By Maureen Gilmer, IU Health senior journalist, email@example.com
When the news broke that the cardiology and heart surgery team at Riley Hospital for Children at IU Health jumped into fifth place in the nation in U.S. News and World Report’s annual rankings, Dr. Scott Walker texted his team to congratulate them.
“It’s definitely a point of pride for all of us,” he said, yet Dr. Walker is neither a surgeon nor a cardiologist.
He leads the Congenital Cardiac Anesthesia Team, joining five other anesthesiologists who work exclusively with pediatric heart patients undergoing surgery or procedures in the cardiac cath lab.
So when the cardiac team succeeds, he knows it’s a reflection of a lot of effort by a lot of people, his team included.
“It’s a multidisciplinary approach, for sure,” Dr. Walker said. “A lot of attention goes to the surgeons, as it should, but there are a lot of other people too – operating room nurses, cath lab nurses, intensivists, perfusionists, cardiologists, ICU nurses.”
He also gives a shout out to Riley’s Clinical Data & Research Outcomes Center, which does the painstaking work of gathering and reporting the required data.
The CCAT launched Jan. 1, 2016, as a way to improve outcomes for patients by having a dedicated team of physicians caring for them. When Dr. Walker joined Riley 23 years ago, there were 16 anesthesiologists, and all of them took turns in the OR for heart surgeries.
“Now we have well over twice that number and a lot of other folks as well,” he said. “It became clear that we needed to create a smaller group of anesthesiologists who were dedicated to delivering care to congenital heart disease patients.”
ON THE RISE
Dr. Brian Egan, clinical director of anesthesiology at Riley, agrees with the approach.
“If you’re only doing one open-heart surgery anesthetic a month, you don’t get a chance to refine your technique. Our dedicated team of cardiac anesthesiologists work closely with the ICUs and with cardiac surgeons … so patients do well during surgery and post-operatively,” he said.
The results speak for themselves in improved outcomes, Dr. Egan said, leading to that top 5 ranking this year. Riley moved up four spots from last year. Since 2016, Riley’s heart team has climbed from 29th in the nation to fifth.
“I have the rankings from five years ago posted in my office,” Dr. Walker said, “and we’ve gone up every year since then, so when we made it to the top 5 this year, it was very exciting.”
As a smaller team, they have been able to accomplish some goals that likely wouldn’t have been as easy or even possible when 20 to 30 anesthesiologists were rotating through the cardiac operating rooms. The team has developed more uniform protocols for how they deliver anesthesia in the operating room, as well as when it is appropriate to extubate a patient in the OR, rather than leaving the patient on a ventilator when he or she is moved to the ICU.
They’ve also created a new training program, a congenital cardiac anesthesia “super fellowship,” led by team member Dr. Rania Abbasi. The first fellow, Dr. Clayre Tanis-Arens, completes the program this year and will join the team as faculty.
Currently, there are six anesthesiologists dedicated to congenital cardiac surgery patients: Dr. Abbasi, Dr. Matthew Hamilton, Dr. Michael Mazurek, Dr. Chan Saysana, Dr. Tanis-Arens and Dr. Walker. Three more anesthesiologists specialize in cardiac cath lab anesthesia: Dr. Doris Hardacker, Dr. Gabriel Krause and Dr. Thomas Feehan.
In addition, Krysta Merritt, CRNA, is part of the CCAT anesthesia care team, and two support nurses (Kyle Hainje and Rhonda Barclay) help screen cardiac patients prior to surgery.
“You need all the infrastructure in place, all the right people in all the right places to really have the success we’ve had,” Dr. Walker said. “And it’s measurable success – that’s why we made the top 5.”
SHARING THE GLORY
Longtime cardiothoracic surgeon Dr. John Brown is delighted, but not surprised, by the heart team’s elevation in the rankings, thanks to the support it receives from around the hospital.
“We have an incredible crew of OR and ICU nurses who take care of these kids, we have our NPs and PAs and cardiology, who are an integral part of this whole team. We’ve got an incredible anesthesia team we work very closely with and have for the 43 years I’ve been here. It’s just a great place to work all the way around, with everybody pitching in and doing what they do.”
Dr. Jeremy Herrmann, cardiothoracic surgeon, is as proud as anyone of the heart team’s performance, but he is also quick to share the glory.
In an email, he wrote: “I have been compiling a list of all the components that comprise our CV service line, and the list is long: cardiothoracic surgeons and advanced practice providers, cardiologists (general, interventional, transplant and advanced practice providers), anesthesia (physicians and techs), the ICU team, nursing (ICU, step-down, OR and cath lab), transplant coordinators, perfusionists, pharmacy, custodial staff.”
He knows he’s leaving someone out, albeit unintentionally.
“It is remarkable how so many factors have to come together to maintain a high-quality program,” Dr. Herrmann said. “Your request made me appreciate just how many personnel are involved in our program.”
Dr. Brown likens it to an orchestra.
“When everyone is playing their part, together we’re able to make beautiful music.”
Debra Murphy, transplant coordinator on the cardiac team, is thrilled for Riley’s Heart Center staff and program to be recognized as a national leader.
“This is such a team effort,” she said. “Everyone involved with our patients either directly or indirectly contributes to the care our patients receive and the outcomes that are achieved. Our team members walk the talk of the IU Health mission and values statement by providing expert and compassionate care to each patient.”
While physicians lead the team, they are supported by a large group of people – from the support staff in the cardiology and transplant offices to the members of the heart transplant procurement team who fly to donor sites in the early morning hours, she said.
“One of our recipients recently passed away, and his mother sent a note of thanks to Dr. Darragh (Robert) for giving them eight wonderful years with their son,” Murphy said. She wrote: “We appreciate you and are so grateful for every decision, hope, prayer and care you have shown to our sweet son.”
IT’S ABOUT TEAMWORK
Dr. Brian Gray, pediatric surgeon, explains that the USNWR rankings are not like a sports score, pitting one institution against another. The team approach is reflected in the results.
“It’s a way for the public to see in an encapsulated look how we form these programs to take care of patients with specific needs,” he said. “We have a huge team of nurses, doctors, social workers, all sorts of care providers who come together to develop these really amazing programs.”
Even if a specific unit doesn’t appear in the rankings, it doesn’t take away from the excellent work they do.
“There are people from all over the hospital who help those rankings come to be,” Dr. Gray said. “For example, in pediatric general surgery, we do surgery on patients with many types of conditions, so our work is reflected in many of the categories. Then there are really important people like social work and the ED and those don’t get ranked at all, but they are integral to these categories.”
The message is similar, no matter whom you talk to: “There are people all over Riley doing really great work,” Dr. Gray said. “There are huge teams of care providers that really come together to take care of these kids and it’s reflected in these rankings.”
This year, Riley is one of only 24 children’s hospitals in the country to rank in all 10 pediatric specialties. Its urology program placed second in the nation.
Photos submitted and by Mike Dickbernd, IU Health visual journalist, firstname.lastname@example.org