A recent investigation by CNN into the pediatric cardiothoracic program at St. Mary’s Hospital in Palm Beach, Fla., raised alarming concerns related to high mortality rates and other complications. Amid the flurry of headlines, state investigations and peer reviews, St. Mary’s announced it would shut down the fledgling program.
While I have no insider knowledge into this program or hospital, this most unfortunate situation nonetheless can serve as an important cautionary tale for patients, families and providers.
The first thing this story reveals is the importance of surgical volume, especially when treating the most complicated cases involving the most vulnerable infants and children. St. Mary’s Hospital acknowledged that it had fewer than 100 cases a year, attributing this to the newness of the program at the hospital. But by industry standards, minimum surgical volume for a top-tier heart program is approximately 500 cases per year. During the last four years, Children’s Hospital of Wisconsin’s Herma Heart Institute completed an average of 695 surgeries per year.
Why does that matter? Because as with just about anything, with more experience comes better results. The correlation between the number of procedures performed and the skill and proficiency of the medical professionals involved is very strong. Moreover, with higher volumes, health care systems are able to attract the best and most experienced surgeons and staff, can invest more meaningfully in lifesaving research and technology and are positioned to deliver better outcomes that come with that level of specialization and resources.
Second, this story illustrates why pediatric specialization matters. Today, more than half of pediatric surgeries happen at adult-focused hospitals, even though the systems of care children need are fundamentally different from the rest of the population. Their age, growth plates and smaller and more fragile anatomy make operating on children a far more specialized skill than is often appreciated. And that’s to say nothing about the recovery process and hospital environment, which at a dedicated, established pediatric system is better equipped to address the unique needs of kids and their families.
Third, this is a cautionary tale for parents and caregivers to be informed about the quality of the providers and systems treating their kids. In the St. Mary’s case, the hospital did not publicly report key patient outcome data, such as mortality rates. Patients and their families should be able to easily access the number of procedures the hospital has completed, survival rates, as well as data that demonstrate patient and family satisfaction. Children’s Hospital of Wisconsin publishes that data right on our website for all to see. While it would be unfair to assume that the outcomes at St. Mary’s would be different had that data been available, it nonetheless illustrates the importance of transparency so patients and families can make the best decisions possible.
As I’ve traveled the country and talked with other pediatric systems about the challenges they’re facing, I’m often met with surprise and admiration for what we have in place for kids here in Wisconsin. Typically you see a system like ours in much larger cities. In a state with a population as small as ours, it is fairly unique that we have built and maintained a pediatric health system with the breadth and depth that we have here at Children’s Hospital of Wisconsin.
But as the health care industry continues to evolve and competition for market share among adult providers intensifies in Wisconsin, patients and their families must be more informed than ever. As the sad situation in Florida reminds us, treating infants and kids — especially those with complicated medical challenges — requires experience and specialization that aren’t readily available at all hospitals. And it’s up to all health systems to be transparent about their experience, specialties and outcomes so patients and families can make the best decisions possible for their kids.