Table 1

Audit tool to assess compliance with current infective endocarditis service delivery guidelines

Audit toolCompliant
4.1 Endocarditis teams
 Hospital is involved in the care of patients with confirmed or suspected IE and has an IE team.y/n/na
 IE team includes an infection specialist.y/n
 IE team includes a cardiologist.y/n
 IE team includes an accredited specialist in echocardiography.y/n/na
 At heart centres, the IE team includes a cardiac surgeon.y/n
 At heart centres, the IE team includes a cardiologist with expertise in adult congenital heart disease.y/n/na
 At heart centres, the IE team includes cardiologists with expertise in the removal of infected implantable cardiac electronic devices.y/n
 Local guidelines for the diagnosis, investigation, and the empirical and directed antibiotic therapy of suspected/confirmed IEy/n
 Weekly IE team review of patients with confirmed or suspected IE (MDT meeting and/or bedside patient review, over and above daily clinical review)y/n
4.2 Endocarditis service infrastructure and support
 IE team in referring centres can transfer patients to a heart centre 24 hours a day 7 days a weeky/n/na
 Operating schedules allow for urgent or emergency surgery in patients with IEy/n/na
IE team at the heart centre has access to specialist advice:
  • Spinal surgery.

  • Neurology.

  • Neurosurgery.

  • Renal medicine.

  • Radiology (with specialist interest in cardiac imaging).

  • Antimicrobial pharmacist.

y/n y/n y/n y/n y/n y/n
IE team has access to on-site
  • Transthoracic echocardiography.

  • Transoesophageal echocardiography.

IE team has timely access (within a week) to
  • MRI.

  • CT scanning.

  • FDG-PET/CT scanning.

y/n y/n y/n y/n y/n y/n
 Substance misuse teams are available to support people who inject drugs and have IEy/n
4.3 Endocarditis referral processes
 All patients with IE at a referring hospital discussed with the IE team at a heart centre to allow decisions regarding treatment and transfer% compliance/na
 Cardiac imaging from all patients included in discussions with IE team at heart centre% compliance/na
 All patients with IE at referring hospitals with ‘red flags’ (box 2) transferred to a heart centre% compliance/na
 Clear point of contact for the IE team (including a dedicated phone line or email address)y/n
 System of alerts based on clinical, microbiological or echocardiographic findings that trigger referral to the IE teamy/n
 Communication system for referral of new patients to/between IE teams in placey/n
 Patients with IE transferred between hospitals accompanied by records detailing their
  Clinical presentation% compliance
  Medical/cardiac history% compliance
  Medications% compliance
  Allergies% compliance
  Microbiological findings% compliance
  Imaging findings% compliance
  Details of all recent antibiotic therapy (including start/stop dates, doses, frequency and route of administration)% compliance
  Vascular access device(s) details (presence and insertion date)% compliance
4.4 Patient follow-up and patient information
 All patients being treated for IE offered written information about the condition.% compliance
 All patients who are discharged following treatment for IE advised of the risk of relapse and recurrence, and how to recognise the symptoms of IE.% compliance
 All patients advised to inform their GP that they have had IE and discuss the need for blood cultures if they have a persistent non-specific feverish illness.% compliance
 All patients with IE offered follow-up in a valve or general cardiology clinic.% compliance
  • GP, general practitioner; IE, infective endocarditis; n, no; na, not applicable; y, yes.