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The Impact of Nurse-Led QI Projects

Jamin Sinclair-Lee, RN, (right) leads a rounds discussion outside of a patient room in the Children’s of Alabama Heart Center.

By Conan Gasque

In mid-2024, the Children’s of Alabama cardiovascular services team implemented a shift in the way they handled daily rounds. Instead of having attending doctors, fellows, or residents lead them, they decided to put nurses in charge. It was a quality improvement (QI) project that represented more than a process change; it handed the leadership role to the people closest to the patient. And its impact has been significant.

“It makes the most sense,” said Ashley Moellinger, MSN, CPNP-AC, MSHQS, the team’s lead pediatric nurse practitioner, “because [the nurse] knows the patient best, has been with the patient all along.”

Santiago Borasino, M.D., a cardiac intensivist at Children’s, agrees, saying it not only gives the nurse a greater voice, but puts the entire team in a better place. “It actually pushes the team to become a little bit more interdisciplinary where we all have something to say—we all have something to add to the to the plan.”

That’s crucial for the nurse and, by extension, the patient. For young nurses in particular, Borasino pointed out, it’s not always easy to speak up about the patient’s needs when a physician is leading rounds—even though the nurse may understand the needs better.

Moellinger
Borasino

“Having them present allows them to have the microphone and to be able to say what they want to say,” Borasino said. “They can choose what they say instead of having to interrupt us or correct us or bring up what they think needs to be done when we didn’t say it.”

More than two years after Children’s started the project, which was led by Caitlin Arney, RN, it’s now a core philosophy in the Children’s of Alabama Pediatric and Congenital Heart Center. “It used to be that if the nurse wasn’t at the bedside for whatever reason, we would start without the nurse,” Borasino said. “Now we don’t. The nurse is always there because they’re integral to this concept.”

The nurse’s presence helps standardize the process. “They use a script and a piece of paper, and it’s the same thing every time, whereas when someone else presents, it’s kind of what they think should be shared,” explained Moellinger, who serves as co-director of quality improvement in the Heart Center.

This standardization is one reason the QI project has made a significant impact on the effectiveness of rounds within the Heart Center. According to data gathered by the interdisciplinary nurse-led rounds task force that spearheaded the project, nurse-led rounds have sparked a statistically significant change in discussion of the patient’s history, titration goals for vasopressors, fluid balance goals, respiratory support weaning goals, withdrawal assessment tool scores, state behavioral scale scores, vital sign goals, and rescue medication plan. The group’s report also highlights improved communication among the interdisciplinary rounding team and a boost in confidence among the nurses, some of who were initially skeptical of the new strategy.

“They went from being really sort of anti and not really wanting it to now they love it,” Borasino said.

Moellinger and Borasino have twice presented data on nurse-led rounds at the annual Pediatric Cardiac Intensive Care Society (PCICS) conference. They believe other units within the hospital can use the same strategy to help improve communication and comprehensive discussion of each patient’s condition.

The Impact of Nursing in the Heart Center

Nurse-led rounds is just one of many nurse-led QI projects the Children’s cardiovascular services team has implemented over the last few years. Below are some of most recent ones. While they’re too new to have any significant data yet, they do provide hope for the possibility of improved processes and outcomes, especially in light of the success of past projects. “I would say nothing changes without the investment of those frontline people,” Moellinger said. “You have to have buy-in.”

The projects underscore the pivotal role that nurses play on the Heart Center team. “Nursing is extremely important for our center,” Borasino said. “And the relationships we have with our nurses are an extremely important part of the outcomes that we have and the work and joy that we all have.”

CURRENT NURSE-LED QI PROJECTS

Vital Signs and Parameters

Each patient has their own set of goals, limits, and parameters for their vital signs. In an ideal situation, the care team is discussing these numbers and entering them into the monitors at the patient’s bedside. The process ensures that the patient is staying within the proper range, and it can—through the use of alarms—help the team identify when the patient might be at risk for an adverse event, which would trigger the need for provider intervention. But if the correct numbers are not entered, the alarm may not go off when needed, or it may go off too frequently—creating a white-noise situation where a nurse might develop the habit of reflexively silencing the alarm every time.

To correct this issue, the team originally implemented a QI project in 2019, when alarms were sounding hundreds of times per bed each day, according to Borasino. That project helped to dramatically reduce that number. Now, in a second iteration of the project—led by RNs Abi Capouya, Emily Beach, and McKenna Leahy—the team is taking more steps to ensure that the alarms go off at the right time. Moellinger says the project focuses on ramping up daily discussions about each patient’s vital signs, while also auditing and adjusting processes to ensure that providers are being notified when limits are surpassed. With this latest version of the project, which stared in mid-2026, the team hopes to reduce cardiac arrest rates and identify patient deterioration sooner.

Dual Sign-off Process for Medications

To decrease medication errors, the Heart Center team uses a process called independent double check, which simply means that when administering high-risk medications to a child, two people must independently check that the medication is being administered properly. With the recent installation of new smart pumps designed to help with double check, the process is changing. That’s why the team—led by RNs Haley Cobb, Samantha DeArman, and Yanci Horton—has implemented a QI project to ensure that each step of the new drug administration process, now called dual sign-off, is being taken. This can include following the medication bag to the pump, making sure it’s programmed correctly, checking that the medication is reaching the patient in the correct access port, along with other responsibilities. “We haven’t really had a good step-by-step process for what double check looks like, which has made the compliance low,” Moellinger explained. “And especially now that we have these new pumps, there’s going to be a different process because you electronically sign off or hand off the drug together with a signature in the [electronic medical record].”

