November 26, 2019

A year’s worth of planning and preparation came to fruition last month as Texas Children’s Hospital hosted the 24th Annual Society of Pediatric Liver Transplantation (SPLIT) Conference, bringing together experts from more than 40 national and international liver transplant centers.

The two-day event, designed for health care professionals involved in the care of pediatric liver transplant patients, featured speaker presentations, panel discussions, and case and poster presentations. Major discussion session topics included:

  • Unique Transplant Considerations
  • A Village Approach to Liver Intensive Care
  • Surgical and Interventional Considerations
  • The Many Faces of Rejection
  • Advocacy

Texas Children’s multidisciplinary approach to liver transplant care was on display throughout. Of the 36 presenters who spoke, 15 were from Texas Children’s and academic affiliate Baylor College of Medicine. This year’s SPLIT meeting also boasted the best attendance ever, with 236 attendees, which included physicians, surgeons, advanced practice providers, trainees, data and transplant coordinators, dietitians and social workers.

The event was spearheaded by Dr. Daniel Leung, Texas Children’s Director of Pediatric Hepatology and Liver Transplant Medicine, and the event’s Continuing Medical Education (CME) Activity Director; and Melissa Nugent, education coordinator for Transplant Services, who was the event organizer and the meeting’s Nurse Planner for Continuing Nursing Education. Thanks in large part to the planning committee, the conference was such a success that it won Texas Children’s award for Best CME Course.

The planning committed included:

  • Dr. John Goss, Medical Director of Transplant Services
  • Diesa Samp, Director of Transplant Services
  • Julie Economides, RN, SPLIT data coordinator at Texas Children’s

“It was an honor to be selected to host this year’s SPLIT Conference,” said Leung. “We not only showcased the breadth of our subspecialty expertise – including ICU, infectious diseases, immunology, interventional radiology, transfusion medicine, nephrology and others – all dedicated to pre- and post-lever transplant care at Texas Children’s, but we also continue to lead the country by example in how we collaborate and learn from one another. I am truly grateful for our special team of surgeons, hepatologists, coordinators, nurses, pharmacists, dietitians and social workers. It really does take a village.”

About SPLIT
The Society of Pediatric Liver Transplantation is a unique multidisciplinary, multicenter consortium focused on optimizing outcomes pediatric liver transplantation through research, advocacy, and dissemination of best practice in this field. SPLIT is the only such academic body dedicated to pediatric liver transplantation.

About Transplant Services at Texas Children’s
Transplant Services at Texas Children’s was the nation’s largest pediatric transplant program in 2018, performing a remarkable 107 solid organ transplants including the highest volumes of pediatric liver, lung and kidney transplants.

Transplant Services provides a comprehensive, multidisciplinary approach to care through all aspects of the transplant process, from initial referral to hospitalization and outpatient management. Our team of experts includes physicians and surgical advanced practice providers, transplant coordinators, pediatric ventricular assist device coordinators, perfusionists, child life specialists, dietitians, social workers, financial counselors, pharmacists, inpatient and outpatient nursing and support staff, Perioperative Services, physical and occupational therapists, Radiology, Pathology, our LifeGift partners, and many others.

Our depth of skill and service enables us to offer world-class care for patients, from newborns to young adults, in need of heart, kidney, liver and lung transplants. That expertise has allowed us to successfully treat some cases that other national and international programs might consider untreatable.

Learn more about Transplant Services at Texas Children’s Hospital.

November 25, 2019

When Jennifer Bryan showed up at the hospital to deliver her second child, she was in a considerable amount of pain, more than she had experienced with her first child, but not enough to request an epidural.

Desperate for relief, Jennifer asked for nitrous oxide, more commonly known as “laughing gas.” Being a labor and delivery nurse at the Pavilion for Women, she knew the hospital had just started offering the gas as a pain reliever for labor pain and was curious if it worked.

To her pleasant surprise, it did! About five minutes after inhaling the mixture of nitrous and oxygen through a face mask, Jennifer stopped feeling the pain of her contractions.

“It gave me some breathing room to decide whether to get an epidural or try to have natural child birth,” Jennifer said. “I would definitely do it again and am happy to be able to offer it to our patients.”

The Pavilion for Women started offering nitrous oxide for labor pain in October. The gas is administered via mask about 30 seconds before a contraction begins and is continuously breathed in until the contraction ends. Starting before a contraction begins helps the gas reach its full effect as the contraction reaches its peak.

No extra monitoring is required and there are no known effects on the baby. Nitrous oxide is the only pain relief method for labor that is cleared from the body through the lungs. As soon as a patient pulls the mask off, the effects of nitrous oxide quickly diminish.

“It’s fast acting and it’s fast to wear off,” said Kristin Thorp, assistant clinical director of nursing for the inpatient portion of the Women’s Assessment Center. “It’s a viable option for pain relief and women love it. It’s the No. 1 requested method of pain relief for labor pain.”

