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
  • 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
    • 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, 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
    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.

      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
      Medicine 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
      to supporting our community – from caring for uninsured or underinsured
      kids, homeless teens and pregnant moms, to helping re-establish school
      nurse positions in local schools. Learn more at stanfordchildrens.org
      and on our Healthier,
      Happy Lives blog. You can also discover how we are Building
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      Contacts

      Lucile Packard Children’s Hospital Stanford
      Robert Dicks,
      650-497-8364
      rdicks@stanfordchildrens.org