December 23, 2014

122414transition640

Texas Children’s Transition Medicine Team hosted a dinner this fall at Texas Children’s Pavilion for Women in conjunction with the Annual Chronic Illness and Disability Conference. More than 100 people interested in transition medicine attended to learn about Texas Children’s program and the progress being made in this new branch of medicine.

Transition medicine describes the planned process of moving pediatric patients into the adult health care system in a way that optimizes their health and ability to function. Texas Children’s is dedicated to helping these patients smoothly transfer to adult care without a decline or break in treatment needed for optimal health.

David Gonzalez, a Texas Children’s patient and student at Saint Thomas University, kicked off the dinner with his inspirational story and spoke to the importance of a solid transition program. He encouraged the audience to support the hospital’s efforts so that future patients will not have the same difficulties he had during his transition period.

The October 2 dinner also offered an opportunity to award the second Benjamin B. Ligums Scholar to Dr. David Hall, medical director for the Harris Health System’s El Franco Lee Health Center. The scholar program allows a provider in the community to receive training on the adult special needs population as well as project management assistance in setting up a referral process between them and their surrounding pediatric providers. Hall will build upon the successes of Dr. Elizabeth Bosquez, the first Benjamin B. Ligums Scholar.

This night also celebrated and acknowledged two remarkable families who have dedicated themselves to the transition medicine cause with their generous philanthropic support. The Ligums family was acknowledged for their support in creating the Benjamin B. Ligums Scholar Program, and the Robbins family was acknowledged for their commitment to support the Annual Chronic Illness and Disability Conference each year.

The transition medicine team has been working together for more than two years and has made great progress. They have focused on:

Readiness – preparing patients to self manage their disease and succeed in the adult world.
Handoff – ensuring that patients are not lost to follow-up during the move from the pediatric to the adult health care system.
Transfer – guaranteeing an adult provider for our patients to transition to at the appropriate age.

For a more comprehensive look inside the transition medicine plan, visit www.texaschildrens.org/transitionmedicine. For questions or additional information, please contact Caitlyn Barrow at crbarrow@texaschildrens.org or 713-798-3323, or Kris Barton at krbarton@texaschildrens.org or Ext. 4-1265.

December 18, 2014

Dr. M. Elizabeth Tessier, a pediatric gastroenterology fellow at Texas Children’s, received the 2014 Fellow Research Award from the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN).

Her award-winning study titled, “Bile acid signatures in children confer protection from clostridium difficile infection,” found that changes in the bile acid composition in the stool may predispose patients to Clostridium difficile (C.diff), a bacterial infection that causes intestinal inflammation and diarrhea.

In general, children are less susceptible to C.diff infection than adults and tend to have milder disease. However, Tessier says pediatric cases are on the rise, which may be attributed to a newer more toxigenic strain of C. diff called NAP1.

Antibiotics disrupt the bacterial communities in the colon which can alter bile acid compositions, creating favorable conditions for C.diff spores to germinate. Certain types of bile acids can activate or inhibit the growth of this bacterium.

In their study, Tessier and her colleagues in Tor Savidge’s lab in the Texas Children’s Microbiome Center, collected stool samples to examine the bile acid profiles of healthy children between the ages of 7 and 12, healthy adults, patients with antibiotic-induced diarrhea and C.diff patients.

The healthy control group had higher levels of chenodeoxycholic acid (CDCA) – which inhibits C.diff growth – compared to the other two groups. They found healthy children had more CDCA than healthy adults, which may contribute to children’s decreased susceptibility to C.diff infection.

In contrast, patients with antibiotic-induced diarrhea, who may be prone to C.diff infection, had elevated levels of the spore-germinating bile acid called taurocholate. While C. diff patients had lower levels of both bile acid types, they had high serum levels of fibroblast growth factor 19 (FGF-19), a hormone that regulates bile acid synthesis in the liver.

“Based on our findings, C.difficile toxins may alter bile acid profiles in the gut by inducing FGF-19 production,” said Tessier. “Further studies need to be done to determine if this hormone is a true marker of C.diff infection.”

Tessier’s study also examined the bile acid profiles of four patients who received liver transplants. High levels of taurocholate were found in their stool, which increased their risk of C.diff infection.

