The Heart Center at Nationwide Children’s Hospital combines all clinical and research disciplines under one umbrella in order to meet our mission. We are out in front by discovering the causes of heart disease and developing the therapies of the future for our patients by focusing on them one at a time and providing state-of-the-art care that all patients deserve, regardless of age. We support Nationwide Children’s mission to provide our services in a safe environment.
Three years ago, The Heart Center began a quality improvement initiative to transform outcomes for a key chronic illness. The LAUNCH (Lifetime strAtegies and oUtcomes for siNgle ventricle and Complex Hearts) team was organized with a focus of improving care for hypoplastic left heart syndrome (HLHS) patients, with a particular goal of reducing hospital length of stay in the first year of life. Since 2012, the initiative has garnered significant improvements in clinical outcomes through a structured, proactive approach to reliable care and reducing variation. The initiative tracks several process measures, each of which has an associated key driver diagram, physician champion, control chart and multiple plan-do-study-act cycles. Ongoing process measures include parental rooming-in prior to discharge (93 percent), compliance with anticoagulation protocol following comprehensive stage 2 palliation (100 percent compliance since 2012) and compliance with newbornfeeding guidelines (64 percent compliance in 2014).
The initiative continues to expand. A dedicated singleventricle team was formed in 2014 with a goal of reducing variability in the inpatient and outpatient care for patients with single ventricle physiology (including HLHS). We also added several new process measures, including 1) standardized medical management during first procedure; 2) standardized pulmonary artery surveillance following second procedure; 3) standardized hypoxemia management protocol following second procedure; and 4) developed staged neurodevelopmental evaluation protocol.
The primary outcome (hospital length of stay in the first year of life) has improved from 50 percent in 2012 to 82 percent in 2014 for HLHS patients, with less than 60 total hospital days in the first year of life. The initiative’s overall impact reaches far beyond the HLHS patient population since many of the process measures include a much broader patient population.
In 2014, we launched our congenital heart disease quality improvement collaboration with Dayton Children’s Hospital. Nine unique initiatives were defined in the Dayton Children’s Hospital – Nationwide Children’s Hospital Heart Service Alliance and measured at each location. We achieved success in all metrics, and in 2015, we defined a new set of QI projects.
This year, The Heart Center and the heart program at Rainbow Babies and Children’s Hospital in Cleveland formed the Congenital Heart Collaborative around the concept of “one program, two campuses.” The two programs enjoy an excellent working relationship and are building a premier congenital heart program centered on quality of care, education and research.
The Heart Center was founded on providing care to patients with congenital heart disease regardless of age, and we continue to lead the country in developing transitional care for this growing population. In 2012, the American Board of Internal Medicine and the American Board of Pediatrics approved board certification in adult congenital heart disease (ACHD). The first chair of this sub-board is Curt Daniels, MD. An ever-present voice in the advancement of this subspecialty, Dr. Daniels has worked tirelessly to develop testing metrics and has worked closely with the Accreditation Council for Graduate Medical Education to develop ACHD-subspecialty training. The first certifying ACHD examination will be in 2015.
Heart Center leadership conducts top-down review for programmatic improvement, and the center is involved in external quality review such as state and national initiatives related to surgical and catheterization/ intervention outcomes. Other involvement includes:
Our ACGME fellowship program offers both a traditional Pediatric Cardiology Fellowship and a five-year Pediatric/Adult Cardiology Fellowship that is recognized by both the American Board of Internal Medicine and the American Board of Pediatrics. We have nine fellows, all of whom with more than 1.5 years of training are presenting at national/regional peer-reviewed meetings. We also offer advanced training in interventional catheterization and noninvasive imaging.
Heart Center Faculty
Timothy F. Feltes, MD
Chief, Pediatric Cardiology
Mark E. Galantowicz, MD
Chief, Cardiothoracic Surgery
John P. Cheatham, MD
Director, Cardiac Catheterization and Interventional Therapy
Selected Heart Center Publications
Duncan DR, Chen PY, Patterson JT, Lee YU, Hibino N, Cleary M, Naiti Y, Yi T, Gilliland R, Kurobe H, Church SN, Shinoka T, Fahmy TM, Simons M, Breuer CK. TGFβR1 inhibition blocks the formation of stenosis in tissue-engineered vascular grafts. Journal of the American College of Cardiology. 2015 Feb;65(5):512-4.
Feltes TF, Roth SJ, Almodovar MC, Andropoulos DB, Bohn DJ, Costello JM, Gajarski RJ, Mott AR, Koenig P. Task Force 5: pediatric cardiology fellowship training in critical care cardiology. Journal of the American College of Cardiology. 2015 Aug;66(6):712-22; and Circulation. 2015 Aug;132(6):e81-90.
Lawless CE, Olshansky B, Washington RL, Baggish AL, Daniels CJ, Lawrence SM, Sullivan RM, Kovacs RJ, Bove AA. Sports and exercise cardiology in the United States: cardiovascular specialists as members of the athlete healthcare team. Journal of the American College of Cardiology. 2014 Apr;63(15):1461-72.
Raman SV, Hor KN, Mazur W, Halnon NJ, Kissel JT, He X, Tran T, Smart S, McCarthy B, Taylor MD, Jefferies JL, Rafael-Fortney JA, Lowe J, Roble SL, Cripe LH. Eplerenone for early cardiomyopathy in Duchenne muscular dystrophy: a randomized, double-blind, placebo-controlled trial. The Lancet. Neurology. 2014 Feb;14(2):153-61.
Tremoulet AH, Jain S, Jaggi P, Jimenez-Fernandez S, Pancheri JM, Sun X, Kanegaye JT, Kovalchin JP, Printz BE, Ramilo O, Burns JC. Infliximab for intensification of primary therapy for Kawasaki disease: a phase 3 randomised, double-blind, placebo-controlled trial. Lancet. 2014 May;383(9930):1731-8.
Webb G, Landzberg MJ, Daniels CJ. Specialized adult congenital heart care saves lives. Circulation. 2014 May;129(18):1795-6.
Center for Cardiovascular Research