G243 A more efficient regional cardiac network: yes, weccan!

Abstract

Background and aims Outpatient paediatric cardiology services in the West Midlands Children’s Cardiac Network (WeCCaN) consist of cardiology clinics in the tertiary centre and clinics in District General Hospitals (DGHs) run by either Consultant Paediatric Cardiologists (joint cardiology clinics) or by Paediatricians with Expertise in Cardiology (PECs). We aimed to assess the communication between tertiary cardiology, local Paediatricians and PECs and establish whether the cardiac network runs efficiently. Methods We collected data from all patients seen in tertiary cardiology clinics over a period of one month (November 2016). Results In total 1023 patients were seen between 01/11/2016 and 30/11/2016 in 108 Cardiology clinics and 12 specialist cardiac clinics. Age range was 3 weeks-19 years and M:F ratio was 1.3:1. Diagnosis was divided in: simple structural defects (35%), complex structural defects (28%), non-structural heart disease (21%) and acquired/inherited disease (16%). 195 patients were new (12%) and 828 were follow-up (81%). There was no cardiac pathology identified in 66% of new referrals. 369 patients (36%) had underlying non-cardiac comorbidities. Communication to PECs took place in 26% of new referrals and 34% of follow-up patients (postcode in a region with PEC service). Letters to General/Community Paediatrician were sent in 45% of new referrals and 53% of follow-up patients. Looking into disease severity and reasons for referral/follow-up, we concluded that 77% of new and 30% of follow-up patients could have seen a PEC instead of a Consultant Paediatric Cardiologist. Conclusions Communication between tertiary Cardiology and PECs is suboptimal: We are currently working towards an information–sharing network, by providing access to our cardiac database for all West Midlands PECs. Communication with Paediatricians is suboptimal: We wish to approach Community Paediatricians and create a working relationship to ensure that all patients with complex heart disease undergo neurodevelopmental surveillance. 2/3rd of new patients and 1/3rd of follow–ups could have seen a PEC. 1 in 6 patients are under cardiac surveillance for acquired/inherited disease: Re–designing cardiac services to include PEC and/or combined nurse practitioner/physiologist–led clinics in the tertiary centre is being discussed to improve efficiency and enhance workforce development.