Closing pediatric cardiac surgery wards is risky, care watchdog warns: ‘Better plan first’ | Policy

The decision to centralize pediatric heart surgery could have severe consequences for the availability of care in the region. That’s why university medical centers have to come up with a better plan, NZa care watchdog advises after research.

“Closing the department could lead to closure of the pediatric intensive care unit and pose a risk to the regional availability of acute care,” the regulator reports. For example, Leiden LUMC may lose its academic status if the department of pediatric cardiac surgery there closes, while in Groningen access to acute care may be jeopardized if the specialty disappears.

This is why a better plan is needed, NZa believes. The debate about grouping pediatric heart surgery has been going on for some time. After nearly thirty years of bargaining, the previous government assigned Utrecht and Rotterdam to specialized cardiac care for children, and Leiden and Groningen lost this branch. But then a fierce battle ensues, with insinuations and mud-throwing back and forth.

The decision early next year

Health Minister Ernst Kuipers (D66) put the centralization plan on hold and first promised additional research: the NZa analysis is an important building block for the new decision. At the beginning of 2023, he will make a decision whether the various pediatric cardiac surgery departments will continue to open or close.

And he wrote in a letter to the House of Representatives that this month he will talk to patients, health care and all kinds of other interested parties and then make a final decision early next year. He also points out that since 1993 many reports have been published containing advice on this subject. It is “a debate that has been going on for about three decades,” according to the minister.

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The NHS also believes pediatric cardiac surgery should be focused, but warns of “serious and irreversible consequences” if staff moved, wards closed and other branches of care compromised.

Therefore, the regulator believes that university medical centers (umcs) should first be given the opportunity to develop a new plan around a better distribution of specialties and departments, so that a well-thought-out central plan can be drawn up next year.

Quality

If that fails, Kuipers should still force the decision, NZa believes. Because centralization is essential to maintaining quality. Only twelve pediatric cardiac surgeons work in the Netherlands. They do highly specialized work, with a total of about 170 heart operations each year for young children with congenital heart defects. So far work schedules can hardly be completed, and some surgeons will also retire in the coming years.

Happy with the New Zealand analysis

University medical centers that, according to the Cabinet, should stop operations on children’s hearts are happy with the analysis by the Dutch Health Care Authority (NZa) of these plans. The University Medical Center Groningen (UMCG) says it is “glad to be ready” to investigate “with all colleagues from other centers how to jointly organize pediatric cardiac care in a sustainable way”.

In addition, healthcare providers will not move to Randstad if their work from the north disappears, says the UMCG. “It would be a loss of experienced and passionate healthcare professionals and thus highly valued pediatric IC capacity throughout the Netherlands.”

The Center for Congenital Heart Disorders Amsterdam-Leiden (CAHAL) also states that implementation of NZa’s advice ‘prevents the loss of carefully constructed (scientific) knowledge, capabilities and a broad, internationally recognized range of care for the benefit of patients at risk’. . According to CAHAL, the collaboration between hospitals in Amsterdam and Leiden is indeed an example of “focusing care in favor of patients at risk”.

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