Transcription:
KCH and Cincinnati Children's Joint Pediatric Cardiology Outreach in Ashland, KY

Melanie Cole (Host):  Welcome to UK HealthCast with the University of Kentucky Healthcare. I’m Melanie Cole and I invite you to listen in as we discuss Kentucky Children’s Hospital and Cincinnati Children’s joint pediatric cardiology outreach in Ashland Kentucky. Joining me in this panel today are Dr. Louis Bezold. He’s the Chief of Pediatric Cardiology at the University of Kentucky Healthcare and Dr. Bradley Keller. He’s a Professor of Pediatrics at Cincinnati Children’s Heart Institute and Co-Director of Greater Louisville and Western Kentucky Practice. Gentlemen, it’s a pleasure to have you join us today. So, Dr. Bezold, I’d like to start with you. Explain the relationship between Kentucky Children’s Hospital and Cincinnati Children’s. How did this partnership come about?

Louis Bezold, MD (Guest):  Well Kentucky Children’s Hospital as many know has a long standing commitment to caring for our eastern Kentucky families and there’s also a long history of a solid but small pediatric cardiology program here at University of Kentucky starting with Dr. Jackie Noonan. About five years ago, in the midst of a strategic planning for the UK Healthcare System, there were commitments made to expanding our pediatric cardiology service and to restart a dormant pediatric cardiology surgery program. And we believe that the best way to provide the best care for our patients was to partner with a large high profile, high quality program and Cincinnati Children’s Hospital was that program. So, we worked together and in 2016, we signed an agreement to collaborate with the model being one program two sites. We shared resources. We shared quality metrics and operations like that and to make sure that we provided the best care, care similar and comparable to what you would receive at Cincinnati children’s Hospital.

Host:  Dr. Keller, why is this so important? Tell us a little bit about what makes it unique and what services are going to be available?

Bradley Keller, MD (Guest):  Well as cardiologists for children, we know we take care of patients starting in infancy and actually our patients live now fully through adulthood. So, as congenital cardiologists, we take care of patients that might be a newborn, one, two, three, four months of age. We have patients that are 30, 40, 50, 60 years of age. And those patients are distributed throughout the country well in fact, globally. And in Kentucky, those patients live in every community across the state. And while this has been a Children’s Heart Institute and while the University of Kentucky Heart Institutes are based in those cities; there really are a lot of people who really do find it difficult sometimes to make the travel to go to those local centralized programs. And so, cardiology outreach where you get cardiologists, along with your administrative support staff and their nurses and their ultrasound technicians have been travelling to communities around Kentucky honestly for more than 50 years.

Dr. Bezold mentioned that Dr. Noonan started the pediatric cardiology program at the University of Kentucky. She saw patients in eastern Kentucky before the medical center was constructed in the early 60s. So, since the early 60s, cardiologists have been going out into communities to do cardiology outreach clinics. It’s wonderful for the patients and their families. And then when needed, then they can be referred then to centers for more advanced care. And so, it’s really a pleasure working with Dr. Bezold and my colleagues to continue that tradition of bringing cardiology out into the communities where it’s most accessible for patients and their families.

Host:  Dr. Bezold, I’d like you to respond to that and what does this nationally ranked care mean for the children and families of Kentucky?

Dr. Bezold:  The importance of being able to get out into the communities and have outreach clinics is that we can bring that expertise to the families closer to home, allowing them to get care that may be difficult for them to get by having to travel long distances. We’ve also been, for many years, providing some additional resources in the communities. We have about a dozen different hospitals and medical centers throughout the eastern part of the state where we provide extra training for sonographers to do pediatric echoes and we interpret those so they can get those studies done locally even if we are not there for a clinic on that particular day. And we also read EKGs from pediatric patients from about 40+ locations throughout eastern Kentucky and so I think having those resources closer to home really means that the families have much easier way of getting those resources and it provides much better care in settings that are preferable for the families and geographically better.

Host:  And Dr. Keller, at this time, how have you and your team been evolving care for your patients during the pandemic? What’s been happening as far as visits for these children and their families in person visits during the pandemic? How have you been utilizing Telehealth for pediatric cardiology to bridge that gap for parents that may have concerns or questions for their doctor?

