The Cardiothoracic Surgery Program at Nationwide Children’s Hospital has been dedicated to the treatment of all patients, from newborns to adults, with congenital heart defects ranging from the most straightforward to the extremely complex. We offer a comprehensive approach to heart care that is based on a multidisciplinary team model. This model enables our team to constantly monitor quality of care and patient safety pre- and post-surgery to assure the best possible outcomes.
Under the ten-year program leadership of Mark Galantowicz, MD, he has built a team of surgeons that have the training and experience to excel in a full range of pediatric and adult surgical procedures for congenital cardiac disorders — performing more than 500 procedures a year. With the leadership and combined research of Patrick I. McConnell, MD, and Toshiharu Shinoka, MD, PhD, they are developing innovative approaches to cardiovascular surgery and recovery. For example, the use of mechanical assist devices and associated therapies that target heart recovery and bioengineering tissue for use in surgery.
Our patients that require an invasive procedure go through a case review process with our team to determine their treatment path. Our team combines the knowledge and expertise of cardiologists, surgeons, anesthesiologists, researchers, intensivists, advance practice nurses, technologists and clinical staff. Each team member plays an active role in determining the best course of care for our patients. With the combined side-by-side involvement with our patients and families, we are able to provide quality care and receive optimal patient outcomes.
To ensure our program and outcomes are held at the highest standards, we participate in several national databases and registries as well as advisory panels where issues of value (outcomes/cost) are reviewed. With this comprehensive look, we are able to develop quality improvement initiatives and measurements that will continue to lead and enhance cardiac care around the country.
In addition to setting high quality standards for ourselves, we measure quality with our partners. In 2014, we monitored nine quality metrics with one of our partner institutions, and we are proud of the resulting improvements in quality care. Out of the nine metrics — including neurocognitive evaluation, anticoagulation guidelines, reducing transthoracic echocardiography/surgical discrepancies, pre-procedural checklist compliance, completion of inpatient joint discharge conference calls and expedited transfers of critically ill surgery and interventional cardiology patients — we achieved 80 percent of our targets last year.
Our goal is zero preventable harm. This commitment to zero preventable harm is part of our strategic plan and involves 35-40 ongoing quality programs that are constantly in motion within The Heart Center.
Our quality initiative to reduce the number of pressure ulcers experienced by our patients is one example of our success. We have reduced the number of pressure ulcers to less than one per 1,000 patient days.
Prompt discharges are important for patients, families and providers. Our quality initiative to increase the number of discharge orders before noon is a reflection of our family-centered care.
The world-renowned Cardiothoracic Surgery Program at Nationwide Children’s is dedicated to the treatment of all patients with congenital heart disease, from newborns to adults.
(STAT Category 1-5: Level 1, least complex; Level 5, most complex)
|STAT Level||Surgeries||Death 30 Days||Surgeries||Death 30 Days||Surgeries||Death 30 Days|
|STAT Level 1||86||0||114||0||118||1|
|STAT Level 2||94||1||93||2||101||2|
|STAT Level 3||36||0||29||1||34||0|
|STAT Level 4||53||7||70||3||67||4|
|STAT Level 5||27||2||39||3||38||4|
According to the latest data from the Society of Thoracic Surgeons (STS), The Heart Center at Nationwide Children’s is designated a high-volume center, with outcomes ranking among the best in the nation. For the last four years
(2011– 2014), in the STAT category 5 (most complex surgery level), The Heart Center’s mortality rate was 13 percent, compared with the STS all-participant average of 16 percent. The Heart Center is currently ranked 11th in the nation for pediatric heart and heart surgery by U.S. News & World Report.
From 2008 through 2014, our team performed 44 heart, lung and heart-lung transplants.
As part of the Cardiopulmonary Failure and Transplant Program, the Mechanical Cardiopulmonary Assist Program provides hope to the most fragile pediatric and adult patients facing heart, lung or heart/lung transplants. These devices include ECMO (extracorporeal membrane oxygenation) and VADs (ventricular assist devices).
The Heart Center is a Blue Cross Blue Shield Blue Distinction Center of Excellence for heart transplants.
|Mechanical Cardiopulmonary Assist Devices||29||27||32|
We performed 286 open heart surgeries in 2014.
According to the Bureau of Children with Medical Handicaps Program (BCMH) data, our open heart surgery volume ranks above the average of all Ohio hospital averages combined. We performed 268 pediatric open heart surgeries in 2014.
Note: BCMH does not include adult patients in their data. We also performed 18 adult open heart surgeries as part of our ACHD program.
One of our quality projects was to increase pre-op and post-op huddle compliance in the operating room to
100 percent by August 2014 and sustain that compliance. By educating our team, standardizing the information to be discussed, improving time management and improving communication among all team members, we surpassed our goal and achieved 100 percent compliance by January 2014.
We developed a “best practice” for post-procedure debrie?ng in 2014. Since then we have successfully reported a per month average of 100% compliance.