Since offering the new pain relief option several women have received it and many soon-to-be moms have inquired about it. Labor and delivery clinicians believe both of those numbers will continue to rise.

“All of my patients have responded positively when they’ve heard we are offering nitrous oxide for labor pain,” said Dr. Jennifer Bump, assistant director of Quality and Patient Safety for Obstetrics at Texas Children’s Pavilion for Women. “I think it’s an excellent option for our patients who want short-term relief and am happy to have the opportunity to offer it.”

Women can use nitrous oxide as an alternative to other pain management options, or they can use it for the reason Jennifer did, as a way to buy time while deciding to have natural child birth, have an epidural or have intravenous narcotics. Nitrous oxide cannot be used with intravenous narcotics. It also cannot be used by women who:

  • Cannot hold their own facemask
  • Have received a dose of narcotics in the past two hours
  • Have pernicious anemia or a B12 deficiency and are taking B12 supplements
  • Have one of a very few other rare medical conditions

Other situations in which nitrous oxide can be used and will be offered at the Pavilion for Women include external versions, IV starts, placement of cervical ripening balloons, manual removal of placenta and lacerations repair.

November 19, 2019

At Texas Children’s, we care for some of the country’s most critically ill patients, and delivering safe, quality care for our patients is the most important responsibility of each staff member and employee.

In Fiscal Year 2019, Texas Children’s reached several remarkable patient safety milestones, which demonstrate our continued commitment to cultivating a harm-free environment for our patients.

“The key to creating an environment of safe patient care is ensuring that our staff is equipped with the knowledge and tools they need to take preventive action,” said Texas Children’s Chief Safety Officer Dr. Joan Shook. “When analyzing our patient safety statistics over the last several years, we have seen a significant decrease in both serious patient safety events and preventable deaths across the system.”

Texas Children’s reached several patient safety milestones in FY19 including:

  • Decreased serious safety events (SSE) – A serious safety event is a deviation from standard practice or process that reaches the patient and causes moderate to severe harm or death. In FY13, there were 20 SSE’s compared to 5 SSE’s in FY19, resulting in a 75 percent decrease.
  • Reached Zero SSE deaths in FY19 – Since January 20, 2018, Texas Children’s reached 655 days with zero preventable pediatric deaths and zero maternal deaths since 2013.
  • Reduced Hospital Acquired Conditions (HAC) – Pressure injuries have significantly improved over time and we have seen a considerable drop in adverse drug events, catheter associated urinary tract infections and surgical site infections.
  • Immunization compliance – Since implementing new immunization requirement in 2019, the organization has reached a 99.3 percent compliance rate, which is important to patient safety.

As part of Texas Children’s continuing efforts to improve patient safety across the system, employees and medical staff participated in the Agency for Healthcare Research and Quality’s 2019 Hospital Survey on Patient Safety Culture that is administered by Texas Children’s every 18 to 24 months. The survey evaluates 13 dimensions of patient safety and measures the organization’s overall patient safety performance.

When comparing survey results from 2016, Texas Children’s – for the first time ever – showed statistically significant improvement in five major areas including feedback and communication about error, teamwork across individual units, management support for patient safety, staffing, and hand-offs and transitions.

Through the hospital’s systemwide patient safety and quality improvement efforts, employees and staff continue to apply proven safety behaviors in their every day work and are more comfortable speaking up when there is a potential safety concern. Shook says this along with other contributing factors – like reviewing monthly unit-based safety scoop reports and reaccessing current practices to identify areas of improvement where change is needed – have helped us create and sustain a culture of patient safety.

“Our recent patient safety milestones reflect the tremendous work and collaboration from multiple teams across the organization that have led us on a positive trajectory,” Shook said. “Our goal is to build upon these successes and continue to take proactive steps to eliminate preventable harm to our patients.”

Norma Terrazas shares her excitement with colleagues as they prepare to move acute care services from the old Abercrombie Building into 15 West Tower – the former home of Texas Children’s Heart Center — on November 20. Read more

November 18, 2019

Maintaining the privacy and security of our patients’ and Health Plan members’ medical information is a key component of providing high quality care. Patients, Health Plan members, and their families must be able to trust that no one at Texas Children’s inappropriately accesses, discloses, or uses their protected health information (PHI). Having our patients’ and Health Plan members’ trust is an essential element of the care we provide and the relationship we develop with families.

As a Texas Children’s workforce member, you should only access medical records when it is part of your official, assigned work duties. Every “click” within our patient care systems is recorded. The Compliance and Privacy Office uses data analysis software to detect potential inappropriate access. When a workforce member appears to be “snooping,” the Compliance & Privacy Office coordinates with leadership and Human Resources to investigate and determine appropriate disciplinary action, up to and including termination. Three workforce members have been terminated this year for privacy violations.

