G163 A review of the clinical practice of pecs (paediatricians with expertise in cardiology) in the uk

Abstract

Aim To investigate which clinical diagnostic services (including echocardiography) are provided by PECs and to determine the extent and variability of the service support provided for paediatric cardiology in non-specialist district hospitals in the UK. Methods A piloted, structured web-based questionnaire was sent to all contacts on the PECSIG and NICHe databases and to Consultants in the hospitals which were not represented within these databases via an NHS directory. Non-responders were followed up by telephone. Results 177 hospitals were contacted and 141 responses were obtained (80% response rate). In total, 83% (117/141) of the responding non-specialist centres offered a paediatric echocardiography service. Within these hospitals, most of the echocardiography was performed by PECs (79%, 92/117). Support for this service was offered by Consultant paediatricians and/or neonatologists in 30% (35/117) of hospitals. Specialist technicians performed paediatric echocardiography in only 12% (14/117) of the hospitals where this service was available. Overall, 17% (24/141) of hospitals did not offer paediatric echocardiography whatsoever. Most hospitals offered other non-interventional paediatric cardiology adjunct diagnostics services including 12 lead ECG (96%), Holter ECG (91%) and 24-hour ambulatory blood pressure monitoring (74%). Fewer provided long term external cardiac monitoring (54%) and exercise testing (47%). Less than half of hospitals (48%) had dedicated secretarial support for paediatric cardiology, only 14% had dedicated nursing staff and just 7% offered psychological support for patients and their families. Interestingly, 45% of hospitals had neither secretarial nor specialist nursing support for paediatric cardiology. Some form of telemedicine, used for the purposes of paediatric cardiology, was available in 52% (74/141) of hospitals. Where telemedicine was utilised, PACS was the most common form (24%, 34/141). Conclusion There remains some inconsistency in the provision of paediatric cardiology diagnostic services (e.g. echocardiography) at the district level. Development of telemedicine facilities in this field is likely to play an important role in making timely accurate diagnosis and management, and should be a focus for improvement in successive years.