidence in knowing which findings in a TTE report warranted a cardiology referral was modest at best (mean 6.2/10). Majority GPs (38/50 [76%]) requested the inclusion of a cardiologist-guided next-step recommendation in the TTE summary, further highlighting major gaps in familiarity with established guidance on managing common TTE findings.Conclusions Despite established BSE guidance, significant knowledge gaps exist among GPs requesting direct access TTE, along with further communication and reporting limitations. We believe targeted education plus circulation of available resources will reduce low yield requests and improve triage acceptance, thereby reducing downstream workload and improving overall patient care. We will aim to implement these changes to improve service provision.Abstract 441 Figure 1GP direct access TTE service provision survey results",
  "authors": [
    {
      "affiliations": [
        "Salisbury NHS Foundation Trust, Salisbury, United Kingdom"
      ],
      "name": "Balasubramanian Ramgopal"
    },
    {
      "affiliations": [
        "Salisbury NHS Foundation Trust, Salisbury, United Kingdom"
      ],
      "name": "Donna Upson"
    },
    {
      "affiliations": [
        "Salisbury NHS Foundation Trust, Salisbury, United Kingdom"
      ],
      "name": "Kashif Naeem"
    }
  ],
  "title": "441 From knowledge gaps to ignored posters: limited awareness of BSE TTE primary care guidance lowers direct access TTE service efficiency",
  "uid": "81729c3d-4981-57df-a033-7b5d35f199ff"
}