Texas Children’s Hospital: Caring for the Hearts of the Young

Texas Children’s Hospital in Houston recently was named the first accredited pediatric heart failure institute in Texas by the Healthcare Colloquium, making it 1 of only 5 pediatric centers in the United States to receive this distinction. The colloquium is the first organization to develop an improvement-focused, science-based approach to heart failure accreditation using a continuum-of-care model. It also is the only organization that accredits individual institutes and health care systems for heart failure.

More than 600 children with cardiomyopathy or chronic heart failure are followed at Texas Children’s Heart Center. Since its inception in 1984, Texas Children’s Heart Center has performed more than 280 heart transplants.

In an interview with Consultant for Pediatricians (CFP), Jeff Dreyer, MD, medical director of heart failure, cardiomyopathy, and cardiac transplantation, discussed the services and procedures performed at the Heart Center, the process for receiving accreditation from the Healthcare Colloquium, and the rewards of treating pediatric heart patients.

Jeff Dreyer, MD, medical director of heart failure, cardiomyopathy, and cardiac transplantation at Texas Children’s Heart Center, where more than 600 pediatric heart patients are being treated.

CFP: How long have you worked with pediatric heart disease patients at Texas Children’s Hospital?

Dr Dreyer: I have been with the hospital nearly 30 years. I first came to Texas Children’s Hospital in July 1984 as a trainee.

CFP: How many pediatric patients do you see a year at the Heart Center, and what is the age range?

Dr Dreyer: Texas Children’s Heart Center physicians collectively saw more than 20,000 outpatient visits in 2013. Our team also performed more than 30,000 electrocardiograms, nearly 25,000 echocardiograms, nearly 1,000 cardiac catheterizations, over 800 cardiac operations, and over 800 admissions to the cardiovascular intensive care unit (CVICU). 

We treat patients from the time they are a fetus all the way to adulthood.

CFP: What services does the Heart Center provide?

Dr Dreyer: Our services include cardiac catheterization, electrophysiology, diagnostic and cardiac imaging, congenital heart surgery, cardiac nursing, CVICU, heart transplant, and adult congenital heart disease.

CFP: What conditions does the Heart Center treat?

Dr Dreyer: Our cardiologists and surgeons are world-renowned leaders in pediatric cardiology, congenital heart surgery, and cardiovascular anesthesiology, and we offer every procedure available for the treatment of pediatric heart diseases and defects for children of all ages, including preterm and low-birth-weight newborns.

CFP: What role has technology played in detecting heart problems earlier in children, and what are some examples of this technology?

Dr Dreyer: Technology has tremendously impacted the field of pediatric cardiology since its inception. With respect to detecting heart problems earlier in children, the most significant technologic advancement has been in noninvasive ultrasound imaging. We have a very active fetal cardiology program in conjunction with our Fetal Center team at Texas Children’s Pavilion for Women. Advances in fetal imaging have allowed for the early diagnosis of heart disease while the fetus is still in utero. This has allowed for new programs in fetal intervention, as well as for the preparation of families who have an unborn child with a diagnosis of heart disease. It also allows for the immediate care of the infant at birth and tailoring care to the specific needs of the child based on the underlying heart condition.

CFP: How does your approach to treating an infant differ from the approach to older child?

Dr Dreyer: The diagnosis of the infant or child helps us determine our course of treatment. It certainly can be said that the fields of pediatric cardiology and pediatric cardiovascular surgery have moved forward. Technologic advances have been made to assure the possibility of surgical intervention in complex congenital heart disease patients in infancy. Those advances carry with them the expectation of a better long-term outcome than if a child’s heart disease was left unrepaired until later in childhood.

CFP: For parents needing a pediatric heart surgeon, what advice can you offer in helping parents select the best pediatric heart surgeon for their child?

Dr Dreyer: The best advice that I can offer is that parents should look at outcomes for a particular surgeon or surgical center with respect to the type of heart condition their child has. In recent years, there has been a great deal of transparency in looking at surgical outcomes, and these outcomes data should be available to any family that asks. In general, referral centers with larger volumes like Texas Children’s Heart Center have greater expertise and better expected outcomes, particularly for the more complex congenital heart lesions.

CFP: Why is providing outcomes data on the services and procedures performed at the Heart Center important to the health care team and the parents of the children being treated?

Dr Dreyer: Parents need to be fully informed as to the services and procedures that can be offered at the specific heart center and compare data between centers where they may choose to have their child treated. Texas Children’s Heart Center is committed to consistently achieving outcomes that are among the best in the nation.

CFP: What support services do you provide for families?

Dr Dreyer: We have a licensed medical social worker who sees all of our patient families. They can identify specific family needs and local resources that may be available to assist them. Emotional support services are available, as well. A child life specialist will see each child admitted to the hospital and can help to explain expected tests and procedures at an age-appropriate level. Individual private support services such as the Dec My Room program and the It’s My Heart program also are available to patients and their families.

CFP: What steps did the Heart Center need to complete to become an accredited member of the Healthcare Colloquium?

Dr Dreyer: Texas Children’s Heart Center went through a nearly 1-year accreditation process in order to become a member of the Healthcare Colloquium. This included a process of identifying strengths and weaknesses of the program and then establishing a set of 14 milestones for the Heart Center to complete. A peer-review process then took place, looking at the milestones created and completed. This remains a dynamic process, with new milestones created and completed on an annual basis. An in-depth, on-site review also was completed before accreditation was given.

CFP: What do you find rewarding about helping children with heart failure?

Dr Dreyer: The most rewarding aspect of this job is taking a child who is deathly ill and being able to restore their cardiovascular health to a point where they can integrate back into their community and participate with their peers in normal childhood activities, including going to school, playing with friends, and participating in hobbies and sports just like any other child their age. It’s being able to give back to these kids their childhood life experiences that were taken away from them by their heart disease.

Texas Children’s Hospital, affiliated with Baylor College of Medicine, is a not-for-profit organization committed to creating a community of healthy children through excellence in patient care, education, and research. Consistently ranked among the top children’s hospitals in the nation, Texas Children’s Hospital has recognized centers of excellence in multiple pediatric subspecialties, including the Cancer Center and the Heart Center. During the fiscal year 2013, the hospital had 3.2 million patient encounters and performed 26,000 surgeries.

Eileen Koutnik-Fotopoulos is a contributing editor to Consultant for Pediatricians.