Peds patient deaths

[Man o War]

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Anyone know what’s going on here?

A report on child deaths prompts an investigation into NC Children's Hospital surgeries

RALEIGH — The state has launched an investigation into practices at North Carolina Children's Hospital following a New York Times report on the deaths of children after heart surgery, including

www.greensboro.com

 

[NICMAN]

I saw that NYT expose earlier this week. I imagine they are scrambling.

 

[Man o War]

I saw that NYT expose earlier this week. I imagine they are scrambling.

I read another set of articles, they mention a lot of different issues, I saw questionable surgeon capabilities, lack of experienced ICU doctors and nurses, “cultural difficulties”, not doing enough surgeries to be proficient, finger pointing in many different directions.

 

[ambiturner]

Situations like this are a good reminder that if you’re going to work in high risk areas that scrutinize outcomes (peds cardiac, transplant), you unfortunately have to be super careful about protecting yourself and having ironclad documentation. If the program is doing poorly and the finger pointing starts, you don’t want them to have a reason to blame you as anesthesiologists/ICU docs/etc are much easier to dispose of than a difficult to recruit surgical chair.

Not saying that will happen here, but it’s happened before.

 

[Hoya11]

Anyone know what’s going on here?

A report on child deaths prompts an investigation into NC Children's Hospital surgeries

RALEIGH — The state has launched an investigation into practices at North Carolina Children's Hospital following a New York Times report on the deaths of children after heart surgery, including

www.greensboro.com

Wasn't there a similar story from CNN about a Florida hospital and sketchy surgeon a few years ago? Also doing peds cardiac stuff inappropriately..


This same type of thing (though not on such a serious scale as peds cardiac) is happening everywhere ( I think ) in more subtle forms.

I can tell you horrific stories of surgeons and the bad outcomes they created. , I'm sure we all can, and the repercussions are nil. God forbid we stop them from bringing cases to the hospital.

I had a cardiac surgeon just last week Facetime a more senior surgeon for hours during the case. It was a routine CABG gone wrong and on its 8th hour. It was a disgusting site. I have general surgeons who take 4 hrs to do a gallbladder and wonder why there are bad outcomes. Nothing is done or said to fix or improve the process. Surgeons right now are untouchable. It takes little babies dying before someone even raises an eyebrow at this disgusting capitalistic practice.

I mean what year is it that someone can come into an OR late, be rude to staff, do a ****ty job the the patient, everyone int eh room knows it, and its thank you sir can I have another? Hospitals are ******.

 

[PieOHmy]

. Surgeons right now are untouchable.

The cream doesnt rise to the top anymore.

There are kickbacks going on in myopinion. The hospital employs 4-6 general surgeons to do all the cases in the hospital, pay them a salary (the lowest that they can get away with) and give them ALL of the cases. So the patients have no choice. 20 years ago the surgeons had to compete for the cases (read: they had to be good) because everyone knew who was good and bad. No longer, they have a steady stream of referrals (operative cases) so long as they accept the hospital terms (salary).. Clear violation in my opinion and who are the losers? the patients.

 

[Man o War]

I think how untouchable the surgeon is really depends on the hospital and how desperate they are. 2 hospitals in my area have fired 2 high profile surgeons in the past year. One was for bad outcomes and one was very hush hush but word is he had some behavioral issues the the hospital decided wasn’t acceptable to them.
I guess it’s no different than these desperate rural hospitals hiring any CRNA they can get to come there, outcomes be damned. Paired with crappy surgeons, that is a recipe for disaster.

 

[PieOHmy]

2 hospitals in my area have fired 2 high profile surgeons in the past year. One was for bad outcomes and one was very hush hush but word is he had some behavioral issues the the hospital decided wasn’t acceptable to them.

hush... hush... he was a whistleblower... wink wink.. we cant have that.. youre fired.

if people got fired for bad outcomes there would be many people on the chopping block. because bad outcomes happen and will ALWAYS happen..
If you cannot accept that.... you cant work in healthcare..

 

[Man o War]

hush... hush... he was a whistleblower... wink wink.. we cant have that.. youre fired.

if people got fired for bad outcomes there would be many people on the chopping block. because bad outcomes happen and will ALWAYS happen..
If you cannot accept that.... you cant work in healthcare..

