Dr. Peter Wearden, Chair, Cardiovascular Services, Florida, Nemours Children’s Hospital, Florida

Invest: spoke with Dr. Peter Wearden, chair of cardiovascular services in Florida at Nemours Children’s Hospital, Florida, about the progress Nemours Cardiac Center has made over the past decade, building team culture, and Nemours Children’s investment in Orlando’s future. “Our comprehensive heart program delivers the best cardiothoracic surgery outcomes in Florida,” Wearden said.

Can you tell us about your background and how you came into your position with Nemours Children’s Hospital, Florida?

I am a West Virginian. After attending Georgetown University as an undergraduate, I moved back to West Virginia where I went to medical school. I completed my general surgery training in West Virginia and then went to the University of Pittsburgh Medical Center to do adult heart surgery. Following that, I went to the University of Toronto and the Hospital for Sick Children in Toronto, Canada, for pediatric heart surgery. I returned to Pittsburgh, where I was on the faculty at the University of Pittsburgh and Children’s Hospital of Pittsburgh for 10 years. Then, Nemours Children’s Health recruited me to Orlando to build their cardiac program in 2015.

What key metrics define Nemours Children’s cardiothoracic performance?

When we founded the cardiac program, we decided to take a little bit of a different approach than many centers would take. Historically, people would focus on a single discipline, whether anesthesia, surgery, or medicine.

We founded the Nemours Cardiac Center on the idea of what is called an integrated provider unit, and that was to focus a team of providers across all specialties on a specific disease process. In this case, it was children with congenital heart disease. Congenital means you are born with it as opposed to acquired heart disease, which would be like hardening of the arteries that an adult might get.

The early concept was to build an integrated team of people focused on providing the best quality care for a single disease process. When I came in 2015, I was really the first employee in the cardiac center, and now, across the state of Florida, there are probably 300 people that work in the cardiac center, from physicians and nurses, to respiratory therapists and pharmacists. It is all predicated on the idea that we are going to provide the highest quality care for children with congenital heart disease and their families.

One of the ways we measure that is reporting data to the Society of Thoracic Surgeons database. We report not just the patients and their outcomes, but also what operation they had and other comorbidities, which might mean other problems they have. Most centers around the country report that data, so then the Society of Thoracic Surgeons can predict an outcome for a patient.

Then we look at the observed outcome versus the expected outcome to understand expected mortality. If it is greater than 1, that means it is worse than expected, and if it is less than 1, it is better than expected.

How do you build a team culture where what a parent says is treated as meaningful clinical data?

I frequently say to the parents that they obviously know their children better than we do. We might know the medical terms, but the parents notice the problem long before we do, because they will see subtle changes.

It is an interesting dynamic in pediatrics. For example, if I am taking care of an adult, they choose to visit the doctor because they feel sick and want help. Parents recognize their children are sick, and they bring them to the doctor, but parents actually do not feel sick. They feel protective. It is a very different relationship.

Pediatric healthcare is unique because we are taking care of the child, and sometimes they cannot converse with us in the same way or understand in the same way that an adult does.  We also take care of the parents and the families. Because they feel protective of their child, they want to see that they are in the best possible environment.

Our goal is to see all of the kids that we care for, and their families, lead as full and productive lives as possible. We want to return kids to health so that they can join their family and thrive.

How did your experience at UPMC help shape your work at Nemours Children’s today?

One of the things that attracted me to come work for this organization in Orlando and to build this program was its focus on children. Nemours Children’s Hospital, Florida, is the only healthcare provider in Orlando that is focused solely on caring for children. There are others that care for children, but they also have large adult health systems and different priorities. Nemours Children’s is very unique in that all we do is take care of kids. That is our sole focus.

The things I did in Pittsburgh are the continuum of the care that I am also providing in Orlando. I  learned how to provide high-quality care there and how to lead a team, and now I lead a much bigger team here.

I frequently say in my role that there are three priorities. One is to provide the highest quality of care possible to children and their families. The second priority is to be a good steward of Nemours resources. As a not-for-profit, we want to help as many kids in the state of Florida as we possibly can. Lastly, I want to work with a team of people who are happy, satisfied, and engaged.

If I am not leading a team of happy, satisfied, and engaged associates, we are probably not able to provide the highest quality care. We really want to create an environment for the child, the parent, and all the people that work on the team, as the place to be.

As Nemours Children’s continues working on closing the gap for congenital heart patients, how does that transition from pediatric to adult care work?

Currently in the United States, there are more adults with congenital heart disease than there are children. That transition did not happen until about 10 or 15 years ago, because as we got better at saving kids’ lives, more of them live to adulthood. Those patients are called adults with congenital heart disease.

By and large, we feel an obligation to continue to care for those patients. We do not currently operate on adults at our hospital here, but we do see the patients in the clinic, continue to provide them care, and arrange for a transition to an adult provider that can understand their process.

What would you like the people of Central Florida to know about Nemours Children’s Hospital?

It is important for the people of Central Florida, and the state as a whole, to know that Nemours Children’s has really made a significant investment in the future of our community, and particularly in the children of this community, and we are solely focused on that. This commitment has led to our comprehensive heart program delivering the best cardiothoracic surgery outcomes in Florida. I was employee number one in the cardiac program, and now across the state of Florida, spanning from Pensacola and Panama City to Jacksonville, Lakeland and Orlando to Melbourne, and Vero Beach to Port St. Lucie, there are over 300 people working in this cardiac center. That is a massive investment on the part of the organization into pediatric healthcare. We would like to see this generation of children be the healthiest generation ever.