“We’re really trying to focus on and hone in on that process itself to help with medication errors,” she added.

Emergency Simulation

When an emergency arises in the Heart Center, preparation is crucial. Everyone on the team needs to know how to respond. That’s why leaders recently implemented a QI project in collaboration with the Children’s Pediatric Simulation center for training. “We’ve really started pushing into a lot of different areas and using simulation to help everybody get more comfortable with those emergent situations,” Moellinger said.

Missy Britton, CRNP, and Matt Clark, M.D., have led the effort alongside Sara Ewert, a nurse educator in the Simulation Center. One recent training simulated an emergency involving a patient on a ventricular assist device in a CT scanner, requiring multiple disciplines to respond.

In the Cardiac Care Unit (CCU), the team has also worked on response time to emergencies and the various responsibilities that come along with those, such as getting defibrillator pads on a patient, drawing up emergency drugs, administering drugs, recognition of deterioration, and administering bedside epinephrine.

“They’ve been doing a lot of one-on-one education, which is not really with the sim lab, but they’re simulating events in short segments to really work on all those responses,” Moellinger said.

Goals and Other Projects

With each of these nurse-led QI projects, the primary goals are improvement and sustainability. Eventually, leaders want the new processes to assimilate into the culture of the unit. Many previous projects have achieved that level of success, giving Moellinger and Borasino the hope that the newer projects will also become accepted standards.

August 5, 2026 by
Cardiology

A bridge to better outcomes

The bridges that connect UAB and Children’s of Alabama play a key role in the Bridging the Fetus collaboration.

By Conan Gasque

Among the crucial features of Children’s of Alabama’s Benjamin Russell building, which was added to the hospital’s campus in 2012, is a set of bridges that connect Children’s to the University of Alabama at Birmingham (UAB) Hospital. The two institutions have worked in partnership for decades, and the building and adjoining bridges further enhanced the relationship. Specifically, they allowed for patients to be transported efficiently from one hospital to the other when necessary for care. A collaboration called Bridging the Fetus takes advantage of this arrangement to help patients with congenital heart disease. It’s helped save many lives, even in some of the most dire situations.

The collaboration involves the Children’s cardiovascular ICU team, cardiologists, cardiac surgeons, UAB’s Maternal-Fetal Medicine team, and neonatologists. And the bridge, of course, which is perhaps the program’s most unique feature.

“The setup we have with the bridge is a big deal for us because it allows us to best take care of moms but also best take care of babies by being so close,” said Laura Brasseale, MSN, CRNP, chair of the Children’s cardiac fetal team.

Laura Brasseale, CRNP

Proper care for both the mom and baby is vital in these cases because many of the congenital heart diseases the team handles are identified prior to birth. Thus, the team must have a detailed plan in place for delivering the baby at UAB, then getting it to Children’s for care while the mom remains at UAB. Thanks to the bridge that connects the UAB Women and Infants Center to the Children’s Heart Center, the transfer can happen in mere minutes. As a result, Children’s and UAB have taken referrals from other parts of the Southeast in these cases where, in another city, the delivering hospital might be 20 minutes or farther away from the Children’s hospital. “It is very unique to our situation that we have all these resources literally connected to each other,” Brasseale said. Few other hospitals in the Southeast offer this type of setup.

The collaborative effort of Bridging the Fetus begins as soon as a patient is diagnosed with a congenital heart disease. Brasseale follows each case and takes information from the mom’s clinic visits with obstetricians and cardiologists. She uses this info to compile a list with data to help the team plan for the delivery. Before the baby is born, the team provides advice and counseling for the parents. They also arrange logistical services, such as transportation assistance, long-term stay options and other resources. Lactation specialists meet with the mom to discuss feeding options and the importance of breast feeding. Palliative care assists with end-of-life decisions, if necessary.

From the time the diagnosis is made, members of the team meet regularly to discuss details of the case and form a plan of care for the child’s delivery. “It just makes us aware so that we save beds for these neonates,” Brasseale said. “We get them transferred over from [the UAB Regional Neonatal Intensive Care Unit] as soon as possible so that we can plan their next steps after birth.”

Typically, the next steps involve taking the child across the bridge to be seen immediately by the heart team and undergo and operation shortly thereafter. The mother, meanwhile, remains at UAB to be cared for at the Women’s and Infants Center.

Cases like these are highly complex, Brasseale said. And the biggest challenge is the simple fact that no one knows when the baby will arrive. But Bridging the Fetus streamlines that for everyone. “We plan according to your due date, according to whether mom has any pre-existing conditions, whether she’s had other children before, where they live. All of that plays a factor in terms of how we plan for delivery on these babies.”  

Because of the planning, the team will know if the baby needs immediate care or if they can stay in the NICU for a few hours until a bed opens up. “It’s definitely a good heads up and provides a multidisciplinary approach for the family,” Brasseale said, “because Maternal-Fetal Medicine can refer them to genetic counseling and the neonatologist so the family can meet a wide variety of people before having the baby. So it can kind of calm nerves as far as that goes.”

The team also prepares the family by giving them hospital tours beforehand so they’ll get “an up-close look of who is going to be taking care of their baby and what their baby’s future looks like,” Brasseale added.

The most notable success stories owed to Bridging the Fetus involve babies with hypoplastic left heart syndrome with intact atrial septum. Babies with this condition lack intracardiac shunting, so oxygenated blood can’t reach the body. Most require immediate extracorporeal membrane oxygenation (ECMO) cannulation after birth to increase the chance of survival to palliative surgery.

