Referring for echocardiography: When not to test

The COVID-19 pandemic has prompted a reassessment of the traditional pathways and processes involved in the delivery of health care. This is especially true for diagnostic services, which have been profoundly affected during the pandemic as a result of an increase in demand and the reduction in workforce availability that followed staff illness, isolation, and redeployment. This has led to a dramatic increase in the number of patients waiting for key investigations; this is a problem felt acutely by echocardiography services across the UK. The effects of the pandemic have also exacerbated pre-existing tensions for echocardiography services, where an increasing incidence of cardiovascular pathology has not been matched by the number of sonographers trained to perform the scans.1 This presents clinicians and healthcare providers with the potential for significant risk as large numbers of patients wait for a test with no meaningful framework available to easily determine which of them are in greatest need.