Survey: Children’s Heart Center at Lucile Packard Children’s Hospital Stanford Has Exceptional Outcomes — Even While Tackling the Most Complex Cases in the U.S.

For Release: January 21, 2016

STANFORD, Calif. — According to recent data from the Children’s Hospital Association’s Pediatric Health Information System (PHIS), the Children’s Heart Center at Lucile Packard Children’s Hospital Stanford and Stanford Medicine Children’s Health has the highest acuity Case Mix Index (CMI) in the country, yet still tops PHIS peer hospital averages when it comes to outcomes and inpatient length of stay.*

“Taking on the most challenging cases and achieving great results for our patients makes us very proud,” said Stephen Roth, MD, MPH, chief of pediatric cardiology. His team’s formula for success? A combination of medical and surgical innovation, applying best practices to clinical care, a team approach, “and experience, experience, experience.”

It’s a formula that works. The most recently reported PHIS data show the Heart Center has higher marks in a number of key areas compared with dozens of other children’s and young adult cardiac programs nationwide. This means that despite tackling the most complex cardiac problems, Stanford’s program excels in the following:

• Medical outcomes
• Surgical outcomes
• Patient survival
• Average length of stay

A deeper dive into the latest PHIS data reveals:

• The Heart Center’s survival rates were higher than the national data set for PHIS “peer hospitals”:
  • In 2013, the observed-to-expected mortality ratio was 0.79 compared with an average ratio of 0.86 for PHIS peer hospitals. This index difference of 0.07 indicates patients had an 8 percent higher survival rate at Lucile Packard Children’s Hospital Stanford compared with the PHIS national data set.
  • In 2014, a ratio of 0.63 vs. an average ratio of 0.83 for PHIS peer hospitals — a difference of 0.20 — means Stanford patients had a 24 percent higher survival rate compared with the PHIS national data set. CHART

• When looking specifically at cardiac surgical care, Stanford’s outcomes were even more impressive:
  • In 2013, an observed-to-expected mortality ratio of 0.71 vs. an average ratio of 0.92 for PHIS peer hospitals — an index difference of 0.21 — indicates Stanford’s surgical patients had a 23 percent higher survival rate.
  • In 2014, a ratio of 0.29 vs. an average ratio of 0.66 for PHIS peer hospitals — an index difference of 0.37 — means Stanford’s surgical patients had a 56 percent higher survival rate than the PHIS national data set. CHART

• Adding even more weight to these survival rates is the fact that Lucile Packard Children’s Hospital Stanford handles the highest acuity and complexity cardiac cases in the country:
  • Stanford’s overall surgical CMI in 2014 was 20 percent higher than the PHIS peer hospital average (6.05 CMI for Stanford vs. 5.06 CMI for the PHIS national data set, when adjusted for severity). CHART
  • Stanford’s overall medical CMI in 2014 was 19 percent higher than the PHIS peer hospital average (1.24 CMI for Stanford vs. 1.04 CMI for the PHIS national data set, when adjusted for severity). CHART

• Even while surpassing PHIS peer hospital averages for outcomes, the Heart Center’s average length of stay (ALOS) for both surgical and medical cases was shorter than the PHIS national data sets in 2013 and 2014:
  • In 2014, patients who had surgery at Stanford spent an average of 3.31 fewer days in the hospital (7.07 days on average vs. the PHIS peer hospital average of 10.38 days). CHART
  • In 2014, patients who were hospitalized at Stanford for medical care had an ALOS that was 1.01 days shorter (4.07 days on average vs. the PHIS peer hospital average of 5.08 days). CHART

“The PHIS data show that Stanford performs significantly better than most other pediatric cardiac programs,” said Roth. “The key takeaway message is that cardiac patients had a 24 percent greater chance of survival — including a 56 percent higher survival rate for patients requiring surgery — when cared for by our program. This is a noteworthy difference.”

The Heart Center’s success has led to significant growth. Patient volume nearly doubled in a decade, from 674 inpatient discharges in 2006 to 1,114 in 2015. “The demand for our services has never been greater,” said Roth, noting that in less than two years, with the $1.1 billion, 521,000 square foot expansion of the hospital, the Heart Center will also expand — and nearly double its inpatient beds.

“It’s important that no patient needing our care is turned away from the Heart Center due to lack of space,” Roth said.

The Story Behind the Numbers: Q&A with Dr. Stephen Roth

How does the Heart Center achieve such impressive outcomes with the highest acuity cases?

“One key is our willingness to take on those ‘last hope’ patients. Caring for these children often requires us to innovate. We learn something new every time we push the limits of what should be achievable. We get a little better and a little smarter each time we challenge ourselves. Ultimately, this creates new knowledge that changes our treatment paradigms, and it makes our team even more capable.”

What’s the benefit of large patient volumes?

“You need to perform specialized surgeries frequently — as our center does — to do them consistently well. That’s especially true for complex surgeries such as the unifocalization procedure for major aortopulmonary collateral arteries (MAPCAs) in pulmonary atresia.

“We aren’t the only ones to highlight this relationship to volumes. A recent commentary in JAMA noted that ‘the highest volume centers tend to deliver the highest quality care at the lowest costs, particularly for children and young adults with the most complex heart disease.’

“Our success derives from a team of more than 250 highly specialized professionals, including cardiologists, surgeons, anesthesiologists, nurses, social workers and others. We take on everything from complex medical management to the rarest of cardiac anomalies requiring innovative surgical approaches or cardiac transplantation. We’ve also recently built one of the nation’s top adult congenital heart disease programs.”