Children’s and UAB have seen four such cases since they started Bridging the Fetus in 2016. Three of the babies were cannulated onto ECMO within 15 minutes of birth. Two had successful heart transplants. The results far exceed those at other centers, Brasseale says, and it’s due to the team’s coordinating and multidisciplinary approach. Just getting everyone on the same page has a complexity of its own, with multiple service lines involved and each one featuring 10-20 people with rotating on-call schedules. “There are so many players. I think that’s the biggest part,” Brasseale said. “So it’s just nice for the information to all be in one place considering there’s so many different people who need to be involved.”

The team also is participating in research related to its work with Bridging the Fetus. One study is taking a look at how delayed cord clamping among neonates with congenital heart disease can effect neurodevelopmental outcomes. Another is a collaboration with the Pediatric Cardiac Critical Care Consortium (PC4) and aims to advance understanding of the maternal-fetal environment and its influence on postoperative outcomes in children with congenital heart disease. “The role of maternal characteristics in postnatal outcomes is a major knowledge gap in the treatment of congenital heart disease,” Brasseale said. “Identifying these prenatal risk factors is the first step toward developing therapeutics to modify them.”

The team hopes these studies will pave the way to a better understanding of these highly complex neonates, which can only help further streamline their care and produce more positive outcomes.

“It’s really cool to see the team come together to provide the best care for the patient, because it’s a lot of different people from a lot of different disciplines and even hospitals,” Brasseale said. “But it’s very exciting to see a baby thrive that was really not destined to have a good outcome. So it’s very exciting to be a part of such a big team.”

July 29, 2026 by
Cardiology

Aortic Arch Surgery and Cognitive Development

A Children’s cardiac surgeon is researching the connecting between aortic arch surgery and brain development. (Stock image)

By Charles Buchanan

Parents naturally ask plenty of questions when their newborn needs aortic arch reconstruction, a life-saving surgery for congenital malformations restricting blood flow. Their major concerns involve the procedure’s complex logistics and potential complications, which Hampton Gray, M.D., a Children’s of Alabama cardiac surgeon, can explain in detail. But not every answer comes so easily. He says some of the simplest questions from parents are also the toughest: “How’s my kid going to be when he is 5 years old? Can he go to school, or is he going to be delayed? Is he going to be behind the other kids?”

Their worries arise from a critical component of aortic arch reconstruction—the temporary reduction or shutdown of blood circulation throughout the body and to the brain. And the reason those questions are difficult to answer is that little is known about the surgery’s long-term effects on brain development. “There is limited data currently for us to properly educate parents on how their kid will cognitively develop through infancy, toddler, and school-age years,” Gray said. Now he is spearheading a novel, multiyear research project to fill that knowledge gap. The findings could provide parents with the answers they need and help them understand what to expect as their children grow.

Cardiac Surgery Meets Psychology

Hampton Gray, M.D.

The trial kicked off in July, funded by an $80,000 grant from the Kaul Pediatric Research Institute, a Children’s/University of Alabama at Birmingham (UAB) program supporting trailblazing work from rising investigators. During the next two years, Gray and his team will follow up with Children’s patients who had major open-heart surgery to repair a congenitally small native aorta in the last 15 years. That cohort includes up to 200 children, though Gray anticipates the study will attract approximately 80 participants ranging in age from infants to school-age children.

To measure the patients’ long-term progress, Gray has forged an innovative collaboration with the clinical psychologists at UAB and Children’s. “They are pros at testing kids about cognitive function, executive function, fine motor skills, and all the things that dictate how your brain is developing as a young child,” Gray explained. UAB already has an established Newborn Clinic, where the clinical psychologists gauge the growth and development of children who spent time in the neonatal intensive care unit (NICU). For the cardiac surgery study, they created a novel algorithm to tailor their tests for the varying age levels of patients following aortic arch surgery. They also will administer the tests to participants and interview parents about their child’s cognitive development.

“It will be very valuable to test these kids at different time points and different age groups,” Gray said. With the cognitive development data in hand, the researchers will evaluate the trajectories of aortic arch patients alongside children who have not experienced heart surgery.

A Tale of Two Strategies

The study also may shed new light on the two cerebral perfusion strategies used to manage blood circulation during aortic arch surgery. The researchers are eager to know if the techniques affect brain development differently, which leads to the inevitable question: Is one option better than the other?

The original cerebral perfusion strategy, deep hypothermic circulatory arrest (DHCA), involves cooling the body to a temperature between 18 and 20 degrees Celsius and turning off the heart-lung machine so that no blood circulates through the body. That gives cardiac surgeons approximately 40 minutes to complete the reconstruction without increasing the risk for brain injury, Gray said. Cardiac surgeons following the newer strategy, antegrade cerebral perfusion (ACP), cool the body to the same low temperatures but also sew a small graft to the innominate artery and keep the heart-lung machine running, selectively perfusing the brain. As a result, about 15 to 20% of the entire cardiac output continues flowing, according to Gray’s estimate. Today, at least 70 to 80% of cardiac surgery centers, including Children’s, have adopted ACP while the rest continue to rely on DHCA, he noted.

“It would make sense, theoretically, that giving the brain a little bit of blood flow would be better than giving it no blood flow,” Gray said. However, in a 2024 study comparing the two cerebral perfusion strategies, he and his research team found no significant differences in short-term hospital outcomes among 165 newborns and infants undergoing aortic arch surgery at Children’s between 2012 and 2023. Both types of patients also experienced a low rate of neurologic events such as stroke and seizure.

