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Children’s National Heart Institute: Growing Volumes and Improving Outcomes
As Children’s National Heart Institute (CNHI) celebrates nearly three years of success, many exciting changes have been made to the program, allowing Children’s National to make a difference in the lives of patients locally, nationally, and internationally. Last year, Children’s team operated on more infants, children, and adults with congenital heart disease than ever in the history of Children’s National Medical Center. We are able to have impressive survival statistics for our patients because of advances in non-invasive diagnosis, cardiac intensive care, interventional cardiac catheterization, and cardiac surgery.
Increases in Patient Volume
The increase in patient volumes has been most impressive in the areas of interventional cardiac catheterization and cardiac surgery. Since the arrival of Michael C. Slack, MD, in 2001 and the building of a dedicated catheterization suite in 2003, there has been an 100 percent increase in procedures, with 76 percent being therapeutic procedures (Figure 1).
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| Children's National Heart Institute Co-Directors Richard Jonas, MD, and Gerard Martin, MD |
In 2006, Children’s National performed more than 500 catheterization procedures. Children’s Joshua Kanter, MD, is a second interventional cardiologist and Jonathan Kaltman, MD, is a second electrophysiologist (joining Jeffrey Moak, MD), allowing us to grow this program further. Cardiac surgery has seen similar growth since the arrival of Richard A. Jonas, MD, in 2005 (Figure 2). Not only have the number of cases increased by more than 100 percent, the complexity of cases has increased significantly. Compared to previous years where the mix of closed cases to open cases was equal, now more than 60 percent of Children’s operative procedures involve cardio-pulmonary bypass (open). Additionally, nearly 15 percent of patients are from sites outside our region, traveling to Washington from across America or from around the world.
Cardiac Intensive Care Unit (CICU)
Children’s National has the only pediatric-focused CICU in the Washington, DC, region and it is directed by John Berger, MD, who is board certified in both pediatric cardiology and critical care medicine. The CICU provides highly focused subspecialty care for a distinct population of patients recovering from heart surgery and critical cardiac disease. The unit, a state-of-the-art 15-bed unit, provides optimal family-centered care and is staffed by nurses, doctors, nutritionists, pharmacists, respiratory therapists, social workers, and child life specialists specially trained for the care of congenital heart disease.
Cardiac Outcomes
The cardiac surgery program contributes to the Society of Thoracic Surgery Database and compares Children’s risk adjusted results with centers from around the country. Risk adjustment is done by the Risk-Adjustment-in-Congenital-Heart-Surgery-1 method (RACHS-1), which assigns a prediction of survival based upon the disease and procedure to be performed. Overall, survival for cardiac surgery procedures performed at Children’s National has increased to 98 percent with open survival of 96.8 percent and closed survival of 98.5 percent. The results (based upon individual lesions with n of at least 10) are shown in Figure 3. Partnerships with other divisions in the hospital also improve patient outcomes. Collaborations between critical care and cardiology enabled the development of a CAT Team (Clinical Assessment Triage Team), which resulted in a 76 percent reduction in code blue on the cardiology unit. The team achieved a “180 days since last code” performance record last year.
The Future of CNHI
CNHI has accomplished much since its establishment, but more is expected in the upcoming year. Under the direction of anesthesiologist Richard Kaplan, MD, cardiac anesthesia is expanding and providing superb care to patients requiring cardiac surgery, cardiac catheterization, and non-cardiac procedures. Richard J. Levy, MD, recently joined Children’s National as associate chief of Anesthesiology and Cardiac Anesthesia.
David Wessel, MD, joined Children’s National in July 2007 as executive director of the Center for Hospital-Based Specialties. Dr. Wessel is the world’s foremost expert in cardiac intensive care and is expected to further develop Dr. Berger’s team, as well as increase the number of clinical trials offered at Children’s National.
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Figure 3. Results are not risk-adjusted and include low-birthweight infants
weighing less than 2 kg. Procedures with 10 or more cases performed are
included. The data are submitted annually to the Society of Thoracic
Surgeons’ Congenital Heart Surgery National Database.
*** There were five mortalities among the 43 cases of patent ductus arteriosus
ligation, all due to complications of prematurity not related to the surgical
procedure. These have been excluded from mortality statistics in accordance
with the guidelines of the Society of Thoracic Surgeons. |
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