Quality issues for echocardiography in the community.

Community echocardiography refers to cardiac ultrasound imaging which is requested by, reported to, and acted upon by general practitioners. Mobile laboratories can conveniently take echo technology to the patient in the community and may occasionally be appropriate in a large general practice. More usually, however, this represents an ineYcient use of staV time and resources, as well as exposing fragile and expensive equipment to substantial stresses during movement. Consequently, community echo has become essentially synonymous with open access echocardiography (OAE) using hospital based equipment. In the last few years, many OAE services have been initiated. In a survey of 100 hospitals in 1996, 30 were already providing the service and 21 of these had commenced within the last 12 months. A further 11 hospitals were actively planning this facility. Undoubtedly, in the near future many more hospitals will come under pressure from within and without (general practitioner primary care groups, purchasers, patients) to follow suit. For some, an OAE service would represent a clinically sound and cost eVective initiative, while in others the local community might be better (and more cheaply) served by an alternative arrangement such as a hospital based, rapid access clinic focused on a particular type of problem—for example, heart failure or murmur. This paper aims to review OAE in a way that will help the reader to decide whether it is an appropriate investment for a particular locality and, if so, to outline some of its strengths and weaknesses, allowing a more eVective service to be established.