How do your current achievements fit Stanford’s culture of innovation?

“Innovation in cardiac care is synonymous with Stanford. Norman Shumway, MD, pioneered America’s first successful human heart transplant here in 1968, and our team also performed the first pediatric heart-lung transplant in the country.

“Stanford is world-renowned for its basic science research, and we have received many prestigious grants to develop fundamental discoveries. Our researchers also place a high premium on translating their findings on pediatric heart disease into new treatments and preventive techniques.

“On the clinical frontier, we’ve also led the way in advanced bridge-to-transplant therapies for children. We have one of the largest and most experienced pediatric ventricular assist device (VAD) programs in the country, and we hold the record for the longest period of VAD support in North America, at 234 days. Our first Berlin Heart patient was, at the time of his treatment, the youngest child to ever receive this lifesaving therapy for severe heart failure. And in 2002, open-heart surgery was performed here on the smallest and youngest patient ever.

“Our commitment to discovery never stops. It’s all part of the larger culture of discovery and innovation that exists at Stanford University and in Silicon Valley, and it ties in perfectly with our goal of continuously improving patient care and outcomes.”

Who is behind Stanford’s success with new surgical techniques?

“Our surgery team is led by Frank Hanley, MD, a world-renowned surgical innovator and one of a handful of the most accomplished pediatric cardiac surgeons in the world. Many techniques he developed are now fairly routine in our Heart Center, and some are not available elsewhere. If there’s a better, safer or more efficient way to perform a pediatric cardiac surgical procedure, Dr. Hanley most likely helped improve it.

“He invented the one-stage unifocalization surgery for tetralogy of Fallot with pulmonary atresia and MAPCAs, in which the collateral arteries are surgically combined to create functioning pulmonary arteries. He has achieved a remarkable 98 percent success rate with this complex operation. He pioneered new techniques for staged operations for single ventricle defects done without a heart-lung bypass machine.

“In addition, Dr. Hanley performs many reoperations on patients from around the world. His ability to repair hearts that weren’t repaired properly elsewhere — and to do in one surgery what other surgeons would stage over months or years — is a real differentiator.”

What are some other areas of collaborative discovery within the Heart Center?

“Our team approach enabled Chandra Ramamoorthy, MD, chief of pediatric cardiac anesthesia, to reduce the risks of cardiac anesthesia in children, and helped cardiologist Gail Wright, MD, develop a simple but game-changing home monitoring program for single ventricle patients — one that has decreased patient mortality following the Norwood procedure from the national average of 15 percent to only 2 percent. We are also using implantable pacemakers programmed to synchronize the pumping function of the heart’s lower chambers in kids with poor function to improve their heart’s performance.

“In addition, we have advanced techniques in cardiac catheterization to safely deliver catheter-implanted heart valves into the most vulnerable patients, including an 8-month-old infant who was the youngest ever to undergo this procedure.

“And together with scientists at the Stanford Cardiovascular Institute, ongoing research is designed to understand the origins of congenital heart disease and pediatric heart failure. Plus, we’re currently taking part in 20 clinical research trials in pediatric cardiovascular medicine.”

What’s next?

“Some believe that after 70 years of surgical innovation for congenital heart defects, we are nearing the peak of the pyramid of surgical procedures and techniques. We think that the next phase of major advances in our field will come from the biological sciences and include breakthroughs in areas such as tissue engineering, regenerative medicine and genomics. Heart problems in children and adult survivors of congenital heart disease aren’t going away anytime soon, so we need to focus on approaches other than existing surgical procedures to improve treatment of these conditions. It’s going to be an exciting new era, and we are positioning ourselves to be leaders both in quality outcomes and innovation going forward.”

By the Numbers: 2015 at the Children’s Heart Center

• More than 600 heart surgeries, and another 500 surgeries at Heart Center partner programs: UCSF Benioff Children’s Hospital (Oakland, Calif.); Sutter Memorial Center (Sacramento, Calif.); and Valley Children’s Hospital (Madera, Calif.)
• 20 heart transplants
• 16 ventricular assist device implants
• 8,238 transthoracic echocardiograms
• 20 clinical trials under way
• More than 250 faculty and staff members, including:
  • 8 cardiothoracic surgeons
  • 36 faculty cardiologists
  • 11 cardiac anesthesiologists
  • 150 cardiac specialist nurses
  • 3 radiologists dedicated to cardiac imaging

* Data Source: Pediatric Health Information System (PHIS), 2013 and 2014. The PHIS hospitals are 46 of the largest and most advanced children's hospitals in America, and constitute the most demanding standards of pediatric service in America. The Children’s Hospital Association developed PHIS to provide a rich data source for clinicians to conduct comparative effectiveness studies that affect hospitalized children.

* Related news: Dateline NBC profiles Oregon family facing multiple heart transplants  

On Sunday, January 17, Dateline NBC aired an hour-long program about the Bingham family of Haines, Oregon, who face the extraordinary challenge of having 3 of their 5 children with dilated cardiomyopathy. Between them, there have been 8 open-heart surgeries, 3 heart transplants, and their youngest is awaiting a donor heart now at Lucile Packard Children's Hospital Stanford.

Authors

Tara Stultz

Robert Dicks
(650) 497-8364
rdicks@stanfordchildrens.org