Aim The Safe and Sustainable Review of Paediatric Cardiac Surgery will change the way that paediatric cardiology is delivered in the United Kingdom1. Paediatricians working with cardiologists in networks have key roles to play in providing high quality care2. This study reviews the development of local services provided by a paediatrician with expertise in cardiology (PEC).
Methods A retrospective review of paediatric cardiology outpatient activity over an 18-year period (1994–2012) was performed. Clinic numbers and patient attendance data were obtained from the hospital outpatient databases for three clinics: PEC clinic, specialist outreach clinic (SOC) and transition clinic (TC) for patients transferring to adult services.
Results There has been a substantial increase in outpatient activity over the last 18 years with a 93% increase in the total number of patient episodes. The increased activity (Figure 1) has mainly occurred in the PEC clinic with up to 70 PEC clinics annually. The SOC clinic has changed from a monthly clinic to a fortnightly afternoon clinic with a separate morning foetal echocardiography clinic.
The total number of patients seen has increased in parallel with the number of clinics. The 97% increase in new patients shows that increased patient load is not because existing patients are being seen more regularly, but new patients are being added at a consistent rate (Figure 2). The largest increase in new patients seen is in the PEC clinic with almost 65% of the patients being first attenders. Patients with significant heart disease are then seen in the SOC and TC where over 90% of patients are under long-term follow-up.
Conclusion This work clearly demonstrates the extent of expansion of local paediatric cardiology services provided by a PEC and specialist cardiologist over the last 18 years. PECs are ideally placed to deliver a cardiology service at secondary care level and work alongside tertiary centres to optimise workload. A PEC working in “network” can provide the type of care envisaged in the Safe and Sustainable review without overwhelming paediatric cardiologists.
The future of children’s heart services:www.specialisedservices.nhs.uk/safe_sustainable/childrens-congenital-cardiac-services (Accessed January 2013)
Quereshi SA.www.bcs.com/documents/ZBF Outreach_clinic_Paediatric_Cardiology Service_BCCA_document_Oct_2009 (Accessed January 2013)