Pediatric cardiologist in Topeka brings specialty care to medically underserved areas

Children and infants born with heart disease and children and adolescents who develop arrhythmia or other heart conditions can receive care sooner and closer to home because Stormont Vail Health has a pediatric cardiologist on staff.

 

Pediatric cardiology tends to be limited to tertiary care centers, such as children’s hospitals, which are in large metro areas like Kansas City, Mo., or Denver. But Stormont Vail took an opportunity about three years ago to bring that specialty care closer to home for those living in Topeka and surrounding rural areas.

Dhiraj Singh, pediatric cardiologist at Stormont’s Cotton O’Neil Heart Center, said that before he came to Topeka, a specialist from Kansas City visited Topeka once or twice a month to see patients. That meant infants, children and adolescents in need of care might wait two months for an appointment.

 

 

 

“So the wait was two to three months, and now we have been able to cut down the wait to less than a week,” he said. “It’s been really good for the community in that sense. They have ready access to cardiology now.”

There is no other full-time pediatric cardiologist between Kansas City and Denver, Singh said, so his work includes supporting staff at hospitals that are affiliated with Stormont for specialty care. Doctors can refer patients to Singh in Topeka — or at the Cotton O’Neil Manhattan and Emporia outreach clinics, depending on scheduling — rather than sending them to the more distant Children’s Mercy Hospital or University of Kansas Hospital in Kansas City.

Eva Ewers, a pediatrician at Fort Riley’s Irwin Army Community Hospital, said she has referred many patients to Singh and called him for consultations. She said having a pediatric cardiologist working in the area makes a difference.

“It definitely benefits the patients, because as soon as a parent hears a child has anything to do with a heart murmur or arrhythmia or anything, they almost kind of go into panic mode,” Ewers said, “so being able to get them to a pediatric cardiologist who is relatively close and can get them in in a timely manner means a lot to them.”

Singh said doctors in communities such as Hiawatha and Sabetha sometimes use telemedicine for pediatric heart patients. He also receives frequent phone calls from doctors with questions about patients.

“I don’t think there is any day that I don’t get a call,” he said. “Not all calls are critical calls, but they do provide some kind of medical advantage to the primary care doctors.”

Early detection of congenital heart disease is critical to ensuring the best outcome, Singh said, and that is his main focus. Because of the increased accessibility of pediatric cardiology care, more patients have been caught at an earlier age, allowing care providers to optimize pre-surgery care for a better outcome.

For example, Singh said, if an infant’s congenital heart disease goes unnoticed until the infant is 6 months old, they can go to surgery immediately, but the outcome won’t be as good as if it had been diagnosed earlier and managed until the baby reached that age.

Infant patients receive optimized care so they can go into surgery in good shape, then Cotton O’Neil manages post-operative care after discharge from the hospital and checks to ensure the infants’ continued well-being for a period of time afterward, Singh said. He noted that care close to home is important to families whose resources are limited.

“Those type of services can now be delivered closer to home so they’re not going back and forth all the time,” he said.

Ewers said community-based pediatric cardiology care has helped ensure patients can be treated in a timely manner.

“If we call (Singh) and say, ‘This is what we think this child has’ or ‘This is what the echo (echocardiogram) looks like,’ if he thinks they need to be seen sooner, he will work them in and get them seen sooner,” she said. “He’s been very good with helping us to take care of the child, whatever their needs are.”

Clifton Jones, vice president for subspecialty care at Stormont, said he believes having a pediatric cardiologist in a city the size of Topeka is “relatively unique.”

“Whatever we can provide in the community is a service to our patients and their families,” Jones said.

Singh also trains sonographers at community hospitals to perform echocardiograms of infants’ and children’s hearts. Unlike adults, babies don’t hold still for CT or MRI scans, Singh said, so the cardiac echo is all technicians have to determine whether a patient’s condition is critical and needs to be transferred for emergency care.

“It’s operator-dependent,” he said. “How well you can do is dependent on how well the person is trained.”

The technique used to perform scans on infants is different than that used for adults. Babies don’t have the fat or excess muscle of adults, Singh said, so technicians scan through the subcostal or neck windows.

“The heart is still the same, but how you look at it is a little bit different,” he said.

Singh offers technicians opportunities to train by shadowing staff in Topeka, attending a continued medical education conference, or completing hands-on training during sessions offered twice a year. Under his leadership, Washburn University’s medical sonography program works with Stormont’s sonography division to give students opportunities to learn pediatric echo protocol before they enter the field.

Contact reporter Samantha Foster at (785) 295-1186 or @samfoster_ks on Twitter.

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RELATED LINKS

Read more about the Capital-Journal special section, State of Health Care in Kansas, at http://cjonline.com/state-health-care-kansas.

See the 24-page Capital-Journal digital magazine of the special section here.

 

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