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UNC Children’s Hospital can resume complex heart surgeries after independent review

North Carolina Children’s Hospital is allowed to resume complex pediatric heart surgeries after a review by an outside advisory board, UNC Health Care announced Tuesday.

However, UNC should consider whether patients who have complex heart problems along with other illness should be referred to another hospital, the report said.

The pediatric cardiology program stopped some child heart surgeries, STAT 4 and 5, in June after a story in The New York Times revealed high death rates and problems in the UNC-run hospital in Chapel Hill.

The New York Times report included audio recordings of pediatric cardiologists alarmed about the patient deaths, with one doctor wondering whether he would send his children there for surgery.

The hospital voluntarily paused some complex pediatric heart surgeries pending a review of its program by outside experts and the results of a government investigation.

The advisory board commended UNC Health Care’s “commitment to programmatic quality and improvement” and issued several other recommendations to improve the program in its five-page report following an August site visit.

“It is clear that the culture of the program has significantly and fundamentally improved with the establishment of new leadership at both the divisional and departmental levels,” the report said.

In addition to allowing the hospital to resume complex surgeries, the advisory board suggested hiring an additional full-time senior pediatric cardiac surgeon, potentially joining efforts with another regional or national congenital heart program and developing a dedicated pediatric cardiac surgical team that can provide 24-7 coverage every day of the year.

“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,” UNC Health Care CEO Dr. Wesley Burks said in a news release.

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The North Carolina Children’s Hospital on the UNC campus in Chapel Hill. News & Observer file photo

The report noted ongoing improvements, including expanding faculty, creating a dedicated pediatric cardiac intensive care unit and adding advanced practice nurses or physician assistants in the division of pediatric cardiology. It also encouraged continued investment in improving the process for monitoring the quality and outcomes of cases in the pediatric cardiac surgical program.

Faculty and hospital leadership were interviewed for the report. The group also assessed programmatic structure and patient outcomes. The UNC Health Care Board of Directors, who appointed the advisory board, reviewed its report on Monday.

The report and recommendations come on the heels of other surveys of the program by the Joint Commission and the N.C. Department of Health & Human Services. Those surveys discovered there were no issues or deficiencies in the program, UNC Health Care said.

In a May 31 interview with the N&O, hospital administrators said problems were part of the past and blamed them on poor team dynamics.

Along with its decision to suspend some pediatric heart surgeries, UNC Health Care made information about results public — information that The New York Times had sued to get. The information showed that death rates were higher than expected for nearly all levels of surgical complexity.

The program evaluators said the hospital should continue to make public information on patient deaths and the comparisons with national averages, while acknowledging there are “justifiable criticisms” of star rating system The Society of Thoracic Surgeons uses.

The new report also touched on an issue raised in the New York Times article: whether UNC performs enough heart surgeries on patients with complex problems for its surgeons to get enough experience.

It’s preferable for a pediatric cardiac program to have at least two surgeons, the report said. UNC has the congenital cardiac surgery section chief and a senior visiting surgeon who assists with complex cases, according to the report.

The American Board of Thoracic Surgery requires surgeons perform at least 50 operations a year to maintain certification, while most pediatric heart surgeons would say surgeons ideally should do 100 to 150 surgeries a year, the report said. UNC averaged just 120 cases in the last year, though numbers have been slightly higher in the past, the report said.

“On behalf of the UNC Health Care Board of Directors, I’d like to thank the External Advisory Board for its work, and everyone across the health system who remains committed to providing excellent care for all our patients,” Charlie Owen, chairman of the UNC Health Care Board of Directors, said in a news release. “We are pleased with both long term and recent improvements to the program and fully support additional enhancements to ensure that our pediatric heart surgery program is one of the best in the country.”

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Kate Murphy covers higher education for The News & Observer. Previously, she covered higher education for the Cincinnati Enquirer on the investigative and enterprise team and USA Today Network. Her work has won state awards in Ohio and Kentucky and she was recently named a 2019 Education Writers Association finalist for digital storytelling.
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