Since the new streaming device was employed, three major DGHs have been using the facility effectively and frequently. Two regional neonatal units and two general paediatric services together performed 32 telemedicine consultations in seven months during COVID-19 pandemics, and the nature of these transmissions is outlined in Table 3.
Modes of Telemedicine Utilisation in Paediatric Cardiology as outlined below:
1. Emergency diagnosis and management of neonatal and paediatric heart disease
This mode of consultation eased the pressure on local paediatricians and paediatric cardiologists when there was an emergency, by allowing two parties to exchange information and diagnostic evidence instantly between the two distant centres without moving the infant or child to a tertiary centre away from their home. Telemedicine offers significant benefits to the patient, family, and the local medical teams, as well as to the paediatric cardiologists and NHS. The patient can have instant access to specialist opinion, diagnosis can be established earlier, and lifesaving treatment or intervention can be initiated before the arrival of a cardiologist at the patient’s bedside. Parental distress from an unknown heart problem can be alleviated by rapid diagnosis. Local medical teams can enhance their knowledge by developing further skills whilst working in collaboration with paediatric cardiologists. This joint approach leads to improved standards of care at DGHs. The NHS can avoid unnecessary and expensive transfer costs between the paediatric units, resulting in better use of finite healthcare resources. The risk of spreading COVID-19 infection or viral transmission is avoided. During the trial period, 12 ambulance transfers of sick patients were avoided. Transfer of one patient by a specialist transport team is estimated to cost £1,197. Hence, the estimated total saving of £14,364 was made by avoiding transport costs during this study period.
2. Delivering routine, elective, or outpatient consultations during COVID-19 pandemics
Telemedicine has made it possible to deliver routine, elective, or outreach outpatient consultations via telemedicine during the COVID-19 pandemic. As a result, telemedicine prevented unavoidable gaps in the paediatric cardiology diagnostic service provision at times of difficulty.
3. Telemedicine delivered weekly teaching rounds
Nationwide telemedicine-facilitated teaching has been delivered at 6-monthly programmes on every Wednesday morning between 9:00 and 10:00, and continued without being hindered by COVID-19 pandemics. A speciality educational e-curriculum has been followed. Didactic lectures and case discussions have been delivered to a team of at least 10 doctors and nurses in every session. All team members have been given at least one episode of opportunity to deliver a tutorial. External speakers were also invited to give talks on particular subjects. In total, over 24 hours of free CPD meetings and teaching were provided to healthcare professionals during the study period, and over 2000 hours from the start of telemedicine in Paediatric Cardiology. This equates to 48 hours CPD a year for one person, which can be translated to eight conference days. The average cost of attendance to a 3-day conference per person is around £550 nationally and £1000 internationally. Hence, this system provided between £5,500 and £10,000 cost saving per year from the educational budget.
4. Job Interviews
National and international job interviews were made possible by using the telemedicine facility.
5. Telemedicine ward rounds
Weekly telemedicine ward rounds have allowed the patients referred from DGHs to be discussed by referring consultants and the paediatric cardiac specialists, then follow-up arrangements could be agreed. Seamless transfer of care and discharge planning can be delivered.
6. Joint cardiac surgical meetings
Instead of travelling to a surgical centre in Bristol, paediatric cardiac consultants can discuss emergency and routine cases with their colleagues and surgeons. This method does not replace face-to-face meetings, but rather serves as an alternative platform in times of emergencies. This virtual meeting forum can avoid time loss due to travel and reduces the environmental impact of travelling. Travel time can therefore be used in a more effective and productive way, and travel expenses can be avoided. Well over 180 hours of case discussions were delivered. A total of 240 hours of travelling time was saved. 9,600 miles of travelling equates to £3,840 a year cost saving for NHS.
7. Multidisciplinary Teams meetings
Genetics, inherited arrhythmia, structural heart disease, radiology, respirology, and thoracic surgery MDT meetings have been delivered effectively. The development of specialty specific standards with participation of several expert groups across Wales were also made possible.
8. Counselling for congenital heart disease
After diagnosing congenital heart disease in a child at a DGH, the paediatric cardiology specialist can deliver remote counselling to the parents. This technology allowed such specialist activity to be delivered into routine practice in DGHs on 32 occasions in six months.
9. Remote consultation and diagnosis of fetal heart disease
This mode of consultation eased the pressure on local obstetricians, radiologists, radiographers, and fetal cardiologists when there was an abnormal fetal scan finding, by allowing two parties to exchange information and diagnostic quality evidence instantly between the two distant centres. This avoided the need to send pregnant women to a tertiary centre far away from their homes.
10. Counselling of pregnant women for fetal congenital heart anomalies
After diagnosis of a heart defect in their unborn baby, families need counselling by a fetal cardiologist on the severity of the heart problem and the possible outcomes. However, counselling may be delayed for 3-5 days. Telemedicine allows the fetal cardiologist and perinatologist to jointly provide instant counselling together. This alleviates parental stress from any delay in accessing the fetal cardiology opinion.
11. Expanding telecardiology from tele-echocardiography to tele-arrhythmia
The COVID-19 pandemic adversely affected ambulatory arrhythmia investigations for children, therefore urgent acquisition of alternative technology was sought. As a result, numerous wearable watches and ECG plates were sourced from reliable vendors. The purchases were made with the help of citizens as stakeholders, who either set up charitable funds for these specific purposes or sourced the aforementioned portable ECG devices themselves and donated them to the DGHs. This project is subject to another report being prepared for publication.