6307 The evaluation of local cardiology services for neonates and infants with murmurs

Objectives This quality improvement project (QIP) evaluated the local referral pathway for neonatal murmurs with the aim to improve it. The goal was to safely reduce unnecessary referrals, limit the waiting time and improve triage into cardiology clinics therefore improving patient safety. Methods Retrospective data was gathered from the local online patient database, from the national directory of newborn examination and from clinic outcomes. The selection criteria included well infants under 6 months with an audible murmur referred to paediatric cardiology between August 2021 and August 2022. The data was analysed and presented to interpret factors including; wait time for clinic, final diagnosis, outcome of referrals and the correlation with murmur grade. Results From the total of 52 patient referrals, 11 had significant diagnoses (pulmonary valve stenosis, pulmonary artery stenosis, bicuspid aortic valve, aortic stenosis and ventricular septal defect). The mean wait time for a clinic appointment was 2.4 months. 5 had findings which were followed up over a short time frame (under 6 months). Patients with findings which could be deemed physiologically normal for their age (patent foramen ovale and patent ductus arteriosus) were all followed up; we recognise that this practice may vary nationally. At the point of clinic attendance 10% of children did not require an echocardiogram at all. During subgroup analysis there was a correlation between the grade of initial auscultated murmur and the presence of a non physiological finding on echocardiogram. Conclusion Using this retrospective cohort our recommendations were: To create a local neonatal murmur guideline facilitating a reduction in unnecessary referrals but ensuring that significant diagnoses are not missed. To schedule a specific murmur clinic rather than patients being seen in the general cardiology/echo clinic immediately. Patients with low grade murmurs could be seen in this clinic to triage their need to be seen in the general cardiology/echo clinic. This should reduce the wait time and improve patient flow. It can also be simultaneously used as a training opportunity. To initiate pulse oximetry as a routine baby check to further inform on the initial presentation. To produce a patient information leaflet for patients being referred, allowing the families to be better informed.