The 2020 U.S. News & World Report survey of Best Children’s Hospitals was released this morning and Texas Children’s is again one of the best in the nation. I am excited to share with you that Texas Children’s ranked fourth place among all children’s hospitals nationally.
Seven of Texas Children’s specialties are ranked in the top 5 this year, and 9 are in the top 10. Cardiology and Congenital Heart Surgery ranked No. 1 in the nation for the fourth straight year in a row, and Neurology and Neurosurgery moved up from No. 3 to No. 2, which is an amazing feat.
The scores this year were exceptionally tight among the top children’s hospitals, and here are a few highlights of this year’s biggest wins across the system:
We received maximum scores for all system-wide structure and process metrics.
We achieved maximum points for our collaborative efforts on infection prevention.
We exceeded our T-dap and flu immunization compliance threshold, which was increased to 95 percent.
We exceeded the new threshold for number of infection preventionists per 100 beds.
Dr. Jim Versalovic and Dr. Larry Hollier have demonstrated exceptional leadership over their departments, and all of our chiefs of service have worked tirelessly to ensure their respective specialties excelled in this year’s rankings — Dr. Paul Austin, Dr. Susan Blaney, Dr. Michael Braun, Dr. Christopher Caldarone, Dr. Gary Clark, Dr. Peter Hiatt, Dr. Daniel Penny, Dr. Benjamin Shneider, Dr. Brian Smith, Dr. Rona Sonabend, Dr. Gautham Suresh and Dr. Howard Weiner. Please join me in thanking our medical leaders for their hard work and dedication.
Our entire list of 2020 U.S. News rankings include:
#1 Cardiology and Congenital Heart Surgery #2 Neurology and Neurosurgery #2 Nephrology #3 Pulmonology #4 Cancer #4 Gastroenterology and GI surgery #5 Diabetes and Endocrinology #6 Urology #10 Neonatology #15 Orthopedics
The rankings methodology weighs advanced technology, best practices, credentialing, infection prevention, nursing care, outcomes and reputation. The more consistently we deliver high quality care and the safer we deliver that care to our patients, the better their outcomes are, and the better our overall numbers are.
The results also reflect the efforts of our team and their steadfast focus on the U.S. News survey. Compiling and refining our data is a continuous process and, with the support of our medical staff, in-chiefs, service chiefs, as well as Mark Mullarkey, Trudy Leidich, Elizabeth Pham and the entire Quality team, we have again excelled this year.
I hope you are all as proud as I am of this remarkable accomplishment. These results, combined with the resiliency you have all shown over these past few months, exemplify why Texas Children’s is the best pediatric hospital in Texas. Thank you for your commitment and leadership. It takes all of you to be ranked one of the nation’s best.
This year’s rankings will be available online at usnews.com/childrenshospitals. You can learn more about Texas Children’s rankings here.
June 15, 2020
The following is based on information from a story published in TMC and a series of interviews conducted with Dr. Daniel Penny, chief of pediatric cardiology, Dr. Eyal Muscal, chief of rheumatology, and Dr. Lara Shekerdemian, chief of critical care.
In recent weeks, health experts in the United States and abroad began to notice a troubling rise in multisystem inflammatory syndrome in children (MIS-C), a condition in which various organs — such as the heart, lungs, kidneys, brain, skin, eyes, esophagus, stomach and intestines — become inflamed. Earlier this month, the Centers for Disease Control and Prevention (CDC) issued a health advisory to warn doctors about the illness, cautioning them to be on the lookout for a constellation of symptoms, including fever, abdominal pain, vomiting, diarrhea, neck pain, rash, bloodshot eyes and lethargy.
Although the exact cause of MIS-C is still unknown, experts are assessing the association between MIS-C and COVID-19, as many children diagnosed with the syndrome have been infected by or previously exposed to SARS-CoV-2, the virus that causes COVID-19.
This lag between the primary infection and the inflammatory response is what is interesting,” Penny said. “What it appears to indicate is that this is not a manifestation of the primary infection with SARS-CoV-2 itself, but rather the body’s inflammatory response to the infection.”
Texas Children’s is treating children and young adults with the syndrome and Penny is leading a cardiology clinic dedicated to those who have previously had SARS-CoV-2 infection in order to make sure that the handful of patients the hospital has already treated is not just the tip of the iceberg.