Dr. Keller:  It’s a very important point that Telehealth, the ability to transmit cardiology studies like EKGs and echoes has really been available for about 40 years. And actually, the University of Kentucky has been very involved in using Telehealth for more than 20 years. so, during the pandemic, the first thing that we had to do was really reschedule routine nonurgent visits for a later date and then only have patients who needed urgent visits be seen in person. As we relaunched the more visits, we then began to be able to use Telemedicine and cardiology is a bit of a challenge because we often listen to the patients physically. We do testing like EKGs and ultrasounds. Those are difficult things for Telemedicine. So, for most of our patients, cardiology Telemedicine has been follow up visits, following response to medications, talking about new symptoms, discussing upcoming procedures and so that’s kept us connected with families. We’ve now returned to in person visits with the safety requirements in terms of not having people in the waiting room and being very efficient when people arrive of getting them back into the exam room and we returned to full volumes for our clinics.

But I think that from the Cincinnati Children’s Hospital, I can tell you that I think in the month of April of this year, there were as many Telemedicine visits as the proceeding 12 months. And I think that Telehealth now is going to become an established part of our practice forever. And I think that’s going to be a great advantage because it will reduce the need for families to travel when they can accomplish something over their iPad or their telephone.

Host:  Well it certainly has encouraged healthcare systems to be creative and innovative in their ability to deliver this type of care. So, Dr. Bezold, you have several outreach clinics including a new one opening in Ashland Kentucky. Tell us about the services that you’ll provide at this location. Give us a little summary of it.

Dr. Bezold:  As for all our outreach clinics, we have a similar model that we do for all those outreach clinics. As Brad mentioned earlier, we have physicians, and support staff, nursing and registration that goes and we also bring our pediatric sonographer and echo machine and EKG machines so that we can run a clinic very similar to what we would at the mothership on main campus where you can come, get your EKGs done, get your echoes done, see the physician and kind of do everything that we would do at a regular standard outpatient clinic. We also have opportunities to do some additional testing such as Holter monitors. We will be planning on doing ambulatory blood pressure monitoring and then we’ll be able to easily from – the group that we’ll have there will be easily able to get patients in for more advanced testing if they need to back at UK.

Host:  Dr. Keller, in your particular field, for both of you, the program has a focus that engages multidisciplinary teams to best treat patients. This is so important especially for these types of patients and their families. What does this look like for your team? Tell us how important that multidisciplinary treatment, evaluation and care is for children with pediatric cardiac conditions.

Dr. Keller:  Well I think that in our patients with congenital heart disease, and we have to remember that while the heart is forming, other organs of the body form as well, the brain, the lungs, the GI system and so, we certainly see patients who have not only heart problems, but other kinds of problems. In the outreach environment, usually it’s the cardiologist that travels. We’re the ones that go from city to city and so we’re oftentimes the conduit so we sometimes will recognize other issues and then help refer those families to some specialists or we’ll help coordinate the care. And although the cardiologists are the ones that go to a community like Ashland, if someone needs to have the combination of a GI visit and a cardiology visit or very importantly, neurodevelopmental follow up or genetic counseling; we have the ability to help coordinate those visits.

So, if they have to come to Lexington at the University of Kentucky or if they have to come to Cincinnati to the Heart Institute; we can actually arrange for multiple visits on the same day. And so I think as cardiology care has advanced over the past 50 years, it really has become much more of a comprehensive approach and that comprehensive approach includes our patients who have had successful heart surgery as infants who are now 20 years old and pregnant. And we have to kind of coordinate with their obstetricians and the maternal fetal medicine specialists. Do they have unique issues related to their heart? Do they have unique issues related to anesthesia? All of those things are able to be coordinated as a part of sort of a team approach to these unique patients.

And it includes ultrasounds on the hearts of babies in the middle of pregnancy. If a mother has a congenital heart problem which happens in one in 100 individuals in the country; she has an increased risk of having a child with a heart problem than the general population. So, that risk may go from one in 100 to one in 15. And so that mother when she becomes pregnant, wants to know that her baby is going to be okay, that the heart is normal and that there’s a team available to take care of her from her perspective and her baby if her baby happens to have a heart problem. So it is very much a team approach to healthcare delivery.

