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A review of paediatric cardiology outreach clinics
  1. A Davis1,
  2. W Kelsall2,
  3. R Yates3
  1. 1School of Clinical Medicine, University of Cambridge, Cambridge, UK
  2. 2Department of Paediatrics, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
  3. 3Department of Cardiology, Great Ormond Street Hospital for Sick Children, London, UK

Abstract

Background Paediatric cardiology outreach clinics allow children with congenital heart disease (CHD) to be seen close to their home by visiting paediatric cardiologists, as recommended by the Kennedy Bristol Inquiry1. The British Congenital Cardiac Association (BCCA) has published guidance for outreach clinics, outlining referral process and clinic size2. The aim of this study was to review outreach clinic activity and determine whether BCCA recommendations were met.

Method Clinic letters and appointment history for each patient seen in the outreach clinic between June 2004 and June 2009 were reviewed to determine: reason for attendance; underlying diagnosis; prenatal diagnoses; number of appointments attended; outcome following last appointment attended and clinic size.

Results Over the 61-month study period, 489 patients were seen in the outreach clinic. 257 (53%) were male. 271 (56%) children were followed after surgical or catheter intervention; 167 (34%) children with CHD had not undergone any procedure and were monitored; 35 (7%) children attended for screening in view of family history; 12 (2%) children were reviewed with arrhythmias and 4 (1%) after Kawasaki's disease. The most common diagnosis was ventricular septal defect (113; 23%). 49 (10%) children were diagnosed antenatally with CHD. Overall 272 children (56%) are still seen in the outreach clinic. 15 (3%) are seen in the local paediatric cardiology clinic. 102 (21%) have been discharged; 42 (8%) were transferred to other centres; 42 (8%) were transferred to adult services; 8 (2%) died during the study period and 8 (2%) were lost to follow-up. There were 113 outreach clinics. The median number of patients attending was 14 (range: 7–19). 36 clinics (32%) exceeded the recommended maximum of 15 patients, while seven clinics (6%) had fewer than the recommended minimum of 10 patients. There were a total of 1415 appointments in the outreach clinic. The median number of appointments attended by each child was 2 (range: 1–23).

Conclusion The outreach clinic is well utilised by local families, reducing travel to specialist centres with significant financial benefit. All referrals made to the outreach clinic met BCCA guidance. A significant proportion of the outreach clinics were overbooked, which could have a detrimental effect on patient care. The workload following antenatal diagnosis remains small.

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