His bad outcomes were way outside the average.

 

[PieOHmy]

His bad outcomes were way outside the average.

It was incompetence? not bad outcomes.

 

[deleted87051]

Wasn't there a similar story from CNN about a Florida hospital and sketchy surgeon a few years ago? Also doing peds cardiac stuff inappropriately.

Despite warnings, All Children’s kept operating. Babies died.

The heart program’s mortality rate tripled since 2015.

www.tampabay.com

That’s this one. Slightly different issues though. The hospital had an existing program with good outcomes but wanted to “improve” it with a higher profile, widely published, academic surgeon. Unfortunately the replacement surgeon had worse outcomes.

I’ve seen almost the exact same thing happen in an adult cardiac program at my previous job. Existing program had a very good, low key, low profile surgeon. Hospital wanted someone who could grow the program. The newly recruited “star” surgeon lasted 6 months but the questions started within his first few cases. He is now a “consultant/entrepreneur”.

 

[narcotics999]

Despite warnings, All Children’s kept operating. Babies died.

The heart program’s mortality rate tripled since 2015.

www.tampabay.com

That’s this one. Slightly different issues though. The hospital had an existing program with good outcomes but wanted to “improve” it with a higher profile, widely published, academic surgeon. Unfortunately the replacement surgeon had worse outcomes.

I’ve seen almost the exact same thing happen in an adult cardiac program at my previous job. Existing program had a very good, low key, low profile surgeon. Hospital wanted someone who could grow the program. The newly recruited “star” surgeon lasted 6 months but the questions started within his first few cases. He is now a “consultant/entrepreneur”.

Profit at Johns Hopkins hospitals tumbled. All Children’s was to blame.

Profit at Johns Hopkins hospitals tumbled. All Children’s was to blame.

The decline was $31.7 million — 70 percent of the system’s total — compared to the first quarter last year.

www.tampabay.com

 

[IlDestriero]

Profit at Johns Hopkins hospitals tumbled. All Children’s was to blame.

Profit at Johns Hopkins hospitals tumbled. All Children’s was to blame.

The decline was $31.7 million — 70 percent of the system’s total — compared to the first quarter last year.

www.tampabay.com

I know someone at that hospital. It troubles me that they could have known about these bad outcomes and kept on passing gas. That’s one thing I’m very thankful for where I am now, not everyone is a superstar super fast whiz kid, but there really aren’t any known assassins, slow ortho sports guys though, we’ve got them in abundance.

 

[PieOHmy]

Despite warnings, All Children’s kept operating. Babies died.

The heart program’s mortality rate tripled since 2015.

www.tampabay.com

That’s this one. Slightly different issues though. The hospital had an existing program with good outcomes but wanted to “improve” it with a higher profile, widely published, academic surgeon. Unfortunately the replacement surgeon had worse outcomes.

I’ve seen almost the exact same thing happen in an adult cardiac program at my previous job. Existing program had a very good, low key, low profile surgeon. Hospital wanted someone who could grow the program. The newly recruited “star” surgeon lasted 6 months but the questions started within his first few cases. He is now a “consultant/entrepreneur”.

The way i read it when it came out was the existing cardiac surgeon who had been there for years doing those cases, wouldnt play ball with the new owners so they replaced him with a less experienced but more polished cv guy.

 

[cards67]

Reminds me of what was happening at Baylor in houston. After reading the barage of stories and talking to some closer to that situation, I'm even more skeptical of any of these types of news stories that come out or it being outside the norm of what we deal with regularly. It's curious though how all these stories are only about cardiac depts, I guess public outcomes data and high-risk patients go hand-in-hand with easy, dramatic storytelling.

 

[Merely]

Wasn't there a similar story from CNN about a Florida hospital and sketchy surgeon a few years ago? Also doing peds cardiac stuff inappropriately..


This same type of thing (though not on such a serious scale as peds cardiac) is happening everywhere ( I think ) in more subtle forms.

I can tell you horrific stories of surgeons and the bad outcomes they created. , I'm sure we all can, and the repercussions are nil. God forbid we stop them from bringing cases to the hospital.

