Dr. Sanjiv Gandhi leads the revolution in caring for B.C.’s tiniest hearts
Pediatric cardiologist seeks to introduce in-province transplant program
Since being recruited to work at BC Children’s Hospital, heart surgeon Dr. Sanjiv Gandhi has been like an injection of adrenalin for a surgical program that needed a champion for change.
He’s performed B.C.’s first and only pediatric heart transplant, slashed surgical waiting lists, stemmed the flow of patients to other provinces for surgery, drastically reduced blood transfusions, introduced new anesthetic drugs that reduce hospital stays, overseen the introduction of a new heart-lung machine, and halved the length of stay in intensive care units.
All of that in under two years.
Gandhi, a Nova Scotia native, came to B.C. in mid-2010 after spending 17 years at top pediatric hospitals in St Louis and Pittsburgh. He came here, he said, because he always wanted to return to Canada, plus he was assured he could implement changes that would benefit patients born with congenital heart defects and others needing cardiac surgery.
The promise of a new children’s hospital, with state-of-the-art operating rooms that should be built in about five years, was enticing. Other things, like the purchase of state-of-the-art machinery and time in the operating room were non-negotiable conditions attached to his accepting the job.
Neil Casey, chief of perfusion at children’s hospital, documented the changes since Gandhi arrived in a submission to the BC Patient Safety and Quality Council. Casey, who operates the heart-lung (cardiopulmonary bypass) machine nominated Gandhi in the leadership category for the organization’s third annual BC Quality awards. Winners are expected to be announced at the end of this month.
“He eradicated the waiting list, more than halved the blood donor product exposures and reduced the pediatric intensive care unit stays by more than half for all cardiac surgery patients,” Casey praised in his submission.
“He led the movement to a new anesthetic drug ... and (got) tighter control of operating room start times and scheduling. In reducing patient waiting times from six months to a few days, we reduced family and patient stress. The incidence of having to send patients and families out of province for care has stopped,” he continued.
Well, not quite, Gandhi clarified. There may still be a few patients each year who go to Edmonton for heart surgery, especially those in the East Kootenays for whom a trip to Alberta is more convenient than coming to Vancouver.
Gandhi, one of only two pediatric heart surgeons in B.C., concedes there have been many changes in the heart surgery program to boost production, efficiency and patient safety. “And while change is always difficult, we went about it through many conversations with all the stakeholders, including nurses, anesthesiologists and everyone else. It was just a matter of taking a different set of eyes and then having the cooperation of everyone else,” said Gandhi.
Casey said in an interview that Gandhi provided the right tonic at the right time.“In large organizations, you can always see a certain amount of inertia. But Sanjiv got around it by just ignoring it. He brought in new ideas and perspectives and showed that patient outcomes would actually improve.”
Although Gandhi performed nearly 200 heart transplants in the U.S., he’s done only one in B.C. There are between six and 10 patients a year here who would benefit from transplantation, he said. Instead of sending such patients to Edmonton or Toronto, a business plan for a transplant program is being developed that would allow all those cases to be treated here.
“We’re working on the proposal now. Transplants are a necessary part of a cardiac surgery program, in my opinion. I’ve got that experience and it’s something we should be offering,” Gandhi said. The recruitment process came about after a hospital working group was put together to create a vision for the heart surgery program. The group, led by cardiologist Dr. Derek Human, identified current and future demands for heart surgery capacity. When Gandhi was hired, he implemented all the goals identified by the working group with blazing speed.
To see a video news clip about Addison Yong McArthur, the tiny baby who last year became Gandhi’s first B.C. heart transplant patient, go here
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