Karen Otero: Collaborative care across countries and continents

By Karen OteroThe medical and surgical management of a patient with a congenital heart defect is a complex, collaborative effort, one focused on ensuring the best possible patient outcome.

Nowhere is that collaborative approach more important than in the care of patients traveling from overseas.

Boston Children’s Hospital has one of the most comprehensive Heart Center programs in the world. Boston Children’s Hospital’s Heart Center has more than 500 specialized physicians, nurses and associated staff with expertise to advise on and deliver advanced care to patients from around the world. Coordinating this care with the patient’s physician at home is critical since that physician provides continuity of care and ongoing clinical management.

Karen Otero, the Heart Center’s global network manager, works with physicians and families from 30 to 40 nations every year. The Heart Center’s approach for managing a second opinion involves obtaining a comprehensive patient history and records. If additional information is needed, the program contacts the patient’s cardiologist or pediatrician to discuss her medical history. Integral to this process is the involvement of the appropriate Boston Children’s cardiologist, cardiac surgeon or other specialists as needed to discuss the patient’s history and develop a customized plan of patient care.

Otero explains: “Our cardiac team works closely with other specialties across the organization. If a patient has comorbidities, coordinated care is essential. The Heart Center’s cardiac specialists and the patient’s team work together—via email, phone or videoconferences, and involving interpreters when necessary—to develop a plan of care and decide the timing for implementing it.

“We formally present the opinion and plan of care to the family and clinician, via conference call or videoconference,” she continues. “We want to ensure that families and their physicians have a thorough understanding of the expectations and recommendations outlined by our team. It’s not unusual for the review and remote evaluation to include multiple emails and phone calls before proceeding to schedule and plan for arrival.

“And we must be flexible and nimble,” she adds. “We need to plan for contingencies—the ‘what-ifs’—and manage expectations. You cannot overcommunicate.”

Open communication remains of utmost importance throughout the patient’s treatment. “It’s a never-ending conversation,” Otero says. “The Heart Center stresses the importance of ongoing collaboration even after a patient is discharged. We provide every family with clinical notes summarizing treatment plans, along with a letter addressed to their physician. I enjoy continuing to support patients even after their return home. A good portion of my day is receiving updates about a patient’s evolution and requests for medication management or follow-up care.”

Otero also stresses the importance of learning from families and their physicians what works and what doesn’t. “The patient comes in for a final checkup before traveling home. At this point, we ask for feedback about their experience, which we factor into the service we provide for future patients, families and their physicians.”

The Heart Center’s collaborative approach arises from the recognition that the ability to deliver on the promise of innovation and care is founded on accessibility and inclusiveness.

“The way to communicate our desire to partner in the care of as many children as possible,” Otero says, “is to remove barriers to access and collaboration and provide international families and their providers the same level of service and communication we offer everyone else.”

To contact Karen Otero, please email her at karen.otero@cardio.chboston.org.