How the Cardiac High Acuity Monitoring Program (CHAMP) is Helping Change Lives
CHAMP (Cardiac High Acuity Monitoring Program) is a multi-disciplinary based team that has been designed to meet the needs of the most complex cardiac population with single ventricle heart disease. The program closely monitors patients with single ventricle heart disease between the critical first and second stages (before stage II Glenn surgery). The team at the Ward Family Heart Center at Children's Mercy has also developed a tool that makes it easier for families to report their single ventricle child's vital signs from home and provides the hospital team with frequent updates needed to keep these patients well between visits. Dr. Hancock discusses everything you need to know about CHAMP.
Featured Speaker:
Learn more about Hayley S. Hancock, MD
Hayley S. Hancock, MD
Hayley S. Hancock, MD is Assistant Professor of Pediatrics, University of Missouri-Kansas City School of Medicine.Learn more about Hayley S. Hancock, MD
Transcription:
Dr. Michael Smith (Host): Our topic today, CHAMP Saves Lives. My guest is Dr. Hayley Hancock. Dr. Hancock is a pediatric cardiologist and she’s the Medical Director for the Cardiac High Acuity Monitoring Program which we call CHAMP. Dr. Hancock welcome to the show.
Hayley S. Hancock, MD, FAAP (Guest): Thank you.
Host: So, tell us in general, what is CHAMP, right? And why was it even developed?
Dr. Hancock: Yes, so, the Cardiac High Acuity Monitoring Program or CHAMP is a monitoring program for our highest risk patients, those with single ventricle congenital heart disease. And this program was designed for our most complex patient population, that single ventricle population or patients with hypoplastic left heart syndrome and they have a very high-risk period called the interstage period. This is the time that these infants spend between their first and second heart surgeries. It’s about four to five months. And these nurses at Children’s Mercy really envisioned this program to help monitor these very fragile infants at a critical time period in their lives for them and for their family. And the Children’s Mercy Heart Center’s goal was really to decrease morbidity and mortality in this patient population during the high-risk period.
Host: Yeah. So, between the first and second surgery, I think I saw some stats, anywhere between 10-20% of these babies will die, right?
Dr. Hancock: Correct. And yeah, it can range anywhere you know 7-15% up to 20% like you said, for that interstage time period mortality. So, that monitoring through that has been shown to be extremely important.
Host: So, tell us then a little bit – so we understand the need for this program, monitoring these acute babies during this very critical time. How important was the parents’ role in all this and the home monitoring role in all of this?
Dr. Hancock: Yes, so the parents’ role is really, really important and we know that these parents are extremely stressed. If we think about just taking a healthy baby home, that’s stressful. So, taking home a baby who has had a significant heart surgery and we are looking to that next heart surgery at around four to six months; that time period is so crucial and so, we really have to support these families and it’s really important that they are engaged with something that works for them to be able to monitor what these patients are doing at home and to even be able to have them at home.
Host: Yes, so why don’t we talk a little bit more about the specifics of CHAMP. Tell us a little bit about who is involved, the doctors, the nurses, the family and tell us what exactly is involved. What are some of the aspects of this program?
Dr. Hancock: Sure so, the program has really grown. It now includes two nurse practitioners, a nurse coordinator, a multisite program coordinator, a dietician, social worker, two physicians, a heart center technology team support and the parents – what it is, is an application was created for this monitoring program on a tablet and families are given this tablet. They are trained on this tablet by our team members and they use that CHAMP application or tablet to provide us clinical information about these babies from home. They enter their heart rates, their oxygen saturation levels which are crucial to know. Their weight by home scales. Their feeding intake, output, any concerns that they have, and they send us a daily 15 second video for us to see at baseline and anytime that they have concerns.
Host: And this is all done on a simple tablet, simple app. How have the parents accepted this? Is this something that they learn really easy? Is this – I guess what kind of feedback are you getting from the family?
Dr. Hancock: Yes, so, some parents can feel overwhelmed at first with the technology and just – they are overwhelmed in general and stressed with the care of these fragile babies. But I really think the majority of these parents and actually our group has shown this, we have looked at this in a study; they prefer the application over a traditional pen and paper binder model. We know that we have to monitor all of these crucial things about these patients, so they can enter it easily into an application that is sent directly to us. They don’t have to make phone calls and all of those things. Then they actually feel quite comfortable with this portable technology, particularly with the tablets.
