A Center of Excellence for Children With Heart Problems Opens Its Doors

Tuesday, February 28, 2017

The University Children’s Health Heart Center at University Health System is designed for the care and comfort of patients and their families, designed to meet their physical and emotional needs.

S. Adil Husain, MD, (left) Chief of Pediatric Cardiothoracic Surgery, performs surgery at University Hospital.

For the physicians and staff at University Hospital who mend tiny hearts, the University Children’s Health Heart Center is the culmination of a dream that began three years ago when they packed up their practice and moved across town.

The pediatric subspecialists at The University of Texas Health Science Center at San Antonio — currently undergoing a name change to UT Health San Antonio — had suddenly ended their relationship with their former teaching hospital and moved to University Health System.

At that time, the start of 2014, University Health System was nearing completion of an $899 million expansion and renovation of University Hospital and the Robert B. Green Campus downtown. Now administrators were faced with the challenge of creating first-class accommodations for a long list of pediatric subspecialties.

S. Adil Husain, MD, Chief of Pediatric Cardiothoracic Surgery at UT Health San Antonio and Pediatric Surgeon-in-Chief at University Hospital, had a vision of a new kind of center for children with heart problems. Dr. Husain’s fragile young patients came from all over Texas, and their parents — frightened and uncertain about their child’s condition — would often be uprooted for weeks while their children underwent complex surgery and aftercare.

Dr. Husain outlined his vision during a meeting with George B. Hernández Jr., President and CEO of University Health System. The University Children’s Health Heart Center at University Hospital would be designed around the comfort and well-being of his young patients and their families.

2016 Overall Mortality Rate, University Hospital — 1.04 percent
2016 Society of Thoracic Surgeons Reportable Cases Mortality Rate, University Hospital — 1.25 percent
Society of Thoracic Surgeons National Average Mortality Rate — 3.06 percent

Patients would remain in one unit throughout their stay, including those in intensive care. Parents could stay within steps of their child. And because the long-term care of their child would require both training and confidence, the education of parents would be a critical component. Both outpatient clinics and inpatient rooms would be in the same location.

“We came here three years ago and pitched the idea to Mr. Hernández,” Dr. Husain says. “We were nervous about what would happen with the program. We kind of felt like we were starting from scratch — and if we were going to have to start from scratch, let’s use it as an opportunity to really create something novel. Let’s create something that isn’t found anywhere else in Texas — and really anywhere else across the country.”

In the next few weeks, the new center will open on the ninth floor of University Hospital. It comes at a time when patient volumes — and outcomes — are at an all-time high.

“It’s really exciting for us — on a personal level, on an emotional level, and obviously on a clinical and care-delivery level,” Dr. Husain says.

Comfort a priority

Jennie Winkler had a better support system than most when her yet-unborn daughter Evie was diagnosed with hypoplastic right heart syndrome last year. Her brother-in-law is an obstetrician in Midland, and both her sisters are nurses — one in a cardiac intensive care unit, the other in a NICU.

“First you just break down, not knowing what’s going to happen,” says Winkler, who lives in New Braunfels. “Then, with my family’s medical background, we knew the next step had to be finding the best place for her so she would have the best chance of survival.”

An echocardiogram on a young patient

They met with heart surgeons in nearby San Antonio, including Dr. Husain at University Hospital. They connected instantly with Dr. Husain and his staff.

“This was the only place that would allow me to be at her bedside, 24 hours a day in her room with her. It was the only program that was so geared towards family.”

Little Evie’s first surgery took place in October. A second is being scheduled.

When they return, they likely will be staying in the new Heart Center’s Pediatric and Congenital Cardiac Care Unit, or PCCU. It will feature 18 “variable acuity” rooms capable of intensive care but with the features and amenities of a regular room. That means in most cases a child will remain in the same room, with the same nurses and staff, throughout his or her stay. The PCCU currently occupies temporary space on the hospital’s 10th floor.

It was a model borrowed from Ann & Robert H. Lurie Children’s Hospital of Chicago. Research found that patients, families and staff are happier with a variable acuity model. Outcomes are better, and it leads to fewer medical errors.

Comfort was a priority. Each patient room has a sofa that converts to a bed for family members, as well as a recliner. Parents also have the option of staying in one of four hotel-like rooms on the unit, with an adjoining kitchen, living area and library — to make extended stays less disruptive.