December 17, 2014
The Texas Children’s Hospital Division of Neurosurgery was well represented at the recent American Association of Neurological Surgeons annual meeting in Amelia Island, Fla. The division had eight posters accepted for presentation. Of those eight, three were selected as “Top Posters.” In addition, Neurosurgery had four abstracts accepted for oral presentation.
Top Poster Presentations
  • Comparison of Patient Populations and Utilization for Hypothalamic Hamartoma Treatment
    Dr. Sandi Lam, Dr. Daniel Curry, Dr. Thomas Luerssen, Iwen Elaine Pan, PhD
  • Use of a Formal Assessment Instrument of Evaluation of Resident Operative Skills in Pediatric Neurosurgery
    Caroline Hadley, Dr. Sandi Lam, Valentina Briceno Marmol, RN, Dr. Thomas Luerssen, Dr. Andrew Jea
  • Endonasal Endoscopic Resection of Pediatric Craniopharyngiomas
    Dr. Sohum Desai, Dr. William Whitehead
Poster Presentations
  • Endoscopic Third Ventriculostomy and Ventriculoperitoneal Shunting: A Comparative Effectiveness Study with MarketScan Administrative Data
    Dr. Sandi Lam, Dr. Dominic Harris, Dr. Thomas Luerssen, Iwen Elaine Pan, PhD
  • Cerebrospinal Fluid Shunt Placement in Children: A Model of Hospitalization Cost
    Dr. Sandi Lam, Dr. Visish Srinivasan, Dr. Thomas Luerssen, Iwen Elaine Pan, PhD
  • Using Pediatrics National Surgical Quality Improvement Program (NSQIP) Data to Examine 30-Day Outcomes of Craniosynostosis Surgery
    Dr. Jared Fridley, Dr. Sandi Lam, Dr. Thomas Luerssen, Iwen Elaine Pan, PhD
  • Using Pediatrics National Surgical Quality Improvement Program (NSQIP) Data to Examine 30-day Outcomes of Posterior Fossa Tumor Surgery
    Dr. Sandi Lam, Dr. Jared Fridley, Dr. Andrew Jea, Dr. Thomas Luerssen, Iwen Elaine Pan, PhD
  • The Safety and Efficacy of Use of Low Molecular Weight Heparin in Pediatric Neurosurgical Patients
    Dr. David Gonda, Dr. Jared Fridley, Sheila Ryan, JD, MPH, CCRP, Valentina Briceno Marmol, RN, Dr. Sandi Lam, Dr. Thomas Luerssen, Dr. Andrew Jea
Oral Presentations
  • Outcomes of Pediatric Autologous Cranioplasty after Decompressive Craniectomy: A Multicenter Study
    Dr. Sandi Lam, Pediatric Outcomes Workgroup
  • Streamlining Fetal Repair of Myelomeningoceles
    Dr. Jared Fridley, Dr.William Whitehead
  • The Efficacy of Routine Use of Recombinant Human Bone Morphogenetic Protein-2 in Occipitocervical and Atlantoaxial Fusions of the Pediatric Spine
    Dr. Christina Sayama, Caroline Hadley, Valentina Briceno Marmol, RN, Dr. Huy Dinh, Sheila Ryan, JD, MPH, CCRP, Dr. Daniel Fulkerson, Dr. Thomas Luerssen, Dr. Andrew Jea
  • Acute Implantatationo Reduced Graphene Oxide Scaffolds in Spinal Cord Injury in Rats
    Dr. Jared Fridley, Dr. Thomas Luerssen, Dr. Andrew Jea
December 16, 2014

121714census640

Six hundred and fifty inpatient beds make up the Texas Children’s Hospital system. On any given day, hundreds of patients come through the hospital doors at Main Campus and West Campus. Whether they walk through our doors on their own, or are transferred from another hospital, these patients require the care of Texas Children’s Hospital specialists.

“Census is patient activity and patient volume across the system,” said Texas Children’s Hospital West Campus President Michelle Riley-Brown. “A high census is an indication that our patient volume is exceeding our capacity to care for patients.”

Reaching that capacity means there are no rooms left to admit new patients. In November, 101 patients had to be turned away. The patients were denied a transfer from another institution because Texas Children’s Hospital was above census.

“We have to always remember that when people come to us, they are bringing their children who are ill for care,” said Surgeon-in-Chief Dr. Charles D. Fraser, Jr. “We have to put ourselves in their position, and respond.”