Gray’s current project, with its long-term, cognitive development focus, offers a logical next step in identifying any differences that emerge between DHCA and ACP patients as they grow up. The study’s participants will include the two groups, since both cerebral perfusion strategies were in use at Children’s as recently as 2022, giving the researchers ample opportunities to compare outcomes. The team also will gather information about nonsurgical factors that can influence brain development, including the children’s family structures and education, to round out the picture of each child’s growth.

Answers at Last

Gray hopes the research will serve as a stepping stone to a broader exploration of aortic arch patients and their progress. Ultimately, he would like for the findings to serve as pilot data for a larger initiative involving multiple cardiac surgery centers and extramural funding from sources such as the National Institutes of Health. The most useful information would come from a trial that pairs a DHCA-exclusive center with an ACP-exclusive center and follows patients from both over several years, he said.

No matter where his investigation leads, Gray says the goal remains the same: to provide parents with meaningful answers to their simple, yet tough, questions about their child’s future. And if the cardiac surgeons and clinical psychologists make pioneering discoveries about the impact of aortic arch surgery along the way, that’s a bonus. “Children’s supports pushing the envelope to make children’s lives and parents’ lives better,” Gray said.

July 24, 2026 by
Cardiology

Pulmonary Vein Stenosis: No Longer a Death Sentence

The pulmonary vein and artery system (Stock image)

Pulmonary vein stenosis (PVS) is a rare yet serious cardiovascular condition marked by progressive narrowing of the veins that return oxygenated blood from the lungs to the heart. Until recently, it was usually considered a death sentence. “There’s no two ways about it,” said Children’s of Alabama pediatric cardiologist Matt Clark, M.D. “It only gets worse once it starts.”

“When diagnosed, we would tell families there was nothing more to offer and to transition to end-of-life type care,” added pediatric interventional cardiologist Stephen Clark, M.D. “Until recently, we didn’t have medical therapies that could treat this. Surgical intervention was generally unsuccessful and sometimes accelerated the progression of the disease.”

Indeed, PVS has historically had grim outcomes, with mortality rates as high as 60% or more. Right ventricular pressure elevation—a marker of pulmonary hypertension (PH)—is strongly associated with mortality.

Now, there is hope.

“I think the biggest thing to come along was more data from studies and centers showing if you change the mindset and consider it as a possibly treatable condition, you change outcomes,” Matt Clark said.

That shift in mindset has driven a transformation in how PVS is diagnosed, monitored and treated. Today, children who would not have survived infancy are living into early childhood—and in some cases beyond—because of earlier recognition, aggressive catheter-based interventions and multidisciplinary care.

Earlier Detection, Closer Surveillance

One of the most important changes in PVS care has been earlier diagnosis, Matt Clark said, by recognizing high-risk populations: neonates with chronic lung disease; prolonged ventilation; those with congenital heart disease; and/or those with pulmonary hypertension (PH). The earlier the diagnosis, the more likely interventions are to be effective.

This surveillance-driven approach means clinicians are often identifying milder disease earlier—with regular echocardiograms, CT scans and diagnostic catheterization—and intervening at the first signs of progression.

PVS often exists in the setting of comorbid conditions such as PH, congenital heart disease or complications of prematurity, requiring close coordination between specialists. Thus, the pulmonary vein stenosis team in the Children’s of Alabama Heart Center has brought together a small group of pediatric cardiologists, allowing for shared memory and standardized decision-making.

“We don’t have to spend time reinventing the wheel,” Matt Clark said. “We can collectively remember all our patients” and which approaches approach worked best.

Catheter-Based Intervention as a Strategy, Not a Last Resort

Treatment for PVS has also evolved. Intervention includes balloon angioplasty to widen narrowed vessels or stent placement to hold them open. The stents are coated with sirolimus, a drug designed to prevent restenosis. However, rather than viewing catheter-based intervention to unblock the vessel as a one-time attempt to rescue a sick child, it is now viewed as a repeated, planned strategy.

“Every time you do an intervention,” Matt Clark said, “you’re signing that kid up for another cath at some interval.” That’s because the baby’s heart and lungs keep growing, requiring additional interventions. Multicenter analyses show that repeat catheterizations are associated with improved survival, reflecting a shift away from passive observation to active disease control.

In some children, repeated dilations and stent expansions over time allow pulmonary veins to reach near-adult size within the first few years of life.

Medical Therapy to Slow Disease Progression

Procedural care is now complemented by medical therapy aimed at the underlying biology of PVS.

Because the disease involves aggressive cellular proliferation within the vessel wall, antiproliferative medications such as sirolimus have become an important adjunct to intervention.

Observational studies suggest that children receiving systemic sirolimus have significantly improved survival compared with historical controls. In one widely cited cohort, four-year survival reached 100% in treated patients compared with approximately 45% in those not receiving therapy.

Sirolimus has also been associated with slower in-stent restenosis and longer intervals between interventions. While randomized trials are still lacking, these findings have helped legitimize systemic therapy as part of standard care at experienced centers.

“We’re probably doing more sirolimus-type therapies now than we used to,” Matt Clark said.

Survival Looks Different Now

Even with advances, PVS remains unpredictable. Not every child can be saved. But survival is no longer measured only in weeks or months.

Matt Clark described children who once would have died in the hospital now going home, growing and returning for planned interventions.

“One of the earlier ones was pretty impactful,” he said, recalling a child who lived long enough to spend two Christmases at home. “That was enough to make us keep going and keep pushing.”

“We know we’re helping,” he said. “So we’re more likely to intervene, to follow closely and to keep trying.”

