OPEN-ACCESS PEDIATRIC ECHOCARDIOGRAPHY - CHANGING-ROLE AND REFERRAL PATTERNS TO A CONSULTANT-LED SERVICE IN A TERTIARY REFERRAL CENTER

Objectives-To evaluate the changing role of an open-access consultant- led paediatric echocardiography service for the detection and assessme nt of cardiac disease in children. Design-A retrospective analysis com paring two patient groups undergoing echocardiography over two corresp onding six month periods in 1989 and 1994. Setting-A tertiary referral centre. Main outcome measures-Patient demographics, indication for ec hocardiogram, source of referral and findings on scan in new referrals , subsequent follow up arrangements. Results-The total workload increa sed by 51% over 5 years but in 1994 fewer neonates were scanned. Patie nts were referred by hospital paediatricians, community paediatricians , and general practitioners and the number of ''new referrals'' as a p ercentage of the total of patients scanned remained The number of chil dren with asymptomatic murmurs who had ''normal'' echocardiograms incr eased, Fewer patients were referred directly for surgery in 1994, but the number of children referred for interventional catheterisation ros e. Conclusions-Open-access echocardiography has an expanding role in t he tertiary referral centre despite increasing availability of echocar diography facilities in local hospitals and increased demand in local outreach clinics with paediatricians. Asymptomatic murmurs continue to be the single most common reason for referral Of ''new patients'' and many scans are used-to confirm the clinical suspicion of a ''normal'' heart. The appropriateness of using echocardiography as a screening p rocedure must be questioned where it would be more logical to refer on ly the children who present diagnostic difficulty. None the less these data confirm the impression of increasing demands on the paediatric c ardiologist, and thus may be useful in planning consultant services wi thin the specialty.