A unique shared management cardiac care model developed by specialists at Riley Children’s Health is contributing to neonatal operative mortality rates that are far better than the national average, based on the most recent data released by the Society of Thoracic Surgeons (STS). Riley achieved an observed to expected mortality ratio of just 0.39 with an observed mortality rate of 4.15% compared to the STS overall rate of 7.56%.
A team of Riley neonatologists and cardiologists integrate an exceptional model at the Riley Heart Center, a system performed by less than 10% of the nation’s pediatric hospitals
A high-volume pediatric heart center that routinely treats the most complex cases, the Riley Heart Center has a long history of achieving exceptional outcomes. Contributing to stellar care in the treatment of neonates who need cardiac surgery or intervention, the collaborative care model is built on shared management between neonatologists, cardiac intensivists, cardiovascular surgeons, cardiologists and anesthesiologists. The model, which integrates the expertise of Riley neonatologists and cardiologists in all phases of the first hospitalization, is executed by less than 10% of the nation’s pediatric hospitals, according to a Children’s Hospitals Neonatal Consortium survey.
“Not only do we have a cardiac-dedicated group of neonatologists for this neonatal population, but all of our subspecialists see the value in co-managing the care of these complex patients—most of whom have more medical issues than just a congenital heart anomaly,” said Laura Haneline, MD, division chief of neonatology at Riley.
With over 550 admissions annually, Riley’s Cardiovascular Intensive Care Unit supports neonates with complex heart conditions and high-risk interventions
Neonates requiring surgery or cardiac intervention are admitted to Riley’s Cardiovascular Intensive Care Unit under the primary care of neonatologists with cardiac intensivists and cardiologists providing consult. Cardiothoracic surgery and cardiac intensivists transition to primary service following surgery or intervention through the initial recovery period, with neonatology picking back up, along with cardiology, as primary services as the babies progress toward discharge from the Riley Heart Center.
“Neonates with complex congenital heart disease are patients undergoing the highest risk interventions for a heart center and have unique needs,” said Larry W. Markham, MD, FAAP, FACC, cardiology division chief. “The forward thinking by Riley neonatologists and cardiac intensivists, followed by the acceptance from cardiothoracic surgery and cardiology, has delivered a model that attends to these needs of the neonatal patient and family. This model has consistently delivered exceptional results, even in the face of significant increases in volume and complexity.”
The prevailing standard at pediatric hospitals around the nation is for these babies to either be admitted directly to a cardiac ICU without formal involvement from neonatology or admitted directly to a neonatal ICU without formal involvement from cardiac intensivists.
“For these medically fragile babies, there are a variety of issues that can develop in the first few hours or days of life that neonatologists are in the best position to address, whether that be nutritional concerns or, as a more specific example, neonates born to mothers with diabetes,” said Paulomi Chaudhry, MD, medical director of the Riley Heart Center NICU. “Our care model is very collaborative; our team of subspecialists round together every day, and we confer in real time throughout the day, which makes a big difference in overall outcomes for these patients."
Riley specialists dedicate expert, cardiac care prior to birth, supporting high-risk conditions from the time a patient is in the utero
Dr. Haneline said the recent expansion of the Riley Fetal Center has also contributed to improved outcomes for neonates with congenital heart disease. With diagnosis and care beginning in utero, Riley neonatologists and cardiologists are part of the center’s multidisciplinary team that supports expert coordinated management of complex and high-risk fetal conditions, including cardiac abnormalities.
“For all of the Riley specialists involved in treating babies with serious congenital heart conditions, it’s really our shared vision and commitment to providing the very best care that’s made this model such a success,” she said. “Not only do we have mutual respect for what each of us brings to the table, but we also see the value and benefits of shared management for our patients and their families.”