February 12, 2026 by
Cardiology

Building a Team Around Pulmonary Hypertension

The Children’s PH team (L to R): Ahmad Khalil, Frank Bennett Pearce, Jodie Kanaday, Kevin Wall and Matthew Clark.

Pulmonary hypertension (PH) is a heterogenous condition stemming from numerous underlying causes, including extreme prematurity, congenital heart disease and systemic diseases like lupus. It causes dangerous increases in blood pressure in the lungs, straining the heart’s pumping ability and potentially leading to heart failure.

Care for children with PH has typically existed across silos: cardiology, pulmonology, neonatology and intensive care, said Frank Bennett Pearce, M.D., a pediatric cardiologist at Children’s of Alabama. Each discipline did its part. But clinicians increasingly recognized that the complexity of the condition and the fragility of the patients required greater coordination.

Today, a formal PH team of Pearce, pediatric cardiac critical care specialists Ahmad Khalil, M.D., and Matthew Clark, M.D., and pediatric cardiology fellow Kevin Wall, M.D., together with pediatric cardiology nurse specialist Jodie Kanaday, RN, round weekly on patients with PH to determine the best course of action for this rare but complex condition.

“We wanted to improve communication by having us all together saying the same thing to the consultant teams and to the families,” Pearce said.

That consistency matters, especially when care unfolds over weeks or months.

From a cardiology standpoint, PH has always been part of the landscape, Pearce said. “A lot of the treatment and diagnostic procedures like catheterizations and echocardiograms come through cardiology anyway,” he said. “So we end up being the treating doctors in lots of cases, or at least consultants.”

At the same time, many of the sickest patients are in neonatal and pediatric intensive care units and managed by critical care specialists.

PH is typically treated with medications like pulmonary vasodilators regardless of cause, but timing and diagnosis matter. That’s why it’s so important to have a precise anatomic diagnosis before starting medication, Pearce said. In babies with bronchopulmonary dysplasia, for instance, PH may be driven by acquired pulmonary vein stenosis—a condition that requires catheter-based or surgical intervention before medication.

Previously, decisions like these might have been made in parallel by different services. Now, they are made together.  

The team manages about a dozen inpatient pulmonary hypertension cases each month on inpatients at Children’s and the University of Alabama Birmingham (UAB). But inpatient care is only part of the story.

PH does not end at discharge. Medication management, insurance approvals, symptom monitoring and urgent questions follow families home. That’s where Kanaday, who is the Pulmonary Hypertension Clinic care coordinator, shines.

“We literally couldn’t do it without her,” Pearce said. She allows the team to see more patients, stay more organized and keep up with the paperwork/regulatory side of things in the PH world, he said.

Kanaday sees herself as a conduit to the physician. “Our patients know they can contact me directly for questions about medications, symptoms or side effects. I’m able to pass those concerns along quickly, which usually means they get help faster than they otherwise would.”

Her role, she said, is “making sure the doctors have all the information that they need to best take care of the patients.”

While the team is not formally tracking outcomes yet, Pearce says he’s seen a difference. “The patients are staying on their medications more consistently. The doses are more consistent. Some of these medications require a lot of paperwork—that’s getting handled quicker.”

In addition, the improved coordination means patients get to the cath lab sooner for pulmonary vein interventions. The team is also closely tied to newer catheter-based procedures, such as closing a patent ductus arteriosus or atrial septal defects in extremely small infants.

“I think it’s really been an asset to our cardiology team in general, taking this burden off of the general cardiologists and putting these patients with a provider who readily understands the disease process, available treatment options and possible complications. I think it makes our consult service much more efficient,” Kanaday said. “It has really made an impact on the patients, their continuity of care as an inpatient, and their follow-up in the outpatient clinic. I feel like we’re really making a difference and giving these kids the best chance to have positive outcomes long term.”

February 12, 2026 by
Cardiology, Inside Pediatrics

Lau shares vision as new Physician-in-Chief

Yung Lau, M.D. was named physician-in-chief at Children’s of Alabama and chair of the UAB Dept. of Pediatrics in March 2025.

After serving as interim chair for five months, Yung Lau, M.D., was officially named chair of the University of Alabama at Birmingham (UAB) Department of Pediatrics and physician-in-chief at Children’s of Alabama in March 2025. The only real change, Lau said, was that he could now formally begin planning for the future. His vision for the department is expansive—centered on collaboration and faculty support. But he believes the path to those big goals lies in the small things everyone does every day.

Lau stepped into the interim chair role in November 2024, following the announcement that then-chair Mitch Cohen, M.D., would be departing at year’s end to join Stanford. “Dr. Cohen led for a decade and helped build this department into a strong and vibrant group,” Lau said. “It has consistently thrived, and I’ve considered it a privilege to be a part of the department as a faculty member for over three decades. Now, it’s an awesome responsibility to carry on this tradition of excellence.”

The role requires close collaboration between two major institutions: Children’s of Alabama and the University of Alabama at Birmingham. With more than 30 years of experience across both organizations—including in leadership roles—Lau understands their individual missions and how they intersect.

That understanding came into sharp focus in 2007, when Lau led the UAB group in a major collaborative effort between the two institutions. At the time, UAB housed the pediatric cardiac program. But as Children’s leaders planned to build a new hospital tower, they wanted to bring the program under their roof. Over the next five years, Lau played a significant role in bringing physicians and other clinical staff to assist in the design of the cardiac intensive care units, operating rooms, catheterization labs, step-down units and cardiovascular perioperative areas. He then worked closely with Children’s leadership on staffing and operations planning. On October 14, 2012, the program moved into the new building—seamlessly.

