Cincinnati Children’s is taking a broad, collaborative approach to providing pediatric care.
In February, the system partnered with a fifth hospital and its fourth partnership outside of Ohio. Its partners include Lexington-based Golisano Children’s at University of Kentucky, Peyton Manning Children’s in Indianapolis, Akron (Ohio) Children’s Hospital, Sheikh Khalifa Medical City in Abu Dhabi, United Arab Emirates, and its newest addition, Mary Bridge Children’s Hospital in Tacoma, Wash.
These partnerships are part of a strategy to expand pediatric cardiac care access far and wide.
“The fundamental vision driving us to form these collaborations is the belief that families and patients should be able to receive expert care as close to their home as possible,” Michael Gaies, MD, executive co-director of the Cincinnati Children’s Heart Institute and director of the division of cardiology, told Becker’s. “We try to partner with these hospitals to help them achieve their goal of serving their population close to home and we provide a kind of safety net. When their patients’ needs outstrip their experience, expertise and infrastructure, they have a partner they trust to take care of them.”
Addressing the specialist shortage
Nationally, the number of pediatric specialists is decreasing. Cincinnati Children’s has more than 1,000 pediatricians and pediatric specialists, a resource that system leaders believe should be shared. Thanks to telehealth and technology, specialty consultations across states and countries are possible, David Morales, MD, executive co-director of Cincinnati Children’s Heart Institute and division director of cardiothoracic surgery at Cincinnati Children’s, told Becker’s.
By sharing their expertise and resources, Cincinnati Children’s can help keep smaller programs alive.
“What I have been seeing over 20-some years of practice is these small children’s hospitals opening a pediatric program and then closing a pediatric program,” Dr. Morales said. “Pediatric heart surgery is probably the specialty that opens and closes more than any other.”
These smaller programs often shut down due to limited staff, infrastructure and sometimes poor outcomes, he said. But opening a program, closing it and reopening is expensive and wasteful. A collaboration with a comprehensive center like Cincinnati Children’s can stabilize programs by providing specialty care consultations for patients and mentorship for leaders building the program.
“We’re there to consult and collaborate, ensuring the appropriate infrastructure and personnel are present as a program starts and increases the complexity of patients they care for. That was the missing piece at many of the programs that close,” he said. “What we’ve been able to show our partners is that if we’re slow and steady in our progression, take great care of kids and keep the program going, that is actually much better, even economically.”
Cincinnati Children’s provides a number of collaboration opportunities, including remote consultations, shared clinical decision-making conferences, clinical guidelines and protocols, sending staff to overlay with a new operation or catheter intervention, and on-site education such as a course for cardiac ICU and acute care nurses to improve care.
The two-way learning and access street
These collaborations are a two-way street for learning and access.
“A network, I think, helps address some of the access issues, because sometimes providers don’t even know what new things are being offered,” Dr. Morales said. “One example: We’re doing complex biventricular repairs in patients who usually have single ventricle palliation, but because of the network, some children are getting care that they wouldn’t have had access to before. However, access works both ways because we are always learning from our partners as well.”
Each partnership also brings shared learning, education and a new focus on the patient. For example, one partnering hospital is able to get some patients home on postoperative Day 1 after heart surgery, which is not typical at Cincinnati Children’s. This collaboration has given them an opportunity to explore more ways to further shorten stays post-surgery.
The future
Each partnership is growing and expanding in its own way, Dr. Morales said, and Cincinnati Children’s is meeting the demand by thinking creatively about providing sustainable care.
“The number of specialists is going down, so the answer to improve access is probably not going to be more people — it’s going to be collaborating and creating networks to provide access and maximize outcomes for patients everywhere,” Dr. Morales said. “That’s our mission: to positively affect the cardiac health of as many children as we can, no matter where they live.”
Balancing staff demands across a system and partnerships is still a tricky and evolving model, Dr. Gaies said. Currently, physicians provide care to both Cincinnati patients, and consultations across the nation, but the system is considering a model that would have some clinicians focus on the network while others focus on in-person care.
“This evolving model also opens up some unique recruitment potential,” Dr. Gaies said. “Faculty don’t necessarily have to live in Cincinnati, and could support these centers from other locations. That widens the pool of specialists we can involve.”
Although Cincinnati Children’s is in conversation with additional centers about possible future partnerships, it has paused any additional formal collaborations, “because we needed to know, first, that we are able to provide the highest quality care at all of our partner sites and here at home in Cincinnati, before expanding further,” Dr. Gaies said. “It was very important to us to prove to ourselves that we could do this at this scale with excellence before continuing to grow. When we prove that, we will enthusiastically form new partnerships to help even more patients and families in other communities.”
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