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G418(P) An audit examining patient flow and the current demand placed on a joint paediatric cardiovascular clinic
  1. E Morton1,
  2. P Thakker2,
  3. A Davies2
  1. University of Nottingham Medical School, University of Nottingham, Nottingham, UK
  2. Nottingham Children’s Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK


Background and Aims With a 51% increase in demand for paediatric cardiology services from 1989 to 1994 [Arch Dis Child 2006;91:11 892–895], a major recommendation of the Paediatric Congenital Cardiac Service review was that a cardiologist from the tertiary centre and the local clinical lead should join to hold outreach clinics, reducing the major strain on tertiary treatment providers. As such, a 61% increase in outpatient clinics over 5 years was reported by Wagstaff et al. [Heart 1998;79:223–224]. It is key that these joint clinics provide the same high standard of care as otherwise provided; thus, the aim of this audit was to ensure that this bi-monthly joint-clinic provides that, and to study the demand currently placed on it.

Methodology 238 patients scheduled to attend the clinic over 4 months from December 2015 to March 2016 were studied retrospectively from patient records, using a pro forma to examine ‘Did not attend’ (DNA) rates, referral routes, requested outcomes v’s actual outcome, investigations undertaken etc.

Results 36 patients were overbooked, with a higher-than-average DNA rate of 25.63%. 212 patients attended for routine follow-up appointments, with 40.66% of patients being seen by a Paediatrician with expertise in cardiology (PEC), and 43.96% seen by a cardiologist. 29% of patients attended had a simple congenital defect, while 17% had a complex congenital defect. 70% of patients were requested to follow-up in the same clinic; 25 fewer patients than requested returned to the clinic between 1–12 months, while 3 patients more than requested returned to clinic >24 months later than their previous appointment. 42.94% of patients seen had an ECG, and 75.71% an Echocardiogram.

Conclusions Although there is a sufficient level of care with a high number of investigations being carried out, this clinic is highly overbooked, predominantly due to the excessive DNA rates and the fact that few patients are discharged back to the PEC. There is an urgent need for more joint-clinics.

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