The success of the move laid the foundation for a quantum leap in the ability of the Pediatric and Congenital Heart Center of Alabama to provide state-of-the-art care. Today, the program consistently ranks among the top performing pediatric and congenital heart centers in the nation by numerous metrics, and the Society of Thoracic Surgery has classified the program as an overperforming center—one of 12 in the country. For Lau, who served as the division director of pediatric cardiology from 2012 until his appointment as chair in 2025, the experience left a lasting impression about what’s possible when Children’s and UAB work together.

“The opening of the Heart Center marked one of the most satisfying periods of my career,” he said. As he steps into his new role, he hopes to lead more collaborative efforts with similarly meaningful impact.

The Heart Center’s success is a powerful example of the synergy between Children’s and UAB—a synergy Lau believes can grow even stronger. “What I’ve seen is a real willingness among leadership across both institutions to reduce barriers and connect silos,” he said.

Lau has outlined three key priorities to strengthen that collaboration: maximizing current resources in clinical care, education and research; strategically recruiting and developing faculty; and building a resilient foundation of financial stability and physician well-being.

Education and research are crucial parts of his strategy, and UAB and Children’s have a history of successful collaboration on both. From an education perspective, Children’s serves as the teaching hospital for the UAB pediatric medicine, surgery, psychiatry, research and residency programs. “There’s this deep core of understanding between Children’s and the department that we are really training the future physicians for the state,” Lau said. And that’s a crucial role in a state that, Lau says, needs more physicians and pediatricians. “Part of our duty here is in our obligation to do that,” he added.

On the research side, the two institutions work together to “advance knowledge for the children of Alabama and beyond for the future,” Lau said. This benefits both entities, sometimes leads to advancements and breakthroughs that influence the broader world of medicine, and enhances the reputation of both.

“When we collaborate more extensively and continue to strengthen those ties of collaboration, two important things happen,” he said. “First, children receive better care, now and in the future. Second, our faculty experience significantly greater job satisfaction.”

Faculty support is another central pillar of Lau’s vision. Since becoming chair, he has met with many faculty members—some he’s long known, others he’s come to know better through these conversations. What stands out most, he says, is their passion and the profound impact they have on children’s lives. His goal is to listen, support and help them succeed.

Lau also acknowledges the tension between moral obligation and financial reality. “That’s just medicine in America today,” he said. But he’s confident the department can thrive within that framework.

“I think both institutions understand that we need to maximize our resources—our people and infrastructure—to provide the best possible care, to train the next generation of pediatricians, and to innovate through research,” he said.

Though there are multiple facets to Lau’s vision, everything is focused around the patient.

“The patients in front of us are the cornerstone of everything we do,” he said. “And while our goals may be big, the real progress happens in the small steps we take every day.”

“Yes, having a goal is important,” he continued. “But sometimes if we focus only on the goal, we risk losing sight of what’s happening in the moment—and that can distort the work being done on the ground. Sometimes the things that matter most get sidelined in the name of progress.”

With a strong focus on the patient—and through strong collaboration and faculty support—Lau believes UAB and Children’s will continue to deliver exceptional care to every child they serve.

August 4, 2025 by
Cardiology

Law appointed division director of pediatric cardiology

Mark Law, M.D., is the new director of the Division of Pediatric Cardiology at Children’s of Alabama and UAB.

By Heather Watts (UAB)

The University of Alabama at Birmingham (UAB) Department of Pediatrics announces with great pleasure and gratitude the appointment of Mark Law, M.D., professor in the Department of Pediatrics, to the permanent position of director of the Division of Pediatric Cardiology at UAB and Children’s of Alabama. Since stepping into the interim role in November 2024, Law has made substantive changes that address current needs as well as laying a strong foundation for continued growth and success within the division and the Pediatric and Congenital Heart Center of Alabama at Children’s of Alabama. Law brings his remarkable thoughtfulness paired with a blend of clinical excellence, research innovation and mentorship to this leadership role.

“In a twist of irony, when I interviewed Dr. Law to join us in 2008, he confidently declared that he had no interest in becoming a division director,” said Yung Lau, M.D., professor and chair of the Department of Pediatrics and Law’s predecessor as division director. “Fortunately, his thinking evolved. When the intersection of his unique talents and the Heart Center’s greatest needs became clear, he answered the call.”

Over the years, Law has progressed through the academic ranks—from assistant professor to his current role as professor of pediatrics. He also serves as medical director of Adult Congenital Interventional Cardiology at UAB Medicine, with a secondary appointment in the Division of Cardiovascular Disease within the Department of Medicine.

Widely respected as a leader in pediatric and interventional cardiology, as well as adult congenital heart disease, Law has authored or co-authored more than 70 peer-reviewed articles and book chapters. He has also mentored more than 20 post-doctoral fellows and junior faculty, contributing meaningfully to the future of academic medicine.

In recognition of his many accomplishments and unwavering dedication, Law was recently appointed to the prestigious Lionel M. Bargeron Endowed Chair in Pediatric Cardiology by the Board of Trustees of the University of Alabama—a most fitting appointment given the pioneering contributions Bargeron made to the field of heart catheterization when it was in its infancy.

July 23, 2025 by
Cardiology

Children’s of Alabama’s interstage home monitoring program growing

Brittany Abercrombie, NP, and Alan Brock, M.D., discuss the progress of a patient in the Hearts at Home program.

As the reputation of the Children’s of Alabama Pediatric and Congenital Heart Center of Alabama has grown, so has the success of its programs. Case in point—Hearts at Home, an interstage home monitoring program for any patient with single ventricle physiology who has undergone their first palliation procedure. In the last five years, the program has seen steady growth in the number of these patients, and leaders say the center’s reputation is among the reasons why.

