title: Trends in pediatric cardiology referrals, testing, and satisfaction at a Canadian tertiary centre.
abstract: Anecdotal and European evidence suggests that outpatient pediatric referrals and their diagnostic testing burden are increasing. We sought to characterize new pediatric cardiology referrals, testing performed, outcomes, and patient satisfaction in a Canadian academic hospital and how these had changed over time. Clinical data were extracted from new outpatient consultations to the IWK Children's Heart Centre between August 1, 2011 and August 17, 2012 and compared with similar local data collected in July-February 2002 using χ(2) testing. Predictors of significant differences were sought using regression analysis. Satisfaction data were collected from a validated patient questionnaire, and 620 new outpatients were evaluated. Organic disease was more likely in younger patients (odds ratio [OR], 2.7; 95% confidence interval [CI], 1.8-4.0) or in patients referred by pediatricians (OR, 2.3; 95% CI, 1.6-3.3). Odds of echocardiography being performed were significantly increased if patients were younger than 1 year (OR, 2.0; 95% CI, 1.3-3.0), were seen at outreach clinics (OR, 1.7; 95% CI, 1.2-2.3), or were referred by pediatricians (OR, 3.7; 95% CI, 2.6-5.3). Cardiologists differed significantly in ordering echocardiograms for referred patients (P = 0.002). The patients referred in the current era have significantly less organic disease than did those in 2002 (27% vs 37%; P = 0.007), but they underwent significantly more echocardiography (58% vs 38%; P < 0.001) and Holter monitoring (12% vs 4%; P = 0.001). Satisfaction results were high and unrelated to diagnostic testing. Pediatric cardiology referrals in Maritime Canada have increased in volume, consistent with changes seen at other centres. This, coupled with changing cardiac investigations, has increased testing burden. Individual cardiologists affected the odds of echocardiography being ordered. Satisfaction with services was high, with no predictors identified.
authors.affiliation: Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Caddell
authors.affiliation: Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada; Cardiology Division, Department of Pediatrics, IWK Health Centre, Halifax, Nova Scotia, Canada.
authors.forename: Kenny K
authors.initials: KK
authors.lastname: Wong
authors.affiliation: Emergency Department, Royal Alexandra Hospital, Edmonton, Alberta, Canada.
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Barker
authors.affiliation: Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada; Cardiology Division, Department of Pediatrics, IWK Health Centre, Halifax, Nova Scotia, Canada. Electronic address: andrew.warren@dal.ca.
authors.forename: Andrew E
authors.initials: AE
authors.lastname: Warren
mesh_terms: D002309:Cardiology / Q000706:statistics & numerical data*; D003935:Diagnostic Techniques, Cardiovascular / Q000639:trends*; D005260:Female; D006331:Heart Diseases / Q000175:diagnosis*; D006801:Humans; D007223:Infant; D008297:Male; D009674:Nova Scotia; D017060:Patient Satisfaction; D012017:Referral and Consultation / Q000639:trends*; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D062606:Tertiary Care Centers