Abstract

Background There is an exponential expansion in the demand for inpatient cardiology assessments which has placed severe pressures on delivering these reviews in a timely manner and has a perceptible impact on other more elective cardiac services. Virtual models of care (Virtual cardiology referral Service or VCRS) may offer timely cardiology decision-making while reducing unnecessary admissions and has the potential to reduce the length of stay. The institution of electronic records (Cerner) at East Lancashire Hospitals NHS Trust in June 2023 enabled VCRS, a new service pathway

Aim Few studies assess the clinical safety and efficacy of Virtual cardiology referral model in real-world hospital settings. This service evaluation analysed the safety and effectiveness of a VCRS using information recorded in the electronic records.

Methods A service improvement project was conducted at Royal Blackburn Teaching Hospital between June and July 2025. A total of 200 in patients referred from different disciplines for cardiology advice was dealt with virtually with no face-to-face reviews. The cardiology team assessed the referral indication and provided virtual management recommendations after reviewing patient records, ECGs, blood tests, and imaging studies documented in the electronic records including other online systems. All referral data was manually extracted from Cerner. Outcomes assessed included transfer to cardiology ward, cardiology advice but transferred or retained under different discipline, in hospital mortality and 30 day post discharge readmission.

Results 200 continuous virtual cardiology referrals were analysed over a continuous 30 day period. 100 patients (50%) were transferred to cardiology wards and the remaining 100 patients (50%) were managed with virtual cardiology service alone. Referral volume averaged 13.7 referrals per day (range 4 -27) and response time averaged 7.96 hours (range 0.083-40 hours).

8 (4%) died in-hospital, 192 (96%) patients were discharged safely. 34 (17.7%) patients were readmitted within 30 days. Only 11 (5.7% of the 192 discharges) required further cardiology advise. Of these 11 patients, 6 were discharged from cardiology with heart failure clinic follow up, 2 were re-admitted with recurrent chest pain, 2 were re-admitted with recurrent atrial fibrillation and one with new SVT. 23 of the 34 (67.6%) of readmitted patients were treated under other disciplines and did not require further cardiology advice.

Conclusion The Virtual Cardiology Referral service (VCRS) is a safe and effective service. It enabled rapid specialist input, leading to admission avoidance, quicker optimisation of medical therapy, reassurance, and appropriate outpatient follow-up. The service improved access to cardiology expertise, reduced delays in patient management and freed up valuable clinical time. Wider adoption of this model will improve patient flow and reduce pressures on cardiology services.