From left to right: S. Adil Husain,MD, Steven Neish, MD and Roozbeh Taeed, MD

“More than half of the kids and families we treat come from outside Bexar County,” Dr. Husain says. “This concept of having an all-encompassing inpatient and outpatient heart center for kids — but perhaps even more importantly, for families — is critically important to the success of the program.”

Thanks to a grant from the William Randolph Hearst Foundation, each room has an iPad loaded with educational materials related to the child’s medical condition — and the child’s favorite movie or game, if desired. More learning materials and entertainment are available through University Hospital’s in-room video link.

Preparing nervous parents for the complex task of caring for their child after discharge is a key element of the program, says Shannon Friesenhahn, RN, Director of the PCCU.

“Discharge teaching starts at admission,” Friesenhahn says. “Many of these families are scared of what they will face following discharge from the PCCU. Teaching encompasses medication management, oxygen management, feeding regimens and home equipment, and a lot more.”

Parents generally spend a couple of days before leaving the hospital taking care of their child under the watchful eyes of staff members, demonstrating what they’ve learned and gaining confidence in their ability to manage the child’s day-to-day needs.

And while the program works to meet the needs of children and their special physical and emotional requirements, in reality the pediatric heart specialists take care of adults, too. Advances in extending the lives of babies born with congenital heart problems means that many require continued care into adulthood.

“Not long ago we had a 41-year-old woman who received a Melody valve and recovered in our unit, right next to a 2-month-old,” says Roozbeh Taeed, MD, Associate Professor of Pediatrics at UT Health and Medical Director of the PCCU.

The new University Children’s Health Heart Center will soon open on the ninth floor of University Hospital.

Best Outcomes

Dr. Husain and his colleagues have some of the best outcomes in the state. Those colleagues include John Calhoon, MD, Chair of Cardiothoracic Surgery at UT Health, and a pediatric cardiothoracic surgeon who pioneered the children’s heart program at University Hospital in 1989.

S. Adil Husain, MD, and John Calhoon, MD

The team includes cardiologists, cardiothoracic surgeons, anesthesiologists, neonatal and pediatric intensive care specialists, nurses, and others who work collaboratively with other pediatric teams.

“The commitment of many program team members, most specifically the intensivists and nurses, to adopt this model of care delivery has been critical to its success,” Dr. Husain says. “Their ability to take care of everyone from neonates to adults should truly be applauded.”

The program has a dedicated pediatric catheterization lab, where cardiologists offer a variety of minimally invasive procedures for a number of congenital heart conditions.

A number of commercial insurers, including Superior HealthPlan, Aetna and Optum have designated the program as a center for excellence in pediatric heart care.

University Health System has a dedicated pediatric and neonatal transport team with a specially designed and dedicated ambulance, as well as air transport capabilities.

And as an academic program, the Heart Center has a special focus on research and innovation, working to develop new and better therapies.

Among the many studies and projects underway, Andrew Meyer, MD, a pediatric critical care specialist with a background in biomedical engineering, is collaborating with Dr. Husain to reduce the risk of bleeding and clotting complications in children who undergo heart bypass procedures.

University Hospital’s dedicated cardiac catheterization lab for children is staffed by a pediatric-trained cath lab team.

“Our understanding of why these occur, when they occur and when to treat them is lacking,” says Dr. Meyer, Assistant Professor of Pediatrics at UT Health.

Dr. Meyer is looking at the role of microparticles that break free from blood platelets as they are pumped through the bypass machine and back into the body. By studying the behavior of these microparticles, Dr. Meyer thinks it may be possible to minimize the risks of bleeding and clotting though targeted medications.

Such research improves care at the bedside, as did a recent study on how children with single-ventricle defects — among the most serious and complex defects in which the child has only one pumping chamber — can be better managed between surgeries. These children may require multiple surgeries, catheterizations and other treatments during the first few years of life. The Heart Center offers a weekly, high-risk single ventricle clinic for these patients.

“There’s no doubt that we deal with a really unfair disease entity every day,” Dr. Husain says. “I think what we’re building here is the best model to deliver care. In the end, we want to create an environment where we’re not just the best place in San Antonio for families that have kids with heart disease, but that we’re regionally and nationally recognized. I think this type of center helps give us a foundation to do that.”

To learn more about the University Children’s Health Heart Center at University Health System, visit universitychildrenshealth.com/pediatric-cardiology or call 210-562-5378.