Earlier this year, a child treated at Texas Children’s Hospital was the subject of multiple news stories. The Compliance and Privacy Office applied Epic’s Break-the-Glass tool to the patient’s record to deter inappropriate access. Despite these measures, two workforce members (who worked in areas in which the patient had no activity) “broke the glass” and accessed the patient’s record. Additionally, thirty-six workforce members searched the patient’s name in Epic but did not proceed past the Break-the Glass prompt into the medical record. This “snooping” was inappropriate and in violation of law and our policies. The two workforce members who accessed the patient’s record received disciplinary action, and the thirty-six individuals who searched the patient’s name received a warning from the Compliance and Privacy Office.

Your responsibility as a Texas Children’s workforce member is to:

  • Only access PHI when it is part of your assigned work responsibilities.
  • Do not access the records of your friends, family members, children, or yourself.
  • Do not access records out of curiosity.
  • Do not disclose PHI to unauthorized persons.
  • Do not share PHI on social media sites (Facebook, Instagram, Twitter, etc.).

Key Takeaway! Do not access any medical record unless it is necessary to do your job. Inappropriately accessing, using or disclosing PHI is a violation of federal and state law and Texas Children’s policy, and may result in disciplinary action, up to and including termination.

Questions? Contact the Compliance and Privacy Office by calling 832-824-2085 or emailing compliance@texaschildrens.org.

On his blog, Mark Wallace continues his Leadership Maxim series with his fourth guest blogger, Kristi Lemmert, who writes about Maxim No. 4: We all should have our own definition of leadership.

By commenting on Lemmert’s blog – and the next blog in the Leadership Maxim series – you can secure a chance to score a spot at a Houston Texans event.

Throughout November, the Corporate Communications team will randomly select 100 people from the comments to attend a private event with the Houston Texans, including a behind-the-scenes tour of NRG Stadium, an autograph session with two Houston Texans football players and photos with Texans cheerleaders. The event will be held on Tuesday, December 3. Read more

During the final week of October, Texas Children’s Hospital hosted visitors from around the world for a very special Rett Syndrome Symposium and Workshop.

The two-day event was momentous for many reasons. It was the inaugural meeting held in the stunning new Auditorium and Conference Center at the Jan and Dan Duncan Neurological Research Institute (Duncan NRI) at Texas Children’s Hospital. It fortuitously coincided with Rett Syndrome Awareness Month. And the symposium also marked the 20th anniversary of the discovery of the underlying cause of Rett syndrome. In 2000, NRI director Dr. Huda Zoghbi’s research team made the pioneering discovery that loss-of-function mutations in methyl-CpG binding protein, MECP2, were the underlying cause of Rett syndrome.

Rett syndrome is a rare neurological disorder that primarily affects young girls between 6 months and 2 years of age. The children appear to hit normal developmental milestones until, inexplicably, their motor, cognitive and social skills start to rapidly deteriorate. Most patients develop autistic features, breathing difficulties, dementia, growth abnormalities, epilepsy and scoliosis.

The symposium opened with a warm welcome from co-organizers Dr. Adrian Bird – Buchanan Professor of Genetics and Welcome Trust Center for Cell biology at the University of Edinburgh, UK – and Zoghbi, who is also a professor at Baylor College of Medicine and Howard Hughes Medical Institute investigator.

“The purpose of this event was to bring together researchers who work on Rett syndrome and leaders from related areas of neuroscience working in academia, industry and government, to think deeply and spark new ideas,” said Zoghbi. “The hope is that out of the work and discussions that happened here, in five years, when we’re marking the 25th anniversary of the gene discovery of Rett syndrome, we’ll also be celebrating new treatments for people with Rett syndrome.”

The international symposium was sponsored by Rettsyndrome.org (formerly the International Rett Syndrome Foundation) and the Rett Syndrome Research Trust. The multidisciplinary group of attendees included scientists, physicians, members of the lay public, and representatives from the National Institutes of Health, the pharmaceutical industry, and several foundations, all brought together to look at Rett syndrome with a fresh, new perspective.

On the first day of the symposium, presentation topics ranged from clinical observations of MECP2 disorders like Rett and MECP2 duplication syndrome to pathogenesis (progression or development) of Rett syndrome, to discussions on neuronal circuit alterations and therapeutics. Texas Children’s pediatric neurologist Dr. Bernhard Suter spoke about MECP2 duplication syndrome, which typically affects male patients and causes symptoms such as hypotonia, motor delays, intellectual disabilities, gastrointestinal issues and epilepsy.

Following a day of stellar research presentations, the investigators split into three working groups that focused on Molecular Pathogenesis, Therapeutic Approaches and Young Investigators. The groups discussed the information presented over the course of the day and their vision for the future of Rett syndrome research. This included the systemic and technical challenges that currently exist, and the group brainstormed ways to overcome those. The next morning, key points from these discussions were shared with the audience.

  • Rett syndrome is a particularly challenging disorder to correct. The levels of MECP2 protein in the neurons need to be precisely regulated because too much MECP2 protein causes a different neurological condition, the MECP2 duplication syndrome. Despite these challenges, research in Rett syndrome is advancing at a rapid pace, having moved from gene discovery to promising clinical trials in under 20 years.