“Even if they weren’t extremely unwell in the first place,” he added, “we are bringing back these children for cardiology assessment with a cardiography in order to make sure they don’t have abnormalities of the coronary arteries that haven’t manifested clinically at this stage but could be problematic in the longer term.”
Not all children with MIS-C exhibit the same symptoms, the CDC noted, but doctors and parents should be vigilant of emergency warning signs, such as trouble breathing, persistent pain or pressure in the chest, new confusion, inability to wake or stay awake, bluish lips or face and severe abdominal pain.
Symptoms associated with MIS-C were first reported by clinicians in the United Kingdom in late April and have since been identified in other European countries and the United States, starting in New York, the American epicenter of the coronavirus outbreak. At least 17 other states have reported cases of MIS-C, including Texas, California and Washington.
Doctors believe that MIS-C is caused by an overactive immune system in response to COVID-19, leading to abnormal inflammation throughout the body. Most children recover from MIS-C after being treated with immunoglobulins to reset the immune system, steroids and immunosuppressive drugs, such as anakinra and tocilizumab; however, in rare cases, the illness can lead to death.
Understandably, this is very worrying to parents and Texas Children’s has received many questions and concerns about MIS-C. The following are some of those questions and our answers. We are sharing them with our employees because many of you are parents yourselves and might have some of the same concerns.
What are the early signs and symptoms of MIS-C and is there anything parents should be looking out for during the early stages of this condition?
Dr. Muscal: Based on experiences in Europe and the East Coast, so the places in the world that have had a head start on us here in terms of the multi-system inflammatory type of syndrome, it appears as if kids often have unrelenting fever that doesn’t really respond to traditional anti-inflammatory measures. And then, usually, a variety of other problems such as abdominal pain, vomiting, inability to keep fluids down, and then usually a variety of issues like rash, sometimes red eyes, and a general appearance of ill appearance. It appears that those are some of their early symptoms. As a child’s become more ill, perhaps he or she will have chest pain or have more difficulty with their breathing.
How common is MIS-C in children, how long does it last and how serious can it actually get?
Dr. Muscal: It appears that MIS-C is pretty uncommon, actually rare, according to some of the other cities that have had cases for a longer period. Some of the experts in New York city believe that less than 1% of the children that actually are exposed to the coronavirus and get COVID-19 seem to develop this more serious post-infectious process. It can last for days or even a couple of weeks as kids recover from it. It appears to be in many cities with more cases, that most of the cases are treated quickly and are not that serious. Though there are kids that end up in the intensive care unit and unfortunately, exceptionally rare, kids that pass away.
What ages are most typically affected, and how old are the oldest children who do get MIS-C?
Dr. Muscal: So again, with the last six weeks of knowing more about this condition, it appears that even if children have some of the features of another entity called Kawasaki disease, they appear to be a little bit older. So perhaps even teenagers that are getting this, whereas Kawasaki disease is usually a disease of early childhood. It does appear that perhaps young adults can also have features of this syndrome. Unfortunately, many adult physicians have never seen Kawasaki disease and it could be that they’re not aware of some of these signs and symptoms.
Does it seem to be that children with underlying illnesses are more prone to get MIS-C?
Dr. Penny: We don’t believe that this condition is more common in children with preexisting conditions. So what it seems to be is that a child gets the coronavirus infection, and then they get this overactive immune response to the infection. And that’s what results in this syndrome. And so this does not appear to be more common in children who have underlying diseases, such as congenital heart disease.
If a child has congenital heart disease, let’s say a relatively simple defect like an ASD or even something more complex, are they going to be at higher risk of getting MIS-C?
Dr. Penny: We haven’t seen any patients with congenital heart disease who’ve developed MIS-C in our hospital, and I think it’s quite rare throughout the world. I don’t see any reason to believe why children with congenital heart disease will be at more risk of developing the syndrome in the first place. And also, if you have well compensated heart disease, I also don’t believe there should be any particular risk to a patient if they did happen to get the condition in the setting of congenital heart disease.
What is the difference between MIS-C and Kawasaki disease? And does this new syndrome seem to only affect kids who have COVID-19?
