A prospective study over 15 months of a telecardilogy service delivered to four district general hospitals in the UK describes the use of this service.  Here.

Now call me a grouchy old general paediatrician, but wouldn’t it be just as effective to get the patients referred in to see the tertiary specialists properly triaged by general paediatricians first?  I can’t comment on the service described here, but it seems to me that with some tertiary services seeing more than 50% of their referrals direct from general practitioners, the arguments for more expertise should be altered into arguments that they only see the children they need to.  They’ve done that in part in this study - but only by access to very expensive technology etc.  Why not actually make sure that generalists are equipped with good clinical skills and appropriate referral pathways, and stop seeing patients sent direct from general practitioners (family doctors).  Or have I got it wrong?

(there is a related Precis here.)