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 one 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 5 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 minutes, and 8.5 minutes in sessions where pre-recorded videos were transmitted. Mean cost comparisons for telemedicine and face-to-face patients over 14 days and six months follow up showed the telecardiology service to be cost neutral for the three hospitals with infrequently-held outreach clinics (£1,519 versus £1,724 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.