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Managed Care Network for the assessment of cardiac problems in children in a district general hospital: a working

K Pushparajah1, D Garvie, A Hickey

  • 1Department of Paediatrics, University Hospital Lewisham, London, UK.

Archives of Disease in Childhood
|May 24, 2006
PubMed

Insights

A new screening clinic model effectively identifies children needing pediatric cardiology care, reducing unnecessary referrals. This approach utilizes general pediatricians with specialized cardiology expertise for initial assessments and echocardiograms.

Area of Science:

  • Pediatric Cardiology
  • Diagnostic Echocardiography
  • Healthcare Service Delivery Models

Background:

  • District general hospitals often face challenges managing referrals for pediatric cardiology assessments.
  • Tertiary outreach services can be overburdened by new referrals, impacting efficiency.
  • A need exists for effective initial cardiac screening in children within local hospital settings.

Purpose of the Study:

  • To evaluate a novel model for pediatric cardiology assessments.
  • To assess the effectiveness of a general pediatrician with pediatric cardiology expertise (PsePC) in a district general hospital setting.
  • To determine the impact of a dedicated screening clinic on referral patterns to tertiary services.

Main Methods:

  • Establishment of a monthly pediatric cardiology screening clinic in May 2004.
  • Inclusion of echocardiography for all referred patients.
  • Audit of referrals, indications, assessments, and management over one year (May 2004-April 2005).
  • Comparison with data from joint pediatric cardiology outreach clinics (May 2003-April 2005).

Main Results:

  • The screening clinic saw 65 patients in 12 months, with 55 having normal echocardiograms.
  • Among 47 asymptomatic children with heart murmurs, only four had structural heart abnormalities.
  • Referrals with normal echocardiographic studies to outreach clinics decreased significantly after the screening clinic's introduction (from 31% and 25.4% to 21% and 9.8%).

Conclusions:

  • The PsePC-led screening model effectively identifies pediatric cardiology cases requiring specialist input.
  • General pediatricians with specialized pediatric cardiology training can competently provide basic cardiac screening.
  • This model optimizes resource allocation and appropriateness of referrals to tertiary pediatric cardiology services.
Abstract

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