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Complex Pediatric Heart Surgeries Can Resume, Outside Review Finds

Findings were based on interactions with faculty and hospital leadership and reviews of the structure and outcomes of the program. (News & Observer photo)

North Carolina Children’s Hospital can resume performing the most complex pediatric congenital heart surgeries following an outside review of the program.

The review by an external advisory board appointed by and reporting to the UNC Health Care board of directors cautioned that the hospital ideally should not rely on a single pediatric cardiac surgeon and should have a minimum of two. A letter sent to the chair of the board acknowledged that “this arrangement becomes challenging at smaller volume centers.”

Signed by physicians from Ohio State University and the universities of Michigan and Pittsburgh, the letter recommended “further exploration of a joint venture or collaborative agreement with another Congenital Heart Program to include surgical collaboration and coverage when needed.”

“It is clear that the culture of the program has significantly and fundamentally improved with the establishment of new leadership,” the letter said. “Significant investment and progress,” it said, include additional faculty and support staff. Findings were based on interactions with faculty and hospital leadership and reviews of the structure and outcomes of the program.

Following publication in late May of a New York Times report of its investigation of the pediatric cardiology surgery program and a subsequent investigation by the state Division of Health Services Regulation, UNC Health Care announced in June that it was voluntarily pausing the most complex surgeries pending an outside review.

Using secret audio recordings given to the Times, the newspaper portrayed an area of the hospital in disarray, including multiple doctors concerned about the hospital’s resources for handling surgeries on children with serious heart conditions and doubts about its chief pediatric cardiac surgeon. Some doctors questioned whether some patients’ cases should be handled elsewhere.

The Times investigation focused on a number of children who died following heart surgeries at UNC, including surgeries that had been considered low-risk.

Hospital officials said in response to the article that the program “faced cultural challenges” in 2016 and 2017 but that it had put improvements in place. They said the issues in those years had not affected patient care. They added that “certain personnel changes were required to improve the culture and new physicians and staff were recruited.”

The state agency reported in August that it found “no current deficiencies” in its investigation.

In a news release, Dr. Wesley Burks, CEO of UNC Health Care and dean of UNC’s medical school, said, “We have made significant investments over the years to improve our pediatric cardiology program, and will continue to make further enhancements because we recognize the importance of caring for very sick children with incredibly complex medical problems.”

The advisory board letter acknowledged that pediatric cardiology had added three physicians since July and that “there is support from the hospital to continue recruitment up to a total of 12 faculty.” UNC also has established a dedicated pediatric cardiac intensive care unit in the past six months.

The hospital, part of the five-hospital complex on the UNC campus, said that from July 2018 through May 2019 the program performed 100 surgeries with a 97 percent survival rate.


 

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