A paediatric telecardiology service for district hospitals in south-east England: an observational study
- 1Health Economics Research Group, Brunel University, Uxbridge, UK
- 2Royal Brompton Hospital, Royal Brompton and Harefield NHS Trust, London, UK
- 3Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
- 4Research Centre for Society and Health, Buckinghamshire New University, Chalfont St Giles, UK
- Robin Dowie, Health Economics Research Group, Brunel University, Uxbridge, Middlesex UB8 3PH, UK;
- Accepted 19 August 2008
- Published Online First 11 September 2008
Objectives: To compare caseloads of new patients assessed by paediatric cardiologists face-to-face or during teleconferences, and assess NHS costs for the alternative referral arrangements.
Design: Prospective cohort study over 15 months.
Setting: Four district hospitals in south-east England and a London paediatric cardiology centre.
Patients: Babies and children.
Intervention: A telecardiology service introduced alongside outreach clinics.
Measurements: Clinical outcomes and mean NHS costs per patient.
Results: 266 new patients were studied: 75 had teleconsultations (19 of 42 newborns and 56 of 224 infants and children). Teleconsultation patients generally were younger (49% being under 1 year compared with 32% seen personally (p = 0.025)) and their symptoms were not as severe. A cardiac intervention was undertaken immediately or planned for five telemedicine patients (7%) and 30 conventional patients (16%). However, similar proportions of patients were discharged after being assessed (32% telemedicine and 39% conventional). During scheduled teleconferences the mean duration of time per patient in sessions involving real-time echocardiography was 14.4 min, and 8.5 min in sessions where pre-recorded videos were transmitted. Mean cost comparisons for telemedicine and face-to-face patients over 14-day and 6-month follow-up showed the telecardiology service to be cost neutral for the three hospitals with infrequently-held outreach clinics (£1519 vs £1724 respectively after 14 days).
Conclusion: Paediatric cardiology centres with small cadres of specialists are under pressure to cope with ever-expanding caseloads of new patients with suspected anomalies. Innovative use of telecardiology alongside conventional outreach services should suitably, and economically, enhance access to these specialists.
Funding: The Department of Health and the Charitable Funds Committee of the Royal Brompton and Harefield NHS Trust funded the project.
Competing interests: None.
Ethics approval: Multi-centre and local research ethics committees approved this project.
Disclaimer: The Health Economics Research Group at Brunel University receives funding from the Department of Health Policy Research Programme. The views expressed in the publication are those of the authors and not necessarily those of the Department of Health.