Open-access paediatric echocardiography: changing role and referral patterns to a consultant-led service in a tertiary referral centre.

Tybulewicz, A; Rigby, Michael L.; Redington, A. N.

doi:10.1136/hrt.75.6.632

Cited by 16 publications

(12 citation statements)

References 2 publications

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“…This study is comparable with other studies in developed and developing countries, which showed between 25% to 100% of referrals have normal hearts, which is similar to other studies [3][4][5][6] . The majority of children referred from primary health care providers were asymptomatic with normal hearts as confirmed by echocardiography 3,4 . The small geographic size of The Kingdom of Bahrain makes it easy and rapid access to a tertiary cardiac unit.…”

Section: Discussionsupporting

confidence: 92%

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Referral Patterns to a Pediatric Tertiary Cardiac Unit

Agab¹,

Fudhala²,

Amer³

2016

BMB

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Congenital Birth Defects (CBD) are the leading causes of infant mortality in developed countries. Congenital Heart Defects (CHD) form the major proportion of the CBD. It is estimated that they contribute almost one-half of the deaths due to CBD, both as isolated lesions and as part of other multiple CBD 1. This prevalence of CHD however, remains static despite modern techniques and technology to improve the evaluation of these cases 2. New referrals to tertiary cardiac centers had and continued to increase dramatically despite the static prevalence of CHD 3. Reports reveal that between 25% to 100% of referrals have normal hearts 3,4,5. The continued increase in referrals is due to numerous factors, which include primary care physician's reluctance to diagnose normality without echocardiography and parental demands of echocardiography to confirm normality. This results in extensive usage of societal and personal resources. The cost involved to society is immense and continue to rise.

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Section: Discussionsupporting

confidence: 92%

“…Demands on pediatric cardiology unit continue to increase with reports of >50% increase in the workloads every five years 4 . This increase has a significant impact on clinical care, teaching and research activities.…”

Section: Discussionmentioning

confidence: 99%

Referral Patterns to a Pediatric Tertiary Cardiac Unit

Agab¹,

Fudhala²,

Amer³

2016

BMB

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“…This enabled a five year comparison, and allowed analysis of the most recently available data. As in our previous study,1 five years was thought sufficient to show conspicuous differences while reducing the possibility of bias because of changing local demographics.…”

Section: Methodsmentioning

confidence: 75%

“…This reflects more new patients presenting and more “old” patients to review. It cannot be argued that improved facilities for local monitoring (for example, all the clinics in this study have facilities for echocardiography) have led to a shift of patient referrals away from the tertiary centre, as simultaneously we have reported increased demand within the specialist centre 1. The increasingly large number of new patients is seen at the request of local paediatricians and will inevitably include some with normal hearts, but equally many will have cardiac disease.…”

Section: Discussionmentioning

confidence: 85%

Increasing workload and changing referral patterns in paediatric cardiology outreach clinics: implications for consultant staffing

Wagstaff

Rigby

Redington

1998

Heart

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Objective-To assess the workload of, and referral patterns to, paediatric cardiology outreach clinics to provide data for future planning. Design-Descriptive study of outpatient attendance during 1991 and 1996. Setting-Five district general hospitals with unchanged local demographics and referral patterns during the study period. Methods-Postal, telephone, and on site survey of clinic records and case notes. Results-The number of outpatients increased by 61%, with a consequent increase in the number of clinics held and patients seen in each clinic. The number of patients aged between 10 and 15 years doubled. Conclusion-These data confirm the impression that demands for paediatric cardiology services are increasing. The increased need for attendance at outreach clinics has inevitable consequences for the clinical, teaching, and research activities of specialists in tertiary centres. An increase in the number of paediatric cardiologists, or development of local expertise (general paediatricians with an interest in cardiology), will be required. Furthermore, the increasingly large cohort of older teenagers and young adults with congenital heart disease underscores the need for the development of specialist facilities. (Heart 1998;79:223-224) Keywords: paediatric clinics; workload; congenital heart disease Outreach clinics (specialist paediatric cardiology clinics conducted with paediatricians in local hospitals) are an important part of the workload of the paediatric cardiologist. Patients and families attending a local specialist clinic have less travelling and perhaps better continuity of care. These clinics provide the cardiologist with an opportunity to educate staV, improve local care, and, in the age of purchaser provider health care system, maintain loyalties and possibly increase patient referrals. There are some disadvantages however: local facilities are not always ideal, and as the clinic is usually consultant led, availability for teaching, training, and service commitments is reduced at the tertiary centre. An increase in outreach clinic workload will therefore have wide reaching implications for paediatric cardiology services.The general impression is that workload in paediatric cardiology is increasing. Our recent review of an open access echocardiography clinic held in a special centre showed a large increase in workload over a five year period; the number of patients increased by 51%.This study aimed at measuring the changes in numbers and demographics of patients attending outreach clinics during a similar five year period. Materials and methodsThe three consultants at the Royal Brompton Hospital attend clinics in over 30 diVerent referring hospitals, on average four times per year. Patient attendance at each clinic during 1991 and 1996 in five referring hospitals was analysed. These clinics were chosen because each had well established clinics serving large regional populations, each was conducted by the same local consultant(s), each had unchanged tertiary referral commitments, and da...

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“…In the UK, there are 15 paediatric Cardiology centres supporting approximately 200 District General Hospitals (DGHs) [1]. There is a general impression that the demands at paediatric cardiology outpatient clinic have significantly increased over the previous years due to reasons such as increased pick up rate of asymptomatic cardiac murmurs by medical practitioners and parental demand for reassurance [2,3]. Consequently, the increased workload at tertiary centres has been thought to have an impact on the patient care, teaching and research as senior doctors become unable to undertake these commitments [4].…”

Section: Introductionmentioning

confidence: 99%