UK HealthCare and Cincinnati Children's Hospital Medical Center have signed a letter of intent for a partnership to return pediatric heart surgery to the University of Kentucky under the guidance of one of the nation's top children's hospitals.
Under terms of the proposal, a heart surgeon will be recruited jointly and have a primary appointment at Cincinnati Children's in a "two sites, one program" model; the surgeon will be based in Lexington and will perform services at Kentucky Children's Hospital.
UK's pediatric cardiac surgery program was suspended in 2012 after an uptick in mortality rates. The program's chief surgeon, Mark Plunkett, left UK in 2013 with a $1 million settlement. An internal review of the program never identified specific problems, but it said better support and nursing care would be needed for complex surgeries.
"In partnering with Cincinnati Children's, we will be teaming up with one of the top three children's hospitals in the country and a top 10 pediatric heart care program," said Bernard Boulanger, UK HealthCare chief medical officer. He led the review of UK's program and helped lead discussions with Cincinnati Children's.
In addition, a director of pediatric heart partnership will be recruited immediately to oversee the program and drive its development.
The program director also will be based in Lexington and be a liaison for both sites. The director will be employed by UK HealthCare, report to UK HealthCare's chief medical officer and have reporting responsibilities to Cincinnati Children's Heart Institute leadership team.
Doctors, nurses and support staff in the program will get intensive training in Cincinnati, Boulanger said. A full agreement is expected to be finalized in late September, with surgeries starting by the end of 2016 or early 2017.
"We're committed to reactivating the program. ... We'll be starting with the less complex program, and as the program matures and under the guidance of the Cincinnati Children's Hospital, we may do more complex surgeries in time," Boulanger said. Initially, all complex surgical cases would be sent to Cincinnati.
Andrew Redington, executive co-director of the Heart Institute and chief of the division of pediatric cardiology at Cincinnati Children's, said the partnership was natural in many ways.
"The opportunity arose and we already provide services for many children in Northern Kentucky, ... and we're committed to providing the best level of care closest to home," he said.
Redington also emphasized the importance of having a strong nursing team to surround the surgeon.
"Just appointing an outstanding surgeon isn't good enough," he said. "It's the rock other institutions have perished on. Even the best surgeon, if not surrounded by a strong team, will not get optimal results."
The move drew immediate praise.
"That's an excellent idea," said Somerset physician Kevin Kavanagh, who chairs Health Watch USA, a medical watchdog organization. Cincinnati Children's Hospital is "a world-class institution for quality, safety, health care policy. I don't think you could have chosen a better program. ... I think this can be viewed as trying to shore up a deficit, and expand and better serve patients."
Tabitha Rainey is the mother of a child with heart problems who was operated on at UK but was moved to another hospital after complications. Rainey has become an advocate for other parents, some of whose children died after heart surgery at UK.
"Honestly, I think this is the best decision they can make, and this decision should have been made a long time ago. They could have saved a lot of lives," she said. "I feel great that they'll be going under Cincinnati's guidance to make sure their center is up to par."
Rainey and other parents were infuriated by UK's initial refusal to discuss why the program was suspended or to release mortality data for the heart program. UK said releasing the information could hurt patient confidentiality, but Attorney General Jack Conway said UK had violated the Open Records Act, a decision UK appealed in circuit court.
In the meantime, CNN published a long segment on UK's pediatric heart surgery program, identifying at least two children who died. UK then decided to release the mortality rates. The UK program's mortality rate increased from 5.2 percent in 2010 to 7.1 percent in 2012.
National mortality rates average 4 percent to 5.3 percent, according to the National Institutes of Health.
As part of the new agreement, officials have said they will establish a transparent, data-driven quality and safety program, with outcomes reported jointly to the Society for Thoracic Surgeons and to other regional and national programs that monitor surgical and clinical outcomes.
Redington said the partnership could become a model of care.
"I think this will be the model for the smaller medium-size units," he said. "We will learn from Lexington, and Lexington will learn from us — it will be a bi-directional learning experience. Currently, I think this is the best way of delivering the highest-quality care."