'Everyone is expected to speak up': How Phoenix Children's cardiac program maintains high surgical quality

Mackenzie Bean - Print  | 

Of the 115 hospitals that perform pediatric heart surgery in the U.S., about three-fourths publicly share mortality data, including Phoenix Children's Hospital.

The hospital was one of the first to participate in the Society of Thoracic Surgeons' Congenital Heart Surgery Database in 2014, which publicly shares surgical outcomes data.

Of the 117 pediatric heart surgery programs in North America that participate in STS' database, Phoenix Children's was one of only 10 programs to receive a three-star rating from STS in June. Based on the most recent data available, the hospital's cardiac surgery program had an overall observed mortality rate of 1.5 percent, halving the expected mortality rate of 3 percent.

Here, Daniel Velez, MD, division chief of cardiothoracic surgery at Phoenix Children's and co-director of the Phoenix Children's Heart Center, shares how the hospital maintains high surgical quality and discusses why it's important to publicly report outcomes data.

Editor's note: Responses have been lightly edited for length and clarity.

Question: Why is it important to publicly report children's heart surgery outcomes and data?

Dr. Daniel Velez: The public deserves transparency, honesty and openness. Consumers should have the right to know about our performance. You probably wouldn't be happy if you didn't know how good or bad a service was as a consumer. It's also a way for hospitals to hold themselves accountable to what they do every day. Not only to share the data, but to always strive for improvement.

Q: Phoenix Children's has achieved lower-than-expected mortality rates across all levels of complex heart surgeries for the past six years. What has been the key to your success?

DV: It's about building a culture of trust among all the stakeholders in our heart center, whether it is anesthesia surgery, cardiology, radiology, interventional cardiology, etc. If we don't like how something went, we don't shy away from discussing it or take it personally. We have these discussions with the patient's best interest in mind. Once you trust each other, then you start functioning as a true team and can do what's best.

Everybody here understands that they can speak up. In fact, they're expected to speak up or point out when something is different than what they anticipated. I empower my team to do so in the operating room. If they see me doing something differently, they should stop and ask why. The team is so professional that they know how and when to bring it up without creating major disruptions. It keeps us honest and on track.

Q: What advice do you have for children's hospitals working to improve surgical outcomes?

DV: Every program has different circumstances and faces different challenges. I don't hold the absolute truth; I can only give my opinion and advice in a noncritical fashion.

I think the programs that aren't reporting outcomes data need to develop a culture of trust. All team members need to be able to communicate the good, the bad and the ugly, and everyone must be ready to do what is best for [the] patient.

Programs will have to take on difficult cases, which can be statistically significant for lower-volume programs. One adverse outcome — which may be totally unrelated to performance — will have an impact on a low-volume program's survival rate. Let's say a program only saw four truncus arteriosus cases in a year. If three patients did well, and one did not survive, the hospital would have a 25 percent mortality rate — much higher than it would be at a high-volume program. However, as long as they know that they've done their best, they should publicly report data. When you can look at the patients' families in the eye and say, "Yeah, we do perform as expected," and you're reporting the data and being transparent, that promotes trust, communication and the desire to improve.

Q: Any final thoughts?

DV: In general, the community caring for patients with congenital heart disease is a very small one. I am 100 percent sure that everybody wants to do what's best for the patient. We're all trying to improve the quality of life, longevity and have one thing in mind: children's well-being.

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