Becker's Clinical Quality & Infection Control

6 INFECTION CONTROL & PATIENT SAFETY 'Beyond horrifying': Cardiologists warned UNC Children's of heart program issues By Mackenzie Bean C ardiologists at UNC Children's Hos- pital in Chapel Hill expressed serious concerns about the safety and quality of the hospital's pediatric heart surgery program in 2016, aer noticing an uptick in surgical complications and deaths, according to a 7,000-word investigative report from e New York Times. For the investigation, NYT reporters interviewed nearly two dozen current and former physicians and nurses at UNC; spoke with patients' families and physicians from other hospitals; and reviewed emails, state death data, medical records and audio recordings of cardiology department meetings in 2016 and 2017 that were corroborated by several sources. Seven takeaways: 1. Nine cardiologists on staff at UNC Health Care began expressing concerns about the quality of its pediatric heart surgery pro- gram in 2016. e physicians had noticed more children were experiencing surgical complications aer low-risk procedures or dying aer high-risk surgeries. ey did not identify a specific reason for these issues but pointed to a lack of program resources and shared apprehensions about the program's chief pediatric cardiac surgeon. "I mean, our house is in total disarray. is is crazy what we're doing," Timothy Hoffman, MD, division chief of pediatric cardiology at UNC Children's, said of the program in an audio recording cited by NYT. "I've never seen anything like it, quite frankly. And we're going backwards, not forward." 2. Some cardiologists questioned whether they should refer patients to heart sur- geons at UNC Children's Hospital. Jennifer Whitham, MD, a former cardiologist at the hospital, said she would oen send patients to get second opinions at other hospitals in the area with comprehensive pediatric heart programs. "As a mother of three children, oh my God. ... It's inexcusable. As a physician, I mean, we all took the oath. We are supposed to do what's right for our patients," she said in audio recordings of a cardiology meeting in which physicians shared their concerns about the program. "I can't get past this. is is beyond horrifying." 3. Former hospital president Kevin Kelly, MD, met with the cardiologists after they expressed these concerns and urged them to listen to their conscience when deciding where to refer patients. However, he also warned the physicians that fewer surger- ies at UNC would affect revenues and put some of their jobs at risk, according to NYT. Dr. Kelly, who retired last year, did not respond to NYT's request for com- ment at the time of publication. 4. On June 17, UNC shared numerous ini- tiatives to "restore confidence in its pediatric heart surgery program," including creating its own external advisory board to review the cardiac surgery program and suggest improvements as necessary. e hospital will not perform complex heart surgeries until the advisory board and state and federal health officials have completed their inspec- tions of the program. 5. UNC Children's Hospital also shared risk-adjusted outcomes data for its cardiac surgery program June 17, which shows mortality rates continued to rise aer car- diologists voiced their concerns about the program's quality and safety. e data set includes observed and expected mortality rates for five categories of pediatric cardiac surgeries ranked by complexity. Between January 2015 and December 2018, UNC Children's reported higher than expect- ed mortality rates for all but one surgical complexity category, according to e News & Observer. 6. In a statement on its website, UNC Children's noted the surgical categories "are imperfect and do not uniformly account for how sick a child is." e hospital also said the outcomes data "does not capture several risk factors that disproportionately impact our patient population as North Carolina's safety net hospital." 7. UNC Children's Hospital has stood behind its heart program, which admin- istrators call "very strong" today. Leaders denied any past issues with patient care and told NYT "a dysfunctional group" gener- ated mistrust and created "team culture issues" in 2016. Since then, four of the nine pediatric cardiologists at UNC have le. e health system hired a new cardiologist last year and plans for three more to start this summer. UNC also plans to hire more cardiac intensive care physicians and open a cardiac intensive care unit, although it denies that the program lacked adequate resources in 2016. n Healthcare professionals tune out messages to wash their hands By Anuja Vaidya P ictures of eye images and messages encouraging compliance with social norms failed to improve adherence to hand hygiene protocols among healthcare professionals in a study published in Infection Con- trol & Hospital Epidemiology. U.S. researchers placed three types of placards near soap and alcohol-based hand-rub dispensers in two hospital units. They placed placards with an image of eyes, a message focused on social norms or a control placard, alter- nating between them every 10 days. They examined hand hygiene opportu- nities and adherence via an electronic monitoring and feedback program. They monitored 166 nurses and certified nursing assistants electronically over a four-month period. In total, they collected 184,172 electronic observations. The study shows the median daily number of electronic observations was 1,471. Prior to the placard intervention, the hand hygiene adherence rate was 70 percent, and the rate did not increase after the intervention. n

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