During the past several months, Texas Children’s Hospital has experienced numerous high census days and on many occasions, the patient volume has exceeded the number of available beds.

“Teams across both campuses are on daily conference calls managing patient flow, management, and so on. Making sure patients get to the right place at the right time,” Riley-Brown said. “It’s managing patients, it’s patient flow, it’s room facilitation, room management and bed control.”

While cold and flu season brings its own challenges to the hospital census, a high census has begun to be the norm for Texas Children’s Hospital. While a high census stresses the system, it’s an opportunity for the staff to show support for one another.

“It is especially important now to work as a team and to make sure we are helping each other,” Riley-Brown said. “It’s always important that everyone is taking care of themselves and of each other to make sure we can do our best to take care of the patients.”

“This is the norm for us now as an organization and we should embrace it and be extremely proud of it,” Fraser said. “It’s unbelievable what we get to do. It’s an unbelievable opportunity, it’s an unbelievable responsibility. These folks have entrusted their children to us. We should feel blessed because of that.”

In response to the increasing number of children seeking our care, the organization has already begun plans to expand capacity at Main Campus through CareFirst and the building of a new hospital in The Woodlands to provide care for many patients in their own community. For more on those initiatives, read here.

121714DOTVinside640

What do Community Coffee, Microsoft and Stryker have in common? All three strategic business partners – and several others – helped us save about $25 million in operational costs.

Delivering on the Vision (DOTV) Non-Labor Initiative was more than just a cost-savings expedition. It prompted us to think like a system and ask ourselves, “What can we do differently to maximize efficiency across the organization?”

In July 2012, Texas Children’s launched DOTV and partnered with Huron Healthcare consultants to identify cost savings opportunities across the organization. They examined several non-labor areas including billing and collection processes, vendor contracting, physician services and clinical care coordination. Fifty-eight initiatives were identified, which yielded $18 million in potential savings and revenue opportunities.

During the second phase – which began in September 2013 – Texas Children’s implemented Huron’s cost-saving strategies systemwide. But, our efforts didn’t stop there. Three non-labor solution teams – administrative support, clinical coordination, and hospital-based services – were tasked with identifying more opportunities to grow our hospital’s savings strategically year-over-year.

“We engaged our employees at every level of the organization to pitch their cost-savings ideas,” said Texas Children’s Revenue Cycle Director Carrie Rys, who was the co-leader of the Administrative Support Solutions Team. “Our three teams generated $5 million in potential savings.”

The DOTV Initiative uncovered 91 cost-savings ideas amounting to potentially $25 million.

“We negotiated and leveraged our vendor relationships to maximize the full value of every contract,” said Texas Children’s Vice President Diane Scardino, who co-led the DOTV Non-Labor Solutions Team. “When we asked the right questions, we discovered bigger savings and revenue opportunities.”

“One of our pathology frontline managers picked up on a workflow that had left out the billing on a pathology test that had existed for years,” said Texas Children’s Pathology Director Ann O’Connell. “After updating the workflow, more than $1 million in annual gross patient revenue is now generated.”

Other impressive ways we Delivered on the Vision include:

  • Microsoft License Optimization: We assigned shared clinical workstations a device license instead of a per user license (as we have more clinical users – physicians, nurses, clinicians – than devices), which saved the hospital $857,000. Also, we were able to negotiate lower costs for our annual support benefits equal to $100,000 in savings.
  • 340B Drug Purchasing: When we purchased medications at the 340B discounted price for our Medicaid patients, we saved $10.3 million for Texas Children’s Main and West Campus in FY14.
  • Surgery: We restructured our Stryker contract so that anytime a new product/service line was added, all previous lines received a savings percentage to ensure we were duly compensated each time their business increased. Additionally, implants around spine surgeries were negotiated with three vendors to meet the physician preference needs of spine surgeons across two service lines – Orthopedics and Neuroscience. We used a benchmark tool and leveraged the support of our surgeons to negotiate more than $1 million in annualized savings.
  • X-ray services: When we purchased five digital X-ray machines in bulk this year, we saved more than $200,000. We leveraged the buying power of a system by aggregating our purchases to drive price concessions from two vendor partners.
  • Community Coffee: Being alert of contract errors helped us trim our expenses. When an administrative employee asked why it was more expensive to buy Sweet N’ Low at the contracted price versus buying it in bulk at the store, our Supply Chain team found Community Coffee had not adjusted its rates appropriately, which resulted in a $58,000 rebate check.
  • Pest Control: We saved $6,727 by streamlining the hospital’s pest control services to one vendor at a reduced cost, which made the process of ordering and tracking supplies easier and more efficient.

