Becker's ASC Review

63 HEALTHCARE NEWS 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 an investigative report from e New York Times. For the investigation, NYT reporters inter- viewed 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. Six takeaways from the report: 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 aer 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 surgeries 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 the publication's request for comment. 4. Of the 115 hospitals that perform pediatric heart surgery in the U.S., 82 publicly share mortality data; UNC does not. Between July 2013 and June 2017, the hospital's cardiac surgery mortality rate was 4.7 percent, ac- cording to limited data shared with NYT aer several requests. is figure exceeds the mortality rates reported by most of the hospitals that publicly share data. 5. UNC claims that mortality data doesn't provide an accurate measure of its surgical program and that any risk adjustment could not adequately account for the high volume of patients with complex medical conditions it serves. NYT is suing the health system for access to its risk-adjusted mortality data. 6. UNC Children's Hospital stands behind its heart program, which administrators call "very strong" today. Leaders denied any past issues with patient care and told NYT "a dysfunctional group" generated 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 doc- tors and open a cardiac intensive care unit, although it denies that the program lacked adequate resources in 2016. n UNC Health Care CEO's memo to staff after NYT exposé By Mackenzie Bean W esley Burks, MD, CEO of UNC Health Care, sent a five-paragraph email to staff members May 30 in response to an investigative report about the Chapel Hill, N.C.-based system's pediatric heart surgery program, according to NC Health News. The 7,000-word investigative report published by The New York Times found cardiologists at UNC Children's Hospital expressed serious concerns about the safety and quality of the heart surgery program in 2016. The report has since spurred state health officials to launch an inves- tigation into the hospital. "While this program faced culture challenges in the 2016-2017 timeframe, we believe the Times' criticism is overstated and does not consider the quality improve- ments we've made within this program over many years," Dr. Burks wrote in the email to staff members about the report. He noted that UNC's pediatric heart program often sees the "most complex and serious cases" in the state and said the hospital is continuously working on quality im- provement efforts. "In addition to process changes, hospital leadership determined that certain personnel changes were required to improve the culture and new physicians and staff were recruited," Dr. Burks wrote. "We are proud of the pediatric congenital heart surgery program, and our team is currently receiving top results that would place us among the best in the nation," he added. n

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