Astonlee Clinical Director to improve cardiology diagnoses in Milton Keynes practices

20th Jul, 2023

  • Research

Bill Nolan, Senior Clinical Director at Astonlee Veterinary Centre in Milton Keynes, has harnessed CVS Group’s unique Advanced Clinical Service Network to improve the diagnosis of small animal cardiology cases in the city’s practices.

Initial research by Bill found that during an 18-month period, only 10% of dogs and cats that were documented to have a heart murmur had a heart scan (echocardiogram) performed within the same period.

Echocardiographic imaging is the first diagnostic tool veterinarians should use in cardiology investigations. It can provide a wealth of information, including the size and shape of the heart, pumping capacity, location and extent of any tissue damage, and assessment of valves.

Further research by Bill established that common barriers to vets conducting echocardiograms included a lack of expertise and training, a lack of time and the perceived costs.

In order the ensure the best possible care was recommended every time, Bill worked with cardiologist Mark Neall at CVS Group’s Advanced Clinical Service Network to design and host a series of ‘all practice’ talks on the importance of recommending echocardiographic imaging, echocardiographic findings seen with the common cardiac diseases, and how to work up cardiology cases. Colleagues from three CVS practices in the city were invited to attend.

The training focused on three main topics: acquired heart disease in cats, acquired heart disease in dogs and congenital heart disease. Mark outlined the usual presentations for these conditions, and the expected echocardiographic findings, using images and video clips from real case examples. The key outcome from these talks was to empower vets and nurses in recommending heart scans for their patients by improving their knowledge and understanding of the benefits. The talks were interactive with case-scenarios and informal discussion about cardiology. These talks were hosted at Astonlee and made available as online webinars.

As part of the Advanced Clinical Service Network, Mark visited multiple CVS practice sites across South-East England to perform Echocardiography studies in primary practices. Given the large and often time variable caseload, and the associated logistics of having a regular peripatetic practitioner, the sessions also included training for nurses and patient care assistants on how to book in cases, including designation of a dedicated cardiology nurse who would be responsible for liaising between the practice, client and ACSN Cardiologist.

A supporting handout was also created for colleagues which can be easily printed and given to clients during a consultation in which a heart murmur was identified.

To ensure that all colleagues could attend, regular service was closed at each practice and dedicated time set aside during these practice hours for colleagues to join the training sessions. This resulted in eight vets and 11 nurses being present across the week of talks.

Commenting on the training, Bill Nolan said: 

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“Continual development is so vital. It’s better for everyone – our colleagues, clients and patients – as it means we can offer better care. As an industry we need to do better at sharing our learning between primary practices, and providing time in our working week to come together as a team and develop ourselves. It’s not about doing consults flat out for nine hours at a time with the occasional ‘lunch and learn’ in our little free time.

“Learning together at practice during dedicated working hours has been brilliant. At CVS Group we are very fortunate to be able to call upon colleagues at our Advanced Clinical Service Network and regional Hub Clinical Leads to help design and hold these discipline-specific courses. We’ve also been supported centrally, with colleagues given specific training time during working hours. The sessions have been so successful that we will design and hold more on different veterinary disciplines in the coming months. It’s something we now want to embed into our industry culture. This is what our future ‘normal’ should look like.”

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To follow up the sessions and to gauge their success, Bill and CVS Group statistician Imogen Schofield will conduct another survey in six months’ time to see if the number of echocardiographic scans increase as a result.

The echocardiographic sessions follow similar locally-led training by Bill and CVS Group’s Hub Clinical Leads and Advanced Clinical Service Network over the last year, including one on Anaesthesia[i] in 2022, and one on Dentistry[ii] in January 2023.

CVS Group operates across small animal, farm animal, equine, laboratories and crematoria, with over 500 veterinary practices and referral centres in the UK, the Republic of Ireland and the Netherlands. In the last five years the company has invested nearly £80 million in its sites, facilities and equipment, in addition to industry leading training and support, to give the best possible care to animals. For more information about CVS Group visit 

[i] Including a series of workshops on human factors, anaesthetic emergencies, morbidity and mortality discussions, and interactive troubleshooting case scenarios

[ii] Including performing and interpreting dental radiographs and practical sessions on open and closed extraction techniques