Dr. Penny: So MIS-C refers to this syndrome that we see in children, particularly related to coronavirus infection. And that’s according to the recent CDC definition, and this is really specific to coronavirus infection. But we do see similar conditions in other situations. What we see in patients with Kawasaki disease is that, that they get dilated coronary arteries. These abnormal coronary arteries are also seen in some patients with MIS-C. Typically, though, it doesn’t seem to be as common in MIS-C as in Kawasaki disease. One of the other differences between MIS-C and Kawasaki disease is Kawasaki disease tends to be clustered in much younger children. Whereas MIS-C, as we said earlier, can affect older children and even adults.
How many cases of the syndrome do you think we’ve had in Houston so far? And do you expect these cases to rise as they have in other cities on the East Coast?
Dr. Shekerdemian: We have seen a handful of patients with MIS-C at Texas Children’s. We don’t have an exact number because we obviously investigate many more than we end up diagnosing according to the strict criteria. It would certainly be less than 10. And the question about expecting them to rise, it’s a difficult one to answer. I think what we’re seeing in terms of the density of MIS-C around the world, not just in the US, very much mirrors the density of primary COVID-19 infection in those cities. So luckily Houston was not hit anything like as badly or hard in terms of severe COVID-19 infection. I think that would really speak to the fact that, while we’re seeing patients present with MIS-C, it seems to be a steady number. We’re not seeing a huge explosion and, touch wood, we hope that’s going to continue.
Do you think patients who have MIS-C, in general, are they still contagious with coronavirus?
Dr. Shekerdemian: That’s a really important question. We believe that the majority of them will not be contagious at the time that they develop the MIS-C. The typical presentation is around the four week mark, after a primary COVID-19 infection. And the vast majority of children at that stage, or anybody contracting COVID-19, would likely be non-contagious. Of course, we do test them with nasal swabs, as well as the typical antibody tests that are required to confirm the diagnosis. So I think it’s reassuring to a point that most children are not contagious, but we do screen them just in case they’ve still got signs of any active COVID-19 disease.
Is it safe to send children back to daycare or school once they reopen?
Dr. Shekerdemian: To be perfectly honest, there isn’t a simple answer to that. As COVID-19 stays in the community, we have to be hyper vigilant. What I would want to know before sending a child or a loved one to a school or daycare or summer camp is, what sort of screening; the numbers of children or adolescents in a specific space; the respect for social distancing, for hygiene, for hand-washing, etc. and how they’re going to screen any care takers or any workers in those environments, I would hope, on a daily basis; and feedback constantly to parents and to caregivers to reassure them and provide constant updates.
The world looks very different than it did just months ago. The outbreak of the COVID-19 pandemic has added a layer of uncertainty and stress to Texas Children’s providers, patients and the community. In response to this crisis, the Texas Children’s Psychology Service has expanded access to its programs and services to ensure our patients and providers receive the mental health support that they need.
On March 23, Psychology launched video visits and completed over 120 e-Health visits in the first week alone. One week later the volumes had doubled and have been climbing ever since. By the end of April the service was 17 percent above budgeted appointments for the month. Since launching e-Health visits in March, Psychology received 127 COVID-specific referrals and completed over 2,942 video visits which included both COVID and non-COVID related appointments thanks to the service’s e-Health capabilities.
“We owe the successful transition to e-Health in Psychology to our clinic staff and providers,” said Manny Hill, practice administrator for Psychology. “Their adaptability and steadfast commitment to our patients allowed us to completely change our care model in such a short amount of time.”
Supporting our patients
Beginning in March, Psychology added COVID-Related Psychological Distress e-Health appointments for patients seen at any location throughout the Texas Children’s system. This includes children and adolescents experiencing difficulties with anxiety, stress, or mood, as well as preschoolers with behavioral difficulties.
“We know that uncertainty, disrupted routines, social isolation, and parental stress impact children of all ages,” said Dr. Karin Price, chief of Psychology at Texas Children’s. “Our goal is to ensure that any child experiencing distress related to COVID-19 has access to a mental health professional who can support coping and resilience during this unprecedented time.”
Any providers who encounter pediatric patients with these concerns should place an Epic order for Referral to Psychology. Any patients referred for “COVID Related Distress” will be contacted for scheduling within 48 hours of referral.