“We have a lot of negotiation power that we don’t always use,” said Chanda Cashen Chacón, vice president of Women’s Services at Texas Children’s Pavilion for Women. “When we think like a system, we achieve better and bigger results.”

121714transplant30th640

Texas Children’s Hospital recently celebrated the 30th anniversary of its heart transplant program. Since its inception in 1984, Texas Children’s Heart Center has performed more than 300 heart transplants, making the program one of the most active and largest in the nation.

A team of experts – including heart transplant surgeons, pediatric cardiologists, transplant coordinators and dietitians, child life specialists, social workers, pharmacists, physical and occupational therapists, infectious diseases experts, immunology physicians and dedicated nurses – focuses on each aspect of the patient’s care. The team’s experience, compassion and access to state-of-the-art facilities helps children in need of heart transplants survive and thrive.

“The true results of our team’s exceptional work over the past 30 years can be seen in the hundreds of success stories of our patient families,” said Texas Children’s Heart Failure, Cardiomyopathy and Cardiac Transplantation Medical Director Dr. Jeff Dreyer. “As one of the largest programs in the nation, our experience in treating patients with heart failure is leading the way in positive outcomes.”

The multidisciplinary team at Texas Children’s has transplanted hearts in newborns to young adults from across the United States. Due to the transplant team’s unique expertise, Texas Children’s Heart Transplant Program sees some of the rarest and most complex cases, resulting in the best possible outcome for each child.

“Texas Children’s has been a pioneer in all aspects of pediatric cardiovascular surgery, and our heart transplant program is a shining example of this,” said Heart and Lung Transplant Program Surgical Director Dr. Jeffrey Heinle. “Over the past 30 years, Texas Children’s has consistently led innovations in this field, bringing hope to children and adolescents from all over in need of a heart transplant.”

Texas Children’s Heart Center is on the cutting-edge of ventricular assist device (VAD) placement, which provides circulatory support until a transplant can be received. The center offers the best VAD tailored to each child’s size, diagnosis and needs for both short- and long-term assistance.

Texas Children’s Heart Center is ranked No. 2 nationally in cardiology and heart surgery by U.S. News & World Report.

To learn more about Texas Children’s Heart Transplant Program, click here.

121714Presurgery640

No parent ever wants to hear their child will need to have surgery – whether it’s a routine procedure that only takes minutes or it’s something more serious. That’s why the Department of Surgery goes out of its way to make the surgical experience at Texas Children’s a good one for patients as well as their families.

The department’s most recent effort to ensure a positive surgical experience is had by all is a video for parents that talks about what to expect when their child has surgery at Texas Children’s. The video, available in English and Spanish, covers eating and drinking instructions, what to bring to the hospital and what parents will experience while their child is in surgery.

After doing more than 25,000 surgical procedures each year, we know parents need to be prepped for surgery just as much as their children do. We hope this video helps parents who are going through that process.

“Our goal in the Department of Surgery is to have our patients and their families prepared as well as possible for the surgical experience,” Chief of Plastic Surgery Dr. Larry Hollier said. “Setting appropriate expectations is crucial to patient satisfaction. This surgical video covers all important issues pertinent to the patient’s arrival, registration, surgery, and discharge.”

Other efforts the Department of Surgery has made to enhance the surgical experience for patients and families at Texas Children’s include:

  • Pre-surgery paperwork have been streamlined to lessen parent’s preparation load before they bring their child in for surgery.
  • A greeter program has been implemented to help patients and their families more easily find our surgical admission areas. Greeters wearing blue vests are positioned at various entrances of the West Tower, the Abercrombie Building and the Clinical Care Center to help guide surgical patients to such locations.
  • Colorful, kid-friendly animal signage has been posted inside and outside the elevators, lobby, hallways and connecting bridges at the Clinical Care Center and the West Tower to improve navigation to the surgical suites at those locations.

All of these efforts have been based on feedback from parents, something the Department of Surgery is always eager to hear. While taking care of our patients is our top priority, we like to take care of their parents too.