How to select a destination for your child’s heart treatment?

Written by Dr R Krishna Kumar, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala

• Parents of children with congenital heart defects are often confronted with several challenges as soon as the diagnosis is made and the news is broken to them.
• One of the most significant of these challenges is to find a reliable institution that can provide comprehensive care that could include surgery, catheter interventions and intensive care.
• There is still considerable variation in the quality of care between individual hospitals and there is also a substantial difference in costs among these hospitals.
• Unlike in some countries such as the UK, it is not mandated in India that individual hospitals share their results openly in the public domain and therefore becomes difficult for an individual parent to find out how good the results are for specific heart operations.
• A very basic requirement for any hospital is accreditation by the National Accreditation Board for Hospitals (NABH)– but this is quite general and is not specific for pediatric cardiac care.
• It is important also to be aware of certain common pitfalls that commonly misguide parents:
  • Do not base judgements on isolated media reports
  • Internet searches on given hospitals or doctors also do not provide an accurate assessment of the institution’s capabilities
  • Do not base your judgement on other services provided by the hospital
  • Do not base your judgement on the presence of one or two highly famous superstar cardiologists, or surgeons – it is the team that matters much more than individuals
• Below is a 10-item checklist that could serve as a useful guide to parents in identifying a suitable destination for their child’s cardiac care:

1. High level of skill among caregivers

Taking care of children requires high-level of skills in distinct disciplines that include Pediatric cardiac surgery, pediatric cardiology and pediatric cardiac/anesthesiology/intensive care and other skilled personnel that include nurses, perfusion, technologists and respiratory therapists.

2. Cohesive Teamwork

It is not enough just to have individuals with skills. These individuals have to work together cohesively. Cohesive teamwork is perhaps the most critical component of a successful pediatric heart program.

3. Quality Infrastructure & Equipment

While many hospitals advertise and display that they may have the most recent equipment and facilities such as robotic surgery, the truth is that the most advanced technology does not necessarily translate into safe outcomes. To a substantial extent, individuals matter much more than machines & equipment.

4. Constant focus on Quality Improvement

Pediatric heart programs that have a conscious focus on quality improvement are likely to deliver the best results. Often such programs voluntarily share their results in multi-institutional collaborate networks.

5. A system for Charitable Care

Pediatric heart operations and catheter procedures are expensive. Many insurance companies still do not provide cover for congenital heart care. If you are likely to be financially challenged, you must look for hospitals that work with funding agencies & philanthropic organizations to find ways to help parents overcome this financial challenge.

6. Evidence of a Strong Ethical Framework

It is generally challenging to determine whether or not a hospital has a strong ethical framework. Many corporate hospitals tend to compensate physicians or surgeons based on the number of procedures they perform.

7. Support from Other Pediatrics Specialities

Pediatric heart disease often does not manifest in isolation. Other organ systems may also be affected or your child may have a genetic or developmental issue that merits attention from other Pediatric specialists.

8. Other Support Systems such as Social Workers

Support staff, such as social workers, play a very significant role in enabling care and serving as a liaison with funding agencies. Departments with a strong presence of medical social workers can ease the parental anxiety and help secure funding assistance from philanthropic organisations.

9. Communications

Like in other areas, the promptness of responses and quality of communication from a department are a good indicator of their professionalism.

10. Word of Mouth

Experience of previous patients: once you have identified or shortlist a potential destination for your child, it’s always useful to speak to other parents about their experiences with heart surgery, or other procedures in the place that you are considering.

Click here to access Dr. Krishna Kumar’s complete article and make informed choices for your child’s care.