I had a cardiac surgeon just last week Facetime a more senior surgeon for hours during the case. It was a routine CABG gone wrong and on its 8th hour. It was a disgusting site. I have general surgeons who take 4 hrs to do a gallbladder and wonder why there are bad outcomes. Nothing is done or said to fix or improve the process. Surgeons right now are untouchable. It takes little babies dying before someone even raises an eyebrow at this disgusting capitalistic practice.

I mean what year is it that someone can come into an OR late, be rude to staff, do a ****ty job the the patient, everyone int eh room knows it, and its thank you sir can I have another? Hospitals are ******.

Why is FaceTiming a senior doc to seek more expert guidance on a nuanced issue disgusting lol

 

[mikey014]

Why is FaceTiming a senior doc to seek more expert guidance on a nuanced issue disgusting lol

Because ... An elective routine cabg or gall bladder should not need expert guidance. ...... Like if the surgeon was planning to replace an aortic valve and now thinks he needs to fix the mitral. Then by all means FaceTime. But a cabg should not need expert guidance. He should have been proctored from the beginning until he felt comfortable. It would be like having me take care of a neonate. I most likely know what I'm doing. However, I don't do those cases because I know I'm probably in over my head. Calling for help in the middle of the case when things don't go well is harmful to the patient. So having a peds Anesthesiologist take the case from the beginning is what should be done. These surgeons were unprepared from the beginning and not skilled enough for their surgery.

I think his point is ... The hospital lets them get away with it because that is $$$ for them. Until patient outcomes really get affected. But longer operative times ... Is not going to raise enough red flags... So it will continue .....

 

[woopedazz]

Whenever I hear about unnecessary paeds deaths I always think of Sydney's Bankstown-Lindcombe Hospital neonates incident of 2016. The installed Oxygen/Nitrous outlets supplying the wrong gas...

 

[deleted59964]

Whenever I hear about unnecessary paeds deaths I always think of Sydney's Bankstown-Lindcombe Hospital neonates incident of 2016. The installed Oxygen/Nitrous outlets supplying the wrong gas...

terrible incident - would have hated to be the doc at the bedside trying to resuscitate and it all going bad.

would like to think at some point i’d be suspicious of the gas supply and get a cylinder... but in honesty, i doubt it in the heat of the moment

 

[woopedazz]

terrible incident - would have hated to be the doc at the bedside trying to resuscitate and it all going bad.

would like to think at some point i’d be suspicious of the gas supply and get a cylinder... but in honesty, i doubt it in the heat of the moment

They worked it out immediately post-incident (second one). Shame it wasn't until taking a step back and thinking about it/smelling the gas.
By the time the paeds reg had thoroughly freaked out and a code was called... I think I'd just be trying my hardest to bag/tube/CPR and wouldn't even think twice about the gas supply.

 

[deleted162650]

They worked it out immediately post-incident (second one). Shame it wasn't until taking a step back and thinking about it/smelling the gas.
By the time the paeds reg had thoroughly freaked out and a code was called... I think I'd just be trying my hardest to bag/tube/CPR and wouldn't even think twice about the gas supply.

You can smell nitrous??? Ok, now I’m impressed.

 

[woopedazz]

You can smell nitrous??? Ok, now I’m impressed.

I meant breathing; don't know why I typed smelling. But you know what I meant 😉

 

[deleted87051]

Redirect Notice

 

[Man o War]

Redirect Notice

50% mortality? Holy s@@t.

 

[narcotics999]

Redirect Notice

So what was the real problem in this hospital? NYT mentioned a few, but I believe there must be a primary one.

 

[btbam]

So what was the real problem in this hospital? NYT mentioned a few, but I believe there must be a primary one.

Crummy surgeon. In peds cardiac, you can have the best anesthesia/ICU/nurses etc, but if the surgeon sucks you’ll never be able to overcome that (kink in the coronary, BT shunt, Glenn anastomosis on and on...)

 

[Orin]

Surgeon was okay it sounds like as outcomes had been fine before, but maybe had some personal issues going on at the time of the events.
Sounds like a systems issue if they didn't have a dedicated cardiac ICU.

Definitely sounds like a huge problem in the way they responded to it though