title: A paediatric telecardiology service for district hospitals in south-east England: an observational study.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Prospective cohort study over 15 months.
  
  
  METHODS
  Four district hospitals in south-east England and a London paediatric cardiology centre.
  
  
  METHODS
  Babies and children.
  
  
  METHODS
  A telecardiology service introduced alongside outreach clinics.
  
  
  METHODS
  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 1 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 five 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 min, and 8.5 min in sessions where pre-recorded videos were transmitted. Mean cost comparisons for telemedicine and face-to-face patients over 14-day and 6-month follow-up showed the telecardiology service to be cost-neutral for the three hospitals with infrequently-held outreach clinics (1519 UK pounds vs 1724 UK pounds respectively after 14 days).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Health Economics Research Group, Brunel University, Uxbridge, Middlesex, UK. robin.dowie@brunel.ac.uk
authors.forename: R
authors.initials: R
authors.lastname: Dowie
authors.forename: H
authors.initials: H
authors.lastname: Mistry
authors.forename: M
authors.initials: M
authors.lastname: Rigby
authors.forename: T A
authors.initials: TA
authors.lastname: Young
authors.forename: G
authors.initials: G
authors.lastname: Weatherburn
authors.forename: G
authors.initials: G
authors.lastname: Rowlinson
authors.forename: R C G
authors.initials: RC
authors.lastname: Franklin
mesh_terms: D002309:Cardiology / Q000191:economics* / Q000379:methods; D016507:Cardiology Service, Hospital / Q000191:economics*; D002648:Child; D002675:Child, Preschool; D004739:England; D005260:Female; D017721:Hospital Costs; D006767:Hospitals, District / Q000191:economics*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008131:London; D008297:Male; D010372:Pediatrics / Q000191:economics* / Q000379:methods; D011446:Prospective Studies; D019114:Remote Consultation / Q000191:economics*; D013222:State Medicine / Q000191:economics*