Even stronger beating hearts

In the past years, technical and managing initiatives have contributed to the improvement of Cardiology's assistance indicators

In the past five years, Pequeno Príncipe Hospital’s Cardiology Service (clinical, surgical and Intensive Care Unit) has significantly advanced in its main indicators. Despite already having a very low mortality rate, Cardiology made strides in this indicator, reducing it by almost 70% in 2018, in comparison to the rate in 2013. The number of deaths also decreased by 62% in the same period. In practice, these numbers are the result of technical and managing actions that have been structured and strengthened.

The treatment for hypoplastic left heart syndrome is an example of these advances. This congenital heart defect causes a malformation in the left side of the heart and until 2013, it was considered practically fatal. There was a surgery to fix it, but very few babies survived in the ICU after the operation.

The survival rate increased progressively between 2013 and 2018 until it reached 74% in the 2017-2018 biennial, ranking Pequeno Príncipe Hospital’s results among the best in Brazil. This leap in positive results is due to the development and application of detailed protocols for pre-operation, surgery and postoperative periods. Establishing action protocols in each of these critical moments required intensive studies on heart diseases and research for evidence about the practical results of these new techniques.

For example, this way it was able to link treatment to induct the build up of carbonic in levels that were above standard, which would facilitate the passage of blood from one side to the other in the heart. This surgical technique was customized for each different group of patients.

For Dr. Leonardo Mulinari, one of the Hospital’s cardiac surgeons, this improvement began from a paradigm shift. “The focus of care shifted from individual practice to care lines, especially in more complex heart diseases. And it was the increase of attention to these diseases that boosted these indicators. It wasn’t the new surgical techniques that were applied but the better application of these techniques,” he explains. According to him, in addition to the reduction of mortality rates, there was also a drop in the number of infections and complications in the postoperative period.

“Many areas were engaged in order to achieve these results, such as clinical cardiology, cardiovascular surgery, anesthesia and the ICU’s medical and nursing staff. Without this interaction, that allows for a global view of the patient, these advances wouldn’t have been possible,” he points out.

Telemedicine

Another initiative that contributed greatly was the telemedicine project developed in the Cardiac ICU from 2016 and 2018, in partnership with Children’s Hospital of Pittsburgh in Pennsylvania. In sessions, Pequeno Príncipe’s professionals presented the clinical and care aspects of more complex cases, discussed test results, vital signs and, working together with the Pittsburgh team, decided what the best approach should be for this patient’s care.

During this period, about 200 telemedicine sessions were carried out. “With this exchange of knowledge, we achieved an interesting curve. We improved the process of assistance and diminished the time period patients spent in risk areas,” stated Leonardo Cavadas, coordinator of the Cardiac ICU.