• R Dowie, H Mistry, M Rigby, T A Young, G Weatherburn, G Rowlinson, and R C G Franklin.
• Health Economics Research Group, Brunel University, Uxbridge, Middlesex, UK. robin.dowie@brunel.ac.uk
• Arch. Dis. Child. 2009 Apr 1;94(4):273-7.

ObjectivesTo compare caseloads of new patients assessed by paediatric cardiologists face-to-face or during teleconferences, and assess NHS costs for the alternative referral arrangements.DesignProspective cohort study over 15 months.SettingFour district hospitals in south-east England and a London paediatric cardiology centre.PatientsBabies and children.InterventionA telecardiology service introduced alongside outreach clinics.MeasurementsClinical outcomes and mean NHS costs per patient.Results266 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).ConclusionPaediatric 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.

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