| Inclusions |
| Trans Thoracic |
| 12 Lead ECG |
| Ambulatory Monitoring Hook-Up |
| Ambulatory Monitoring Analysis |
| Exclusions |
| Treadmill Stress Tests |
| Head Up Tilt Table Tests |
| Contract Echo |
| Transoesohpageal Echocardiography |
| Stress Echocardiography |
| Any patient that would attend on a stretcher |
Stoke-on-Trent Community Diagnostic Centre inclusion and exclusion criteria
| Diagnostic Endoscopy Inclusions: |
| Diagnostic Colonoscopy with Biopsy, 17 years and over / under 90 years |
| Diagnostic Colonoscopy, 17 years and over / under 90 years |
| Diagnostic Flexible Sigmoidoscopy with Biopsy, 17 years and over / under 90 years |
| Flex Sigmoidoscopy Without Biopsy |
| Therapeutic Endoscopic Upper Gastrointestinal Tract Procedures (oral), 17 years and over / under 90 years |
| Diagnostic Endoscopic Upper Gastrointestinal Tract Procedures with Biopsy (oral), 17 years and over / under 90 years |
| Therapeutic Flexible Sigmoidoscopy, 17 years and over (small polyps – level one / 1CM or less) / under 90 years |
| Therapeutic Colonoscopy, 17 years and over (small polyps – level one / 1CM or less) / under 90 years |
| Diagnostic Endoscopic Upper Gastrointestinal Tract Procedures (oral), 17 years and over / under 90 years |
| Trans nasal Endoscopies (TNE’s) 17 years and over / under 90 years |
| Hepatology Exclusions: |
| Liver lesions on imaging |
| Decompensated Liver Disease |
| Endoscopy Exclusions |
| Lower procedures |
| Home oxygen/severe COPD/emphysema |
| Age under 17, over 90 |
| Needs enema prescription not covered by PGD e.g. has CKD, Heart conditions and IBD |
| Frailty |
| Sleep apnoea |
| Recent MI/Stroke (within 3 months) |
| Dual antiplatelet |
| Upper procedures |
| Home oxygen/severe COPD/emphysema |
| Age under 17 over 90 |
| Frailty |
| Sleep apnoea |
| Recent MI/Stroke (within 3 months) |
| Dual antiplatelet |
| Tracheostomy |
| Other exclusions |
| MI in 12 weeks |
| CVA in 12 weeks |
| Patients with bleeding disorders e.g. Haemophillia |
| Patients at risk of a CJD |
| Poorly controlled Epilepsy or recent seizure in last 4 weeks |
| Moderate to severe cardiorespiratory disease where can’t walk 5-meter OR have a saturation rate on air of <92% OR <94% on 2 L of O2. Or any patients on oxygen supplementation. |
| Poorly controlled IDDM resulting in symptomatic hypo or hyperglycaemia or change in antidiabetic medication in 6 weeks requiring gastroscopy or colonoscopy |
| Pregnant patients |
| BMI >35 will be risk assessed by endoscopist on the day as to contraindicate safe sedation (some pts with BMI >35 will not be able to have endoscopy under midazolam) |
| Unstable Angina (occurring frequently and at rest) |
| Oesophageal varices |
| New patients screened for varices if varices found therapy not to be performed & to be referred to UHNM for banding |
| Known varices patients shouldn't be allocated to the CDC |
| Inclusions |
| CT – Contrast and non-contrast procedures |
| MRI – Contrast and non-contrast procedures |
| Projectional Radiography |
| Ultrasound – Full range of US – no interventional procedures |
| Exclusions |
| Interventional procedures / biopsies. |
| Pacemaker patients for MRI. |
| MRI pelvic scans requiring IV hyoscine butylbromide. |
| Like other CDC’s a checklist has been designed to risk stratify CDC activity e.g. contrast naïve patients would not be booked for contrast enhanced CT / MRI scans at the CDC. |
| Patients with a pacemaker |
| Interventional radiology procedures / biopsies etc. |
| Ineligibility for CDC scan appointment due to identified risk factors (previous iodinated/gadolinium contrast reaction, challenging IV access…) – reference will be made to the management of the deteriorating patient SOP. |
| MRI pelvic scans requiring IV hyoscine butylbromide. |
| Patients with significant co-morbidities to be identified during protocolling and triaged at that stage rather than completely excluding – reference will be made to the management to the deteriorating patient SOP. |
| Inpatients |
| Phlebotomy has no exclusions |
| Inclusions |
| Spirometry + Bronchodilator Response |
| Pulmonary Function Tests |
| Fractional Exhaled Nitric Oxide (FeNO) |
| Spot check Oximetry |
| Field Exercise Test – 6MWT |
| Limited Sleep Studies |
| Blood gases |
| CO monitoring |
| Exclusions |
| Thoracic/Abdominal/Brain/Eye Surgery - Any stiches should have been removed, wound site is closed and patient is not experiencing any pain before performing tests. Waiting 6 weeks would be prudent.. |
| Pneumothorax - Most patients should be able to safely perform lung function 2 weeks after treatment, if not in any pain or discomfort. |
| AAA - A large (>6mm) or bulging aneurysm could cause concern for rupture, but for standard AAA’s it is probably safe to perform lung function. If an AAA has grown quickly, it is recommended that this is discussed with vascular surgeon prior to test. |
| Haemoptysis - Prudent to wait until this has resolved, or reason for the bleed has been established |
| Unstable Angina - This is recognised as a serious contraindication (could cause cardiac arrest/serious discomfort). With chronic, stable angina, the use of GTN would be sufficient to avoid symptoms. |
| Severe Hypertension - Lung function should not be performed on patients with severe hypertension (>200mmHg systolic, >120mmHg diastolic) until the patient has been treated with hypertensive drugs. NOTE: New hypertensive drugs can cause dizziness or syncope on forced manoeuvres. |
| Confusion/Dementia - Lung function tests need patient cooperation and understanding. |
| Vomiting/Pain/Acute Diarrhoea - Can cause patient discomfort, submaximal efforts, embarrassment and infection risk. |
| Contagious Disease - i.e. norovirus, TB flu due to infection risk. |
| Myocardial Infarction- Safety data suggests that most patients are stable after 7 days, so lung function can be performed after this time. |