“I think as a heart center in general, we’ve just had an influx of patients,” said Brittney Abercrombie, a nurse practitioner and the coordinator of Hearts at Home. “And so by default, that means that we are having more interstage patients.”

When Abercrombie moved into her role five years ago, Hearts at Home was caring for six to eight patients at a time. Now, she says they typically have about 13. Yearly, the program follows as many as 30, compared with 23-25 when she began. In the last couple of years, they’ve attracted more patients from outside Alabama, including children from Georgia, Tennessee and the Pensacola, Florida, area. Some of the program’s patients chose Children’s over other options in the region.

“I think they recognize that our outcomes here are some of the best in the Southeast,” said Alan Brock, M.D., the program’s medical coordinator. “And when they have the opportunity to look around and pick which program they want, I think patients are choosing us.”

As a result of the program’s success, hypoplastic left heart syndrome—a condition that brings many patients to the program—has become one of the most common forms of single ventricle congenital heart disease the hospital treats, Brock added. “I think it’s because we’re getting better at what we do and we’re saving a lot more lives now,” he said. “That is part of the reason that there are more patients coming into our program.”

What is Hearts at Home?

Through the Hearts at Home program, the families of patients with hypoplastic left heart syndrome and other forms of single ventricle congenital heart disease have access to education and technology that helps them to monitor and track their child’s heart health at home during the period between their first and second stages of palliation—procedures designed to repair their congenital heart defect. This time is tenuous for the child and often stressful for the parents, requiring a great deal of medical management, including monitoring, medications, adhering to strict feeding regimens, checking vital signs and having emergency access to equipment. “I think especially for these first-time parents, they don’t know what’s normal and what’s not,” Abercrombie said. “They’re not only learning to parent, but they’re learning how to parent a medically fragile child, so I think that’s a big challenge for them.”

There’s also the threat of morbidity, which is what led to the creation of interstage monitoring programs. The effort began in 2008 with the formation of the National Pediatric Cardiology Quality Improvement Collaborative (NPC-QIC). Since then, interstage monitoring programs across the country have succeeded tremendously, dropping the interstage mortality rate by more than 40%, Brock said.

The programs are effective because of their focus on education, data and communication. The work begins before a family even leaves the hospital. While there, they go through extensive training to help them understand their child’s condition, how to manage it and the warning signs that might arise. Once they’re home, they track all of their child’s vitals—specifically heart rate, oxygen and saturations—through an app called Locus Health. This data is accessible by the patient’s care team, giving them a look at the patient’s trends and helping them to quickly identify any problems. “It helps us see the whole picture while they’re at home,” Abercrombie said. If any issues do arise, the family can connect with the care team via messages through the app, and providers can even use the app for telehealth appointments, if necessary.

In one case at Children’s, monitoring may have saved a child’s life. Abercrombie says the team detected a change in heart rate and some feeding intolerance, which, combined with the patient’s trends, indicated they needed medical attention. The team called the mom, got the patient in for a visit and prevented a medication overdose. “If we didn’t have [the monitoring], there’s a good chance that could have ended up in a mortality,” Abercrombie said.

The team

The Hearts at Home team includes, in addition to Abercrombie and Brock, cardiologists who see most of the interstage patients, a nutritionist who specializes in cardiovascular disease, a social worker and speech therapists. Nurse practitioners or intensivists are available to answer parents’ questions 24 hours a day, which can be reassuring. “It is just a very small group of people that are caring for these patients day in and day out, along with the family,” Abercrombie said. “And so I think that they feel a lot of comfort and confidence in knowing that there’s someone there to talk with them and help them throughout the day.”

This frequent communication can lead to close relationships between the parents and the care team—so much that when the child eventually “graduates” from the program (after having their second palliation procedure) and no longer has the same level of access to the team, the achievement is often bittersweet.

“It’s a good thing,” Abercrombie explains to the parents. “It means your baby has a much more stable heart. You shouldn’t need us as much. They can do a lot more normal baby things.”

“But [the parents] do have a little bit of sadness about losing kind of that access,” she added.

When a new patient enters the program, the team contacts their pediatrician to share information about the patient’s condition and explain how the program works and what to expect. They also reach to local EMS in the patient’s community to inform them that a congenital heart disease patient lives nearby so they’ll be prepared in case there’s ever an emergency.

Going forward, the program may expand to older patients. Brock hopes to focus future efforts on neurodevelopmental outcomes and “how these kids develop throughout the course of their single ventricle life,” he said. Nationally, the NPC-QIC recently merged with the Fontan Outcomes Network to form Single Ventricle One (SV-ONE) in an effort to follow these patients beyond their palliation procedures into their teens and beyond.

July 23, 2025 by
Cardiology

Flow restrictors offer hope for high-risk newborns

Flow restrictors, like the one pictured, are showing promise for helping patients with hypoplastic left heart syndrome.

Babies born with hypoplastic left heart syndrome, in which the left side of the heart doesn’t fully develop and thus can’t pump blood very well, typically require open-heart surgery soon after birth or a hybrid surgical approach combining stenting and open surgery to establish systemic blood flow and control pulmonary blood flow. Given the already fragile state of the infant, however, neither approach is optimal, and both have high mortality rates.

Doctors at Children’s of Alabama are helping these children by using an internal pulmonary flow restrictor created by modifying a microvascular plug. They form the device by cutting a tiny hole in the Gore-Tex covering of the microvascular plug originally designed to close blood vessels in children and adults. With this use of this device, they are able to postpone surgery for months until the infant is bigger and stronger while still controlling pulmonary blood flow in a completely non-invasive manner.

