P2.C043: Patient Experience in Pediatric Cardiology Referrals: No Association with Testing Intensity

Background: Chest pain, palpitations, murmur, and dizziness/syncope are common reasons for pediatric cardiology referrals but are often benign and/or non-cardiac in etiology. They are associated with significant healthcare resource utilization and caregiver anxiety. We sought to describe the experience with these referrals and investigate the associated between Patient and Family Experience (PFE) and resource utilization.

Methods: We conducted a retrospective review of PFE surveys completed after outpatient visit at a pediatric cardiology subspecialty clinics from 2022-2023. Patients ≤18 years old presenting with a chief complaint of chest pain, palpitations, murmur, or dizziness/syncope were included. We analyzed PFE domains focusing on overall experience, provider respect, clarity of communication, and time spent with the provider. PFE scores were dichotomized, with top-box responses (%9/10 for 0-10 Likert scale, and "yes, definitely" for other questions) considered positive. Additional variables included patient demographics, visit location, testing performed at visit, time between referral and visit, and follow-up recommendations. Univariable and multivariable statistical analysis were used to identify variables associated with higher PFE scores.

Results: A total of 1293 patients were included in this study. There were no statistically significant differences in overall PFE scores (%9-10 or "Yes, Definitely") by visit diagnosis (Table1), clinic location, time between referral and visit, or follow-up recommendations. Similarly, there was no significant association between top-box scores for provider respect, communication, or time spent with the provider and variables such as visit location, testing performed (including EKG, echocardiograms, stress tests, and Holter), or follow-up recommendations. While the proportion of visits with advanced testing (echocardiogram, stress test, Holter monitor) differed by clinic location (p < 0.0001), no significant difference in PFE scores was observed based on the presence or absence of these tests.

Conclusion: Our findings demonstrate that ordering practices for advanced testing (i.e. echocardiogram, stress test, and Holter monitor) in visits for chest pain, murmur, palpitations, and dizziness/syncope visits vary significantly across clinic locations. Importantly, this variation does not correlate with differences in PFE scores. This highlights potential opportunities to optimize resource utilization in these common pediatric cardiology referrals, as PFE appears unrelated to the use of advanced testing.