Telemedicine permits cost effective referral strategies for neonates with congenital heart disease

PURPOSE: To determine if a triage strategy using telemedicine provided cost effective can: for neonates with suspected congenital heart disease, we assessed hospital charges generated at a tertiary care children's hospital by neonates initially referred for real time transtelephonic echocardiography (TTECHO). METHODS: Inpatient and outpatient charges from Children's Memorial Hospital (CMH), a tertiary care children's hospital, were analyzed retrospectively from 3/17/94-11/30/96 in neonates who underwent TTECHO for cyanosis and/or heart murmur between 3/18/94-11/24/95 from the newborn nursery at Northwest Community Hospital, a site 30 miles distant. This allowed a 1 year follow-up period to capture outpatient charges after initial hospital admission. 55 transtelephonic transmissions were received for 52 patients. RESULTS: 17/52 neonates (33%) were found to have congenital heart disease; 6 cyanotic; 5 VSD; 2 PDA; 1 VSD+PDA; 1 RV tumor; 1 complex coarctation of the aorta; 1 LV to aorta tunnel. 7/17 were triaged to CMH for emergent surgery (5 cyanotic, 1 complex coarctation, 1 LV to aorta tunnel), and 2 (unobstructed supra cardiac TAPVD and VSD) were managed at the referring institution and later admitted for elective surgery. Eight patients were triaged to outpatient care (VSD, PDA, RV tumor). Inpatient and outpatient charges for all 17 patients totaled $3,796,158. Total hospital charges for inpatient admissions were $3,719,197. These 9 inpatient admissions subsequently generated $65,727 in outpatient charges for either cardiac or another subspecialty service. The 8 patients who did not require hospital admission as judged at the time of TTECHO generated $11,234 in outpatient charges for CMH. If these 8 patients had been transported to CMH and admitted to the ICU for 1 day for initial diagnosis each would have incurred an average additional charge of $5,300. CONCLUSIONS: Telemedicine has enabled experienced pediatric cardiologists at a tertiary care center to appropriately and cost effectively triage neonates with suspected congenital heart disease born at an outreach site to: transport/urgent intervention; non emergent surgery with care at the outreach site; and outpatient referral in lieu of costly transport/ICU care.