Managed Care Network for assessment of cardiac problems in children in a district general hospital: A working model

Kuberan Pushparajah ¹, Dorothy Garvie ¹, Ann Hickey ¹ and Shakeel Qureshi ^2*

¹ University Hospital Lewisham, United Kingdom
² Evelina Children's Hospital, London, United Kingdom

^* To whom correspondence should be addressed. E-mail: shakeel.qureshi{at}gstt.nhs.uk.

Accepted 17 May 2006

Abstract

Aim:To assess a model for cardiology assessments in children with suspected heart disease by a general paediatrician with special expertise in paediatric cardiology (PsePC) in the setting of a district general hospital.

Methods:A new monthly 'screening' clinic was established in May 2004 by the PsePC to reduce the burden of new referrals on outreach tertiary paediatric cardiology services. All patients were to have echocardiograms as part of their referral for cardiac assessment. Over a 1 year period (May 2004-April 2005), through audit, we recorded details of referrers, indications for referral, echocardiography assessments along with subsequent management. This was compared with the pattern of patients seen in the joint paediatric cardiology outreach clinics over a 2-year period between May 2003 - April 2005.

Results:In the 'screening' clinic, there were 75 appointments for 65 patients seen in 12 months. Fifty- five of these patients had normal echocardiographic studies. Of the 47 referrals with heart murmurs in asymptomatic children, 4 (8.5%) had structurally abnormal hearts on echocardiographic assessment. All echocardiograms were reviewed by the visiting paediatric cardiologist.

Between the 6-month periods of May 2003 - Oct 2003, and November 2003 - April 2004, the number of new patients with normal echocardiographic studies seen in the paediatric cardiology outreach clinic was 33/106(31%) and 28/110(25.4%) respectively. Following the introduction of the 'screening' clinic in May 2004, the number decreased to 21/99(21%) during the 6 months between May 2004 - October 2004, and 10/102 (9.8%) between November 2004 - April 2005.

Conclusion:The provision of paediatric cardiology services in a hub and spoke configuration is widely accepted, but there is no established ideal model of care. We propose that our model can work effectively in order to identify pathology requiring input of a paediatric cardiologist more appropriately. Paediatricians with specific training in paediatric cardiology are potentially well equipped to provide this basic screening service, combining clinical assessment with echocardiography.

Keywords: echocardiography, heart murmur, manpower, paediatric cardiology, screening

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Howard Bauchner
Arch. Dis. Child. 2006 91: 877. [Extract] [Full Text] [PDF]

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