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European Union of Private Hospitals

EPHA awards 2023 – Best Collaborative Projects in Health

1st prize, the IRCCS Policlinico San Donato, Milan and Policlinico San Pietro, Ponte San Pietr (Italy) for a Collaboration on congenital heart diseases patient care (children and adults)

IRCCS Policlinico San Donato and Policlinico San Pietro have reorganised the care pathway for the treatment of patients (adults and children) suffering from cardiovascular-congenital diseases, adopting the on ‘hub and spoke’ model.

What makes your project so special?

What makes this project special is the incredible value that the Hospitals generate for the population. In fact, since the beginning of the collaboration, more than 500 patients, especially children, have been visited. The early diagnosis of cardiovascular disorders, also thanks to prenatal screening, brings important social and economic benefits as it allows these patients to have diseases diagnosed in time and to better respond to treatments.

What does this award mean to you and your teams?

We are grateful and proud of this victory. This award recognizes the value of technical-scientific initiatives and humanization projects that every day our hospital realizes to make healthcare more accessible to the population. This recognition encourages us even more to move forward with projects based on collaborations among structures.

Lucia Di Francesco, Controllo di Gestione, I.R.C.C.S. Policlinico San Donato

The project

The main pillars include the therapeutic continuity between hospitals and local community and a holistic vision of care. Comorbidities and frailties in children with these diseases prompt a peculiar model of care aiming at assuring a link between the specialized referral center, family doctors, local and rural hospitals. Moreover, the epidemiology is changing showing an increase of grown-up patients suffering from acquired conditions complicating the course of the congenital ones.

The San Donato Hospital has been recognized by the Ministry of Health as a Scientific Hospitalization and Treatment Institute for the Diseases of the heart and large vessels in adults and children. Since 2022, the Hospital has been part of the European Reference Network dedicated to the congenital heart disease. It is one of the most renowned hospitals in Europe, specialized in the diagnosis and treatment of congenital heart diseases. Its Pediatric and Adult Congenital Cardiology and Cardiac Surgery Units carry out face-to-face and remotely consultations to other Italian hospitals: Buzzi; Macedonio Melloni; San Raffaele; Del Ponte; San Matteo. The Hospital also cooperates with centers around the world and treats patients that cannot be treated in their home country (e.g., Egypt, Tunisia, Romania). For the past 30 years, the Pediatric and Adult Congenital Cardiology and Cardiac Surgery Units have been treating about 1000 congenital and pediatric patients/year.

The other hospital, Ponte San Pietro serves a large district area (about 135000 people). This pivotal birth center cares for about 590 newborns/year. The hospital provides a high specialty clinical service for cough and wheezing in the pediatric age. A structured pathway of pregnant women, newborns and pediatric patients has been shared with gynecologists, neonatologists and pediatricians. Consultations are performed in the Obstetric and Gynecology department for prenatal screening, and in the cardiology outpatient clinic for newborns, children and adults with congenital heart diseases.

Since 2021, a cooperation between the hospitals has been built. The aims are:

  1. Provide prenatal cardiological screening for pregnant women in collaboration with the Obstretic service
  2. Provide cardiological screening of newborns
  3. Provide cardiological consultation for neonatal and pediatric units, identifying newborns with heart diseases that can be treated locally and those who need advanced care
  4. Assure continuity of care for patients with congenital heart disease pertaining to a large community area contrasting the ‘lost at follow up’ phenomenon
  5. Ensure territorial capillarity of specialized care for frail patients with rare diseases such as pulmonary hypertension

We have elected the following parameter as indicators of result: limitation of admission, reduction of hospital stay in the hub center after percutaneous interventions and surgeries granting continuity of care and treatment of comorbidities in the spoke center; reduction of waiting list for outpatient consultations; early detection of associated congenital heart disease in patients referred for recurrent lung diseases.

The main benefits of this collaboration were the enhancement of cardiological screening for pregnant women and newborns and the provision of cardiological consultation to pediatric and neonatal units. This allows continuity of follow up for pediatric and congenital patients both locally and in the hub center (IRCCS San Donato) and reduces the phenomenon of lost at follow up. Also patients with rare diseases (such as pulmonary hypertension) that need focused care and specific tailored therapies benefit from a territorial capillarity of care and drug delivery. Finally, all congenital patients pertaining to the district may benefit from immediate evaluation at PSP emergency department and cardiological consultation within 48 hours in case of low intensity low complexity emergencies.

The issue of congenital heart diseases

Congenital heart diseases are a rare condition (about 0,8% of new births) characterized by the disruption of the normal embryological development. This leads to an abnormal arrangement of the cardiac segments (atria, ventricles and great arteries) and it encompasses a wide spectrum of clinical presentations, ranging from critical conditions, prompting urgent treatment at birth, to not relevant ones, allowing survival to adulthood without symptoms. Today there is a reorganization of the management of these patients. The main pillars include the therapeutic continuity between hospitals and local community and a holistic vision of care. Comorbidities and frailties in children with these diseases prompt a peculiar model of care aiming at assuring a link between the specialized referral center, family doctors, local and rural hospitals. Moreover, the epidemiology is changing showing an increase of grown-up patients suffering from acquired conditions complicating the course of the congenital ones. A criticism in the management of adult patients is the ‘lost at follow up’ phenomenon. It is expected that this will have a detrimental effect on outcomes and on the organization of the NHS due to complications. In this view, the organization of care based on ‘hub and spoke’ model is becoming attractive.

Main benefits

The main benefits of this collaboration were the enhancement of cardiological screening for pregnant women and newborns and the provision of cardiological consultation to pediatric and neonatal units. This allows continuity of follow up for pediatric and congenital patients both locally and in the hub center (IRCCS San Donato) and reduces the phenomenon of lost at follow up. Also patients with rare diseases (such as pulmonary hypertension) that need focused care and specific tailored therapies benefit from a territorial capillarity of care and drug delivery. Finally, all congenital patients pertaining to the district may benefit from immediate evaluation at PSP emergency department and cardiological consultation within 48 hours in case of low intensity low complexity emergencies.