Community Partnerships in Pediatric Cardiology

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Imagine the anxiety and uncertainties of having a child whose health has been compromised by a hole in his heart.

Imagine learning there are only 50 pediatric cardiologists in Canada and that the five practising in BC are all located at BC Children’s Hospital (BCCH).

Now imagine having to turn your family’s life upside down, to make arrangements for time off school and work, for child care, for extra financial costs, and to travel maybe as far as 851 km so your child can get the specialized medical care he needs. And not just once, but many times.

If you lived outside the Greater Vancouver area, that was the reality you would have faced until 1994 when the Division of Cardiology at BCCH introduced a new program that flip-flopped service delivery, bringing the specialists to the patients.

A BCCH Pediatric Cardiology Outreach Team comprised of a pediatric cardiologist, a pediatric echocardiographer and a cardiac nurse now take to the road each month, travelling to regional care centres around the province to work in partnership with local pediatric staff to provide care closer to home.

Surrey Memorial Hospital in the Fraser Health Authority in British Columbia is among the destinations of this travelling team. Others include Terrace, Kamloops, the Okanagan, Pentiction, Trail, Vernon and Victoria.

“Pediatric cardiology is a highly technical speciality, completely different than the adult version, and with limited specialists we needed to find a way to optimize the use of available resources,” said Dr. Derek Human, Head, Division of Cardiology, Pediatric Cardiologist, BCCH. “And through closer co-operation and joint consultation we have strengthened cardiology related child health care in BC.”

Diagnostic services, and ongoing cardiac care including post-surgical follow-up and long term monitoring for children with congenital and acquired heart disease are the offerings at these partnership clinics.

“What you get at these clinics is what you’d get at Children’s,” said Dr. Human. “It is not just a catch-up operation or watered-down version of the care that would be received here.”

As well, there is an educational component to the partnerships with educational sessions for the doctors and nurses. “This has fostered a collegial relationship between the outreach team and others in the partnerships.”

Introduced seven years ago in Surrey, the outreach clinic originally piggybacked on the adult cardiology service and now operates in the year-old Children’s Health Centre at Surrey Memorial.

Here the complexion of the program is somewhat different than the other outreach areas, with children not only receiving local care from the clinic, but on-going and sometimes even long term care through the office of Dr. Rob White, the pediatrician involved with Surrey’s partnership.

Ten to 12 clinics are offered each year, with as many as 35 children seen each time, double the number cared for at the other centres. And specialists there have an intricate role on the care team, offering a great deal of variability in care depending on the acuity of the child, Dr. White said.

“Our long term goal is to establish something much more than simply an outreach program here for these children,” he said.

Response to the program has been overwhelming, according to Dr. Human. “It has grown far beyond our initial expectations.”

In its first year, 150 children were seen in the clinics. Now500 children are cared for each year. The numbers equate to a 375 per cent increase in referrals, a 300 per cent increase in clinic days, and a 414 per cent increase in total patient visits.

And Dr. Human said all signs indicate that it will continue to grow in leaps and bounds. They are now negotiating with other isolated groups in the northern Vancouver Island area and the Yukon.

Evaluation of the program paints a picture of discernible success. Not only has it considerably improved accessibility to high quality pediatric cardiac care, it has also proven to be extremely cost effective. It costs the health care system about $100 for each child cared for in the clinic, compared to $1,000 if they travelled to BCCH.

As well, the program has been widely embraced, both by the people served and those who partner to deliver the care. “Lives have been dramatically impacted by significant reductions in emotional and financial burden on families,” he said. “It is cherished by the families we serve.”

“This outreach program has really put the compassion into care delivery for children living outside the Vancouver area,” Dr. White said, adding he has been given direction to use this partnership as a template for all programs to be implemented in relation to high intensity conditions requiring frequent visits.

“We are now just starting to work on a similar oncology program,” he said.

For the Pediatric Cardiology Outreach Team, the next big step is the acquisition of a portable pediatric ultrasound unit. “The unit is small enough to fit into a suitcase and would open up tremendous opportunities for us to go into smaller health care centres,” Dr. Human added.