Host:  Dr. Bezold, do you have any current or emerging therapies for pediatric cardiology that you’d like to tell us about? Are there any game changers you’d like to mention? What’s exciting in your field?

Dr. Bezold:  I think one of the things that’s exciting in our field and is something that we are at the University of Kentucky are actively working on is continuing to advance transcatheter approaches to cardiac disease. So, there’s cardiac defects that require an intervention, a hole that needs to be closed or something like that. And now that the cardiac interventional cath doctors have had a 30 year history now or more of developing devices; we’ve managed to be able to treat even premature babies who normally in earlier days would have to undergo an operation for closing certain types of defects that affect premature babies in particular called PDAs and I think it’s very exciting. We have people at both centers able to do that and even in very tiny babies and I think it’s a great service to these children.

Host:  So, I’d like you both to kind of give us a wrap up and Dr. Bezold, I’ll start with you. What would you like the listeners to take away from the Kentucky Children’s Hospital and Cincinnati Children’s joint heart program, how this partnership will benefit the community and really what you would like people to know about getting involved, getting an appointment, what do they need to do?

Dr. Bezold:  The joint program has been really in operation now for about three going on four years. And it’s been a great success. It’s allowed us to be able to bring all the resources of the best pediatric cardiology programs in the country essentially to bear here in Kentucky and to be able to share that between the two centers, it allows us to get patients to where they need to be, to get the best care and but to be able to stay closer to home whenever possible. And I think that it’s allowed us to treat as Dr. Keller mentioned earlier, from fetus all the way up to adulthood in each of our centers and each of our clinics. I think that that has really been a game changer for the people and the communities in Kentucky in particular and we’re going to continue to expand that. We’re going to continue to do everything we can to bring that care always closer to home and be able to do that in the best way possible.

Host:  What a wonderful partnership and Dr. Keller, last word to you. Please reiterate and reassure families that are looking to come to Kentucky Children’s Hospital and Cincinnati Children’s joint heart program what you’re doing to keep the community safe and give us your best information or best advice about what you would like them to know about how you all are doing.

Dr. Keller:  Heart problems in children are fairly common. Many of them are not serious. Many of them do not require intervention. Occasionally, they do require catheter procedures or surgeries. I think when families learn that there’s a concern about the heart of their child, it’s frightening. They’re nervous. And they want to be seen promptly by an experienced team. And so, we’re very excited that we’re able to come to Ashland and we will gradually increase how often we come so that we’re seeing the patients as quickly as they need to be seen.

Dr. Bezold and I both have a lot of years of experience. And our teams are outstanding. And so, when we do identify an issue, back to the question about nationally ranked care; if you have a child who needs to have a heart surgery for example, you want that to be performed by the best possible team with lots of experience and all the related people that are involved. And so, our goal is to be available to families and their providers, to identify problems, provide them the counseling that they need so they feel comfortable that their children are getting excellent care. And I think pediatric cardiology as I mentioned, some of those patients are two years of age and some of them are 45 or 50 years of age. And so, it’s really quite an amazing spectrum and I think for us as pediatric cardiologists, a central aspect of our careers is really that dedication to make sure those resources are available to families and available to families throughout the state of Kentucky. And so we’ve done I think – we’ve been quite dedicated to make sure that that happens. The referring providers have access to us and then there’s also there’s a dedicated phone number that families can call if they need to make an appointment to see Dr. Bezold or myself.

It's a continuation of a wonderful program.

Host:  Thank you gentlemen so much. It certainly is and to learn more, about the Kentucky Children’s Hospital and Cincinnati Children’s joint heart program in Ashland Kentucky, please visit our website at www.ukhealthcare.uky.edu to get connected with one of our providers. That concludes this episode of the UK HealthCast with the University of Kentucky Healthcare. Please remember to subscribe, rate and review this podcast and all the other UK Healthcare podcasts. I’m Melanie Cole.