“The problem we’re addressing is over-circulation of blood to the lungs,” explained pediatric cardiologist Mark Law, M.D. “Traditionally, it requires open-heart surgery to place a band around the pulmonary artery to reduce blood flow. However, this surgery is invasive and can be very stressful for the baby.”

Now, Law and his team are able to treat the infant in the cath lab rather than an operating room. There, they thread the plug through the femoral or internal jugular vein into the pulmonary artery to partially restrict excessive blood flow to the lungs. “It’s a far less invasive procedure and the recovery is faster,” he said. It also allows the surgeons to operate without scar tissue from a previous surgical procedure.

This procedure enables babies who are too fragile for surgery to safely grow stronger before undergoing their first operation. In one study, 10 out of 13 infants treated with this technique survived to their next surgery, typically performed within two to six months of the catheter procedure. When compared to historical data from similar high-risk patients who underwent traditional procedures, the new technique was associated with significantly better six-month survival rates after adjusting for other risk factors.[1]

Importantly, the baby’s pulmonary arteries grow over that time, which is crucial for their long-term outcomes. In addition, the devices can be easily removed during subsequent surgical procedures.

Law and his team have presented a series of five cases in which they used the technique on babies who were too medically fragile for surgery. All survived and all were later able to undergo the needed open surgery. “We’re confident some of these babies wouldn’t have made it otherwise,” he said. “But because they’re older, bigger, stronger, and breathing on their own,” the procedure was much less risky.

Still, challenges remain. The device must be customized for each patient, and its small size limits its use to very young infants.

Nonetheless, pediatric cardiologists across the country are adopting the procedure, Law said. “We’re all learning from each other and sharing data to refine the technique.”

“This technique represents a shift in how we think about treating congenital heart defects,” Law said. “The ability to delay surgery and avoid scar tissue is a game changer.”

[1] Sperotto F, et al. Circ Cardiovasc Interv. 2023;16:e013383. DOI: 10.1161/CIRCINTERVENTIONS.123.013383

January 7, 2025 by
Cardiology

Exercise Testing for Fontan Patients

Cardiologists at Children’s of Alabama are using exercise training to measure Fontan patients’ health.

Children born with single-ventricle heart disease undergo multiple surgeries before age 6, ending with the Fontan procedure, which redirects blood from the inferior and superior vena cava to the pulmonary arteries. This allows blood returning from the body to skip the overworked single ventricle and instead flow directly to the lungs to receive oxygen. While the surgeries have improved survival for these patients, long-term outcomes are still poor. Now, clinicians at Children’s of Alabama are honing in on exercise as an important way to track and improve their quality of life.

“The Fontan operation is one of the most complicated congenital heart procedures we do,” pediatric cardiologist Camden Hebson, M.D., said. “Even with the best outcomes, there’s a shortened lifespan. Many patients start to have major complications by the time they’re in their 20s and 30s, such that it’s pretty unusual for patients to be still living, especially symptom free, in their 50s.”

Camden Hebson, M.D.

The fundamental challenge lies in the procedure’s physiology. In normal hearts, the right side actively pumps blood to the lungs. Because the Fontan operation eliminates this pump, it creates a passive flow system that, while life-sustaining, leads to increased venous pressure throughout the body, particularly in the abdomen and legs.

“The pie in the sky for these patients is getting some sort of pump into them to better push the blood to the lungs,” Hebson said. “There’s all sorts of ideas out there of how to do that, like mechanical implantations and valves. But human beings have our own intrinsic pump that we can maximize: the skeletal muscle pump in our legs, which push venous blood out of the legs back up toward the lungs.”

People who don’t exercise a lot have weak skeletal muscle pumps, he said, which increases the blood pooling and pressure on vital organs, resulting in complications and early mortality. “People who have the strongest legs, the most physically fit legs, the best muscle tone are going to actuate their skeletal muscle pump as much as possible,” he said.

Yet, families and medical teams have traditionally taken a protective approach with these children and limited physical activity, Hebson said. “In some ways, that’s actually a negative, because then these kids are less active than the other kids their age,” he explained. “They exercise less, and then it actually makes the problems of the physiology more likely to occur in their 20s and 30s.”

The link between exercise and better outcomes comes from studies on long-lived Fontan patients called “Super-Fontans.” While the exact reasons for their success aren’t fully understood, physical fitness appears to play a crucial role.

To better understand the effects of exercise on the cardiovascular system of Fontan patients, Hebson and his team use metabolic exercise testing to track heart rate and blood flow during physical activity. This not only helps identify potential treatment targets and provide reassurance about exercise safety, but serves as an early warning sign for complications. For instance, it can reveal issues that aren’t usually apparent at rest, such as the need for stenting the Fontan conduit based on limitations shown in exercise capacity.

“Sometimes, you just need to take the car out on the road and see how it drives,” he said, comparing traditional resting assessments to testing patients during exercise. “For most patients, in particular Fontan patients, your cardiovascular system is what limits your ability to exercise. So how much exercise you can do at any given time is really just feedback on how well the heart works.”

“So we need to encourage our patients to be ahead of the curve on how much exercise they do to keep their legs strong,” Hebson continued. “Not only are they getting the benefits that everybody gets from exercise, they are actually improving the venous return to their heart and their cardiac output as a result.”

“Anything that can be done to improve these patient’s lives and long-term outcomes would be a big deal,” he added.

January 6, 2025 by