Removing pediatric heart surgery from regional hospitals puts acute care at risk: NZa

The Dutch Healthcare Authority (NZa) is very critical of the government’s decision to remove specialized cardiacal care for children from UMC Groningen and Leiden UMC. That will put acute care at risk in Leiden and regionally in Overijssel, Drenthe, Friesland, and Groningen. A new plan is needed before the government can responsibly implement reforms in cardiac care, the NZa said in an impact analysis, NOS reports.

The Cabinet plans to halve the number of expert centers for surgery on children with congenital heart conditions. Only Erasmus MC in Rotterdam and UMC Utrecht will retain this type of care. The idea is that future doctors will perform enough operations each year to keep their expertise up to date.

But the plan threatens the continuity of acute care in the Northern Netherlands, according to the NZa. UMC Groningen is the spider on the web for treating patients with congenital heart defects in Overijssel, Drenthe, Friesland, and Groningen. Without its heart specialization, patients in the northern provinces will run risks in emergencies.

UMC Groningen is also the only place in the region where seriously ill children can receive intensive care. The existence of this care facility is, therefore, essential for the northern hospitals to fall back on in emergencies. Without cardiacal care expertise, full-fledged acute care in the region automatically disappears, the NZa said.

The Cabinet’s plans will also have significant consequences in Leiden. Without specialist cardiac care, the LUMC’s entire pediatric intensive care unit will disappear. Without heart patients, there are too few patients to keep this ICU open.

That also has consequences for other types of pediatric healthcare because an ICU is required for many surgeries, all transplants, and for children with severe viral infections or who got seriously injured. This could result in the LUMC losing its academic status in the field of pediatric care, the NZa warned.

Removing pediatric cardiacal care from these two hospitals could also cost the Netherlands other unique medical specializations because these specializations cannot happen without heart specialists.

For example, LUMC is the only hospital in the Netherlands that can perform heart surgery on a fetus in the womb. UMC Groningen is the Netherlands’ only expert in several areas, including lung transplants, liver transplants, combined organ transplants, and treating pulmonary hypertension.

According to the NZa, these treatments can’t be directly moved within the Netherlands, so patients will have to go abroad for this care.

The NZa urged Health Minister Ernst Kuipers not to implement this plan. It also recommended that the university medical centers jointly develop an overarching vision for distributing medical specializations in the Netherlands.

“As long as this integral perspective on a future-proof academic care landscape is lacking, we find it undesirable that irreversible steps are taken to concentrate cardiac intervention care,” the NZa said. “These steps anticipate the future of the academic care landscape and therefore pose a risk to the continuity of care in the current situation and the near future.”