In addition to outstanding clinical service, The Heart Center is involved in clinical research. Blood conservation research is an important component of how we do cardiothoracic surgery.
Our blood conservation philosophy is part of every surgery performed, whether or not blood or blood products are ultimately used. The combination of advanced techniques and strategies to reduce blood transfusions for cardiac surgeries also works to lower in?ammation, reduce swelling, shorten hospitalization and, ultimately, improve outcomes.
Cell salvaging devices enable whole blood from the cardiopulmonary bypass machine to be processed and reinfused to the patient during surgery. The Cell Saver quality initiative decreased the number of transfusions of donated blood by ensuring that blood collected using a cell salvage device was used and not wasted.
The Interventional Cardiology program is internationally recognized and provides a full spectrum of diagnostic and therapeutic cardiac catheterization procedures for all our patients — from neonates to adults.
Because we use less-invasive modalities for diagnosis as often as possible, 87 percent of neonates who have catheterization procedures are getting therapeutic catheterizations.
We performed 508 therapeutic catheterizations in 2014.
According to the BCMH data, as a leader in the ?eld, our catheterization volumes rank above the average of all Ohio hospital averages combined. We performed 418 pediatric therapeutic catheterizations in 2014. BCMH does not include adult patients in their data. We also performed 90 adult catheterizations as part of our ACHD program.
In 2014, The Heart Center performed 18 Melody procedures and 5 Native procedures.
The Heart Center is a leader in innovation, particularly in transcatheter pulmonary valve procedures. The Heart Center played a key role in the FDA approval of the Medtronic Melody® Transcatheter Pulmonary Valve and Ensemble Delivery System, as well as in the development of both the stent and balloon-in-balloon products. This procedure is used to replace deteriorating valves in existing conduits without additional open heart surgeries. Over the lifetime of a patient, this could reduce the number of open heart surgeries needed potentially from 8 to 3.
Now, The Heart Center is again on the cutting edge of innovation, as one of three institutions internationally participating in a clinical trial of the Native Outflow Tract Transcatheter Pulmonary Valve. The Native PV procedure would enable valve replacement in cases where the patient does not have a conduit already in place. Like the Melody procedure, it eliminates the need for repeat open heart surgeries for valve replacements after the initial open heart surgery.
Concerns related to patient radiation exposure have led The Heart Center to create quality initiatives to reduce median radiation dosage during catheterization and electrophysiology (EP) procedures from 185 mGy in 2013 to 175 mGy in 2014. Through the increased use of collimation when appropriate, implementation a of color-coded dose tracking system (DTS), installation of new software, decrease in the frame rate to 10 fps when possible (based on patient weight), use of “Live Zoom” rather than “Radiological Zoom” and system alerts for staff, we reduced the year to date (YTD) median dose to 159 mGy by the end of 2014, exceeding our goals.
|2014||YTD Median Dose (mGy)||Quarterly Dose (mGy)|
Patients receiving high doses of radiation are at greater risk for radiation-related skin lesions. To address this concern, we initiated a quality initiative focused on obtaining at least 85 percent compliance in post-procedure skin assessment in cases of 3000 mGy or more of radiation exposure at discharge and at the follow-up clinic visit. By improving patient education regarding exposure on the day of the procedure, standardizing a questionnaire for follow-up clinic visits, training staff on detecting radiation injuries and optimizing use of clinical software for documentation and orders, we were able to achieve better-than-target compliance in the third and fourth quarters of 2014.
|2014||Skin Assessment at Discharge||Number of Patients||Assessment at 6-Week Clinic Visit|
|Q3 and Q4||86%||7||100%|
The table below shows our volumes for specialty services other than surgery and interventional cardiology.
|— Other Noninvasive||17,299||17,828||16,735||17,330|
|Adult Congenital Heart Disease||1,220||1,409||1,384||1,501|
|Average Number of Monthly Calls||493||657||739||991|
|Percent Answered at Goal||94%||93%||94%||93%|
According to the latest Society of Thoracic Surgery (STS) database, The Heart Center at Nationwide Children’s outcomes rank among the best among high-volume centers for both children and adults undergoing congenital heart surgery. The Heart Center’s 2011 mortality rate for children was 1.9% and for adults 0%, while the 4-year (2008–2011) average for children was 0.5% and adults 0.8%.
Our bloodless, open-heart surgery target was 50%. And we exceeded it.
With the goal of limiting or eliminating blood transfusion, our comprehensive team of perioperative nurses, cardiologists, intensivists, anesthesiologists and perfusionists work together, and have the expertise to deliver the latest advances, developments, standards and nonblood therapies. As pioneers in bloodless surgery, we accept the responsibility for setting standards and teaching others to the benefit of all patients everywhere.
A multidisciplinary team delivering tailored care leads to better cardiothoracic surgical outcomes.
Heart Transplant Outcomes
Lung Transplant Outcomes