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.

STANFORD, Calif.–(BUSINESS WIRE)–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 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

    • 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
      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, professor
of pediatric cardiology
at the Stanford
University School of Medicine
. “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
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

“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

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

“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

  • 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

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.

About Stanford Children’s Health and Lucile
Packard Children’s Hospital Stanford

Stanford Children’s Health, with Lucile Packard Children’s Hospital
Stanford at its core, is the largest Bay Area health care enterprise
exclusively dedicated to children and expectant mothers. Long recognized
by U.S.
News & World Report
as one of America’s best, we are a leader in
world-class, nurturing care and extraordinary outcomes in every
pediatric and obstetric specialty, with care ranging from the routine to
rare, regardless of a family’s ability to pay. Together with our Stanford
physicians, nurses, and staff, we can be accessed through
partnerships, collaborations, outreach, specialty clinics and primary
care practices at more than 60 locations in Northern California and 100
locations in the U.S. western region. As a non-profit, we are committed
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Lucile Packard Children’s Hospital Stanford
Robert Dicks,