Host: Yeah, and so, how long has the program been going on at Children’s Mercy?
Dr. Hancock: So, it was started back in 2012.
Host: So, 2012, we are at 2018 now. What kind of results have you seen? So, again, just to remind the audience, we were talking about upwards of a 20% chance of – or 20% of the babies died – up to 20% died in that critical time period. What have you seen? Has this program reversed some of that?
Dr. Hancock: Yes. It’s been remarkable. Mortality in the CHAMP group of these patients has decreased to less than 3% for this group. So, we know again, that interstage monitoring is really important from data that we have from the National Pediatric Cardiology Quality Improvement Collaborative or NPCQIC and monitoring with this technology through CHAMP has decreased that mortality to less than 3%.
Host: That’s amazing. So, Dr. Hancock that’s a great outcome of this program, CHAMP. Well so are more hospitals adopting this program?
Dr. Hancock: Yes, they are. So, now the program has expanded to nine centers across the nation who are using the CHAMP application including Children’s Mercy, where it started. We rolled out to other centers – we kind of rolled out the application in 2014 and then we have seen since about around early 2017, we have had seven more centers come on board. So, we are really growing fast. We are covering patients in about 16 states over the nation.
Host: You know I listen to all this and how you describe CHAMP and it makes perfect sense, right, I mean we are increasing our monitoring of these children. The parents are involved. Outcomes get better. Do you see a program like this being extrapolated to other disease states? I mean is this a model maybe for how we can monitor many other critically ill babies?
Dr. Hancock: Yes. Absolutely. We are thinking about it for even other populations within cardiology that are high-risk, but not necessarily single ventricle and then I really think it has an application for pediatric patients with complex disease who we would like to have at home, but need extra monitoring from their healthcare providers and they can, through this application, still be monitored by their healthcare providers but be at home with their families.
Host: You know Dr. Hancock in summary, what would you like people to know about CHAMP?
Dr. Hancock: Yes, I think it’s so exciting and it takes a lot of support and amazing people to make something like CHAMP work and it’s truly saving lives and I believe it’s improving the quality of life for our patients and families.
Host: I think so too. And the proof is, as you have decreased that number, that percent that babies die down to 3%. That’s fantastic. And I’m really happy to see that this program is being adopted by other medical centers as well. Dr. Hancock thank you so much for the work that you are doing at Children’s Mercy and also thank you for coming on the show today. You’re listening to Transformational Pediatrics with Children’s Mercy Kansas City. For more information you can go to www.childrensmercy.org, that’s www.childrensmercy.org. I’m Dr. Mike Smith. Thanks for listening.
Dr. Michael Smith (Host): Our topic today, CHAMP Saves Lives. My guest is Dr. Hayley Hancock. Dr. Hancock is a pediatric cardiologist and she’s the Medical Director for the Cardiac High Acuity Monitoring Program which we call CHAMP. Dr. Hancock welcome to the show.
Hayley S. Hancock, MD, FAAP (Guest): Thank you.
Host: So, tell us in general, what is CHAMP, right? And why was it even developed?
Dr. Hancock: Yes, so, the Cardiac High Acuity Monitoring Program or CHAMP is a monitoring program for our highest risk patients, those with single ventricle congenital heart disease. And this program was designed for our most complex patient population, that single ventricle population or patients with hypoplastic left heart syndrome and they have a very high-risk period called the interstage period. This is the time that these infants spend between their first and second heart surgeries. It’s about four to five months. And these nurses at Children’s Mercy really envisioned this program to help monitor these very fragile infants at a critical time period in their lives for them and for their family. And the Children’s Mercy Heart Center’s goal was really to decrease morbidity and mortality in this patient population during the high-risk period.
Host: Yeah. So, between the first and second surgery, I think I saw some stats, anywhere between 10-20% of these babies will die, right?
Dr. Hancock: Correct. And yeah, it can range anywhere you know 7-15% up to 20% like you said, for that interstage time period mortality. So, that monitoring through that has been shown to be extremely important.
Host: So, tell us then a little bit – so we understand the need for this program, monitoring these acute babies during this very critical time. How important was the parents’ role in all this and the home monitoring role in all of this?
