Report criticizes St. Boniface Hospital's Cardiac Program

A report into the Cardiac Sciences Program (CSP) at St. Boniface Hospital says it needs to reduce wait times, improve management and increase the number of heart donors before it can expand into procedures such as heart transplants.

The Winnipeg Regional Health Authority (WRHA) commissioned the Ottawa Heart Institute to examine the program and give recommendations to take it into the next 10 years.

It was highly critical of the long waiting list — up to 4,000 people — for echocardiograms, which is well above the Canadian standard. The report also cites a high number of cancelled surgeries as problematic to the program moving forward.

Dr. Brock Wright, WRHA senior vice president and chief medical officer, said he doesn't see the report as critical because the WRHA asked for feedback. Wright said the health authority is working to reduce the waiting list by working with private clinics, doing diagnostic procedures on the weekends and training more people to provide them.

Wright said overall the Ottawa Heart Institute was complimentary and very impressed with the WRHA's Cardiac Sciences Program. He says the report's concluding comment said, "in the last decade the program has demonstrated excellent values for compassionate care and helping the community. It's grown considerably, recruited a high number of cardiovascular specialists, achieved excellent results and demonstrated a spirit for innovation."

Heart transplant surgery

One of the plans for the cardiac program at St. Boniface Hospital was to perform heart transplant surgery, something Kristin Millar had to go out of province to have performed.

"I will never be worthy of this gift that has been given to me" said the 55-year-old Millar, who went to the Ottawa Heart Institute to have the transplant procedure.

"I think the steps the WRHA is taking [are] extremely ethical and responsible. Before starting a program, you want to know where you can improve."

The report from the heart institute states, "the current pool of cardiac surgeons does not have sufficient manpower by way of experience to start a new heart transplant program. There is also a significant issue with the donor pool within Manitoba which currently provides a modest number of hearts compared to the needs."

It concludes, "given the limitation of national networking for sharing organ donation, this could be a constant impediment in developing a strong heart transplant program."

Wright acknowledges it is an issue.

"We don't have yet in Manitoba sufficient number of donors to mount our own heart transplant service and we'd have to be sure that we are doing enough volume in order to maintain our excellence," Wright said.

But Wright said having a local transplant program is still a goal.

"So, if we can increase our donor base, and if we have sufficient numbers of Manitobans who need heart transplant then we would absolutely initiate that program and that would be the only piece of our overall heart failure program that's currently missing in Manitoba."

The report also calls the administration and governance of the cardiac sciences program too complex and in need of change. The report has 10 recommendations.

Top 10 recommendations from the report: 

1. Revisit the governance model to empower the CSP to improve operations and performance; promote shared ownership and foster open communication and buy in from the community and the ministry.​
2. Engage the University and WRHA to develop a research environment that will focus on excellence to attract and retain top notch cardiovascular specialists; consider appointment of a scientific director to cardiovascular sciences.
3. Establish immediately a CSP senior management committee. Re-evaluate leadership at all levels of the CSP. This includes reviewing chief of cardiology, chief of cardiac anesthesia and appoint, through a transparent process, a chief of cardiac surgery who will not be the chair of the CSP.
4. Create a Division of Cardiac Anesthesia under the chief of cardiac anesthesia under the chair of the Department of Anesthesia and engage cardiac anesthesia in CSP operations.
5. Engage CSP, Faculty of Medicine and WRHA to develop practice plans across all three divisions, favouring physician engagement towards CSP.
6. Make the development of a provincial heart transplant program conditional to sufficient donor pool and recruitment of an experienced heart transplant surgeon in order to have a sustainable annual number of 8-10 transplants a year with excellent results.
7. Improve the patient selection process between PCI and CABG by increasing the collaboration between interventional cardiologists and cardiac surgeons so they follow the current European and American guidelines for coronary revascularization.
8. Develop a “Heart Team” model for TAVI so cardiologists and surgeons have equal responsibilities and patients are triaged following current guidelines.
9. Re-evaluate the management of critical care beds and harmonize CSP critical care facilities under a uniformed model of intensivists; as CSP moves forward it would benefit from an integrated approach to critical care.
10. Immediately work at solutions to dramatically reduce the wait list for echocardiograms.

On mobile? Read the full report here.