Supporting our patient care providers
The Psychology Section has also partnered with the Practitioner Health and Well-Being Committee to launch the PARALLEL Program for Peer Support. This program is focused on providing emotional respite and support for frontline health care workers at Texas Children’s. The PARALLEL Program offers an opportunity to be coached in managing work-related stress brought on by the COVID-19 crisis. Dr. Gia Washington leads the program as Texas Children’s chief well-being officer.
“It has been a blessing to participate and support co-workers through the PARALLEL program,” said Carolina Coronel, a provider supporting the PARALLEL program. “A few minutes listening to someone can make a big difference in their lives; we all cope differently, but we all are meant to be social beings. This program has brought what many of us have been seeking: being heard.”
If you are a Texas Children’s Hospital Medical Staff provider and would like to access this support, please contact the Well-Being phone line at 832-822-9355 between the hours of 8 a.m. and 5 p.m., Monday thru Friday and request to speak with a PARALLEL Provider. You can contact the Well-Being phone line for support as often as you need to during management of the COVID-19 crisis.
“While the COVID-19 health pandemic can be overwhelming at times, our response to the stress will make us stronger as One Amazing Team,” added Price.
As we navigate the COVID-19 pandemic, more employees are working remotely these days, which has significantly increased the demand for telephone conversations between Texas Children’s and patient families. While video visits are the best option for telemedicine appointments, sometimes our providers and ancillary services need to reach out to families with a simple and quick phone call, like updating them on a medication or test result, without the need to schedule a video appointment or meeting where both parties have to log in at the same time.
Since our providers and ancillary team members are minimizing the amount of time they spend in the clinic with patient families and are conducting more telephone visits remotely, they primarily rely on their personal cell phones to reach out to families instead of using their Texas Children’s desktop phone.
“When our ancillary or clinical teams call families while working remotely, they are unable to mask their personal cell phone numbers and instead have to call from a blocked number reducing the likelihood that a family will answer their phone,” said Director of Entrepreneurship and Innovation Melanie Lowther. “Since 35 percent of our social workers and care coordinators have long distance numbers, they can’t forward their Texas Children’s desktop phone to their personal phone, which puts an extra wrinkle in that communication loop.”
To effectively address these challenges and make it easier to connect remotely with patient families, Texas Children’s Information Services recently expanded the organization’s work-from-home solutions. There are four solutions available, addressing different needs and work configurations, including a mobile function that turns a person’s mobile device into an extension of their desktop phone.
“While we already had a strong foundation in place, we had to modify the organization’s existing phone system to support the mobile application,” said Trey Jones, director of Digital Services for Information Services. “Before enabling this new technology, we validated the product stream to ensure we had enough incoming connectivity pieces to support the number of users that may want to access it.”
This new functionality within Texas Children’s existing phone system was truly a collaboration on many fronts that helped get this product up and running. Even before COVID-19, the organization had been reassessing its work-from-home solutions to better meet the needs of our employees and staff.
“We have a resourceful workforce, and this new mobile app will be beneficial for providers and especially for our ancillary groups who are in close contact with families several times a day,” Lowther said. “These tools are available to anyone who needs to make phone calls that look like they’re calling from their desk number, and receive phone calls through their desk number. These are universal solutions for everyone.”
Every 10 years, the U.S. Constitution requires that all residents of the United State are counted. The 2020 Census will have a lasting impact on our country and the state of Texas. The count will determine how many members of congress can represent the interests of Texans in Washington and how hundreds of billions of federal dollars will be distributed amongst the states. Over the next decade, the Census count will help lawmakers at all levels of government, business executives, school officials, and leaders of various organizations make critical decisions specific to the needs of their communities. Therefore the Census count will have broad impacts for years to come on issues that touch our everyday life like where new schools are needed, road and infrastructure investments, and how Medicaid, CHIP and other health program funding will be allocated. An undercount would dramatically deprive various populations, community organizations, businesses, and institutions like ours of vital public and private resources.
It is extremely important that every member of our One Amazing Team engage in their civic duty and respond to the 2020 Census questionnaire as soon as possible. We should all encourage our family and friends to do the same.
As Mayor Turner recently shared, “Houston could lose about $1,578 for each person who is not counted. And if we undercount 10% of the city’s population, we could lose $3.78 billion over the course of a decade.”
In mid-March, most households received an invitation in the mail to respond to the 2020 Census, followed by multiple reminders and a paper questionnaire. Census takers are scheduled to visit households that have not yet responded to the 2020 Census beginning in August.
In-Person interview: United States Census Bureau enumerators will visit residences that choose not to self-respond.
August 11 – October 31, 2020: Census takers will interview homes that haven’t responded to the 2020 Census to help make sure everyone is counted.
Need assistance?
Lines are open. CST seven days per week.
English (1-844-330-2020) and Spanish (1-844-468-2020).
For the past several years, Texas Children’s Hospital and the Houston Texans have challenged kids of all ages and abilities to be active at least 60 minutes every day through PLAY 60, the NFL initiative encouraging kids to start healthy habits young – an initiative that Texas Children’s serves as the local sponsor of. That mission has not changed – and has become even more important – amid the COVID-19 pandemic.
To help motivate kids to get moving, Texas Children’s and the Texans are hosting a Get Fit with TORO Week this week (June 15-19) and Junior Cheerleaders Online Dance Parties (every Friday for the next few weeks). Details about each event are below. Have fun and keep moving!
Get Fit with TORO Week
Get Fit with TORO is the elementary school program that Texas Children’s sponsors each academic year. With school suspended to COVID-19 and now out due to summer, TORO wanted to bring the curriculum to kids at home.
June 15-19
Every day this week at 5 p.m.
Daily filmed Zoom calls with TORO and “Coach Ryan” – each day focused on a new key to fitness, with a recap and special guest on Friday.
The videos will be live streamed each night on HoustonTexans.com/TORO, TORO’s Facebook and on TORO’s Twitter. The videos will be available afterwards on TORO’s Instagram and YouTube.
Event schedule
Monday: Flexibility
Tuesday: Muscular Strength
Wednesday: Cardio
Thursday: Nutrition
Friday: Recap with special guest
Junior Cheerleaders Online Dance Party
Calling all dancers … the Houston Texans Cheerleaders invite you to join the Junior Cheerleaders Dance Party, presented by Texas Children’s! Practice along with them, record your routine and share with us using #TCHPlay60 #TCHJuniorCheer.
Texas Children’s Hospital is the Official Children’s Hospital of the Houston Texans. To learn more about our partnership, visit: texaschildrens.org/texans.
Did I?
The following passage was written by Texas Children’s Chaplain Jessica Shannon.
Each time I leave a patient’s room, I reflect on the visit while walking to the next room, and the reflection continues while later charting. Each of us wants to do our best and give all that we can to our patients, and there is always room to grow.
There is a long list of questions I ask myself when analyzing an encounter with a patient and their family. Some of those questions are: What did the family process, and what was my response? Did I listen and explore the things weighing heaviest on them? Which spiritual interventions were the most beneficial to them, and which spiritual interventions did not work well? The list of questions goes on, and there is no doubt in my mind that each of you have similar self-check ins depending on your role.
Theologian and author Henri Nouwen gives us a list of questions to ask ourselves at the end of each patient visit, interaction with colleagues, friends, and family, or at the end of the day. Take a moment, and ask yourselves:
Did I offer peace today?
Did I bring a smile to someone’s face?
Did I say words of healing?
Did I let go of my anger and resentment?
Did I forgive?
Did I love?
These are the real questions.
I wonder how your words and actions would change if these questions remained on your hearts. We may live more joyfully and share words of peace if these questions are a part of our daily routine. We may change someone else’s day by offering a calming and hopeful presence.
There is a domino effect in moments like this. Imagine a time when negative words or attitudes seemed to ruin the day. The atmosphere in the unit is heavy, and everyone is grumpy. As you go home, you’re more exhausted than you normally are. In fact, you’re drained. Now imagine you walk onto a unit, feel the negativity, yet you communicate in love, peace, and joy. What a gift you would give to others as well as yourself! Let the smiles be healing, and let peace spread.
My friends, take time to reflect on what words and attitudes you allow to shine. How will you offer peace, or make someone smile? How will you release anger and forgive? How will you love today?