Dr. Hancock: Yes, so the parents’ role is really, really important and we know that these parents are extremely stressed. If we think about just taking a healthy baby home, that’s stressful. So, taking home a baby who has had a significant heart surgery and we are looking to that next heart surgery at around four to six months; that time period is so crucial and so, we really have to support these families and it’s really important that they are engaged with something that works for them to be able to monitor what these patients are doing at home and to even be able to have them at home.
Host: Yes, so why don’t we talk a little bit more about the specifics of CHAMP. Tell us a little bit about who is involved, the doctors, the nurses, the family and tell us what exactly is involved. What are some of the aspects of this program?
Dr. Hancock: Sure so, the program has really grown. It now includes two nurse practitioners, a nurse coordinator, a multisite program coordinator, a dietician, social worker, two physicians, a heart center technology team support and the parents – what it is, is an application was created for this monitoring program on a tablet and families are given this tablet. They are trained on this tablet by our team members and they use that CHAMP application or tablet to provide us clinical information about these babies from home. They enter their heart rates, their oxygen saturation levels which are crucial to know. Their weight by home scales. Their feeding intake, output, any concerns that they have, and they send us a daily 15 second video for us to see at baseline and anytime that they have concerns.
Host: And this is all done on a simple tablet, simple app. How have the parents accepted this? Is this something that they learn really easy? Is this – I guess what kind of feedback are you getting from the family?
Dr. Hancock: Yes, so, some parents can feel overwhelmed at first with the technology and just – they are overwhelmed in general and stressed with the care of these fragile babies. But I really think the majority of these parents and actually our group has shown this, we have looked at this in a study; they prefer the application over a traditional pen and paper binder model. We know that we have to monitor all of these crucial things about these patients, so they can enter it easily into an application that is sent directly to us. They don’t have to make phone calls and all of those things. Then they actually feel quite comfortable with this portable technology, particularly with the tablets.
Host: Yeah, and so, how long has the program been going on at Children’s Mercy?
Dr. Hancock: So, it was started back in 2012.
Host: So, 2012, we are at 2018 now. What kind of results have you seen? So, again, just to remind the audience, we were talking about upwards of a 20% chance of – or 20% of the babies died – up to 20% died in that critical time period. What have you seen? Has this program reversed some of that?
Dr. Hancock: Yes. It’s been remarkable. Mortality in the CHAMP group of these patients has decreased to less than 3% for this group. So, we know again, that interstage monitoring is really important from data that we have from the National Pediatric Cardiology Quality Improvement Collaborative or NPCQIC and monitoring with this technology through CHAMP has decreased that mortality to less than 3%.
Host: That’s amazing. So, Dr. Hancock that’s a great outcome of this program, CHAMP. Well so are more hospitals adopting this program?
Dr. Hancock: Yes, they are. So, now the program has expanded to nine centers across the nation who are using the CHAMP application including Children’s Mercy, where it started. We rolled out to other centers – we kind of rolled out the application in 2014 and then we have seen since about around early 2017, we have had seven more centers come on board. So, we are really growing fast. We are covering patients in about 16 states over the nation.
Host: You know I listen to all this and how you describe CHAMP and it makes perfect sense, right, I mean we are increasing our monitoring of these children. The parents are involved. Outcomes get better. Do you see a program like this being extrapolated to other disease states? I mean is this a model maybe for how we can monitor many other critically ill babies?
Dr. Hancock: Yes. Absolutely. We are thinking about it for even other populations within cardiology that are high-risk, but not necessarily single ventricle and then I really think it has an application for pediatric patients with complex disease who we would like to have at home, but need extra monitoring from their healthcare providers and they can, through this application, still be monitored by their healthcare providers but be at home with their families.
Host: You know Dr. Hancock in summary, what would you like people to know about CHAMP?
Dr. Hancock: Yes, I think it’s so exciting and it takes a lot of support and amazing people to make something like CHAMP work and it’s truly saving lives and I believe it’s improving the quality of life for our patients and families.
Host: I think so too. And the proof is, as you have decreased that number, that percent that babies die down to 3%. That’s fantastic. And I’m really happy to see that this program is being adopted by other medical centers as well. Dr. Hancock thank you so much for the work that you are doing at Children’s Mercy and also thank you for coming on the show today. You’re listening to Transformational Pediatrics with Children’s Mercy Kansas City. For more information you can go to www.childrensmercy.org, that’s www.childrensmercy.org. I’m Dr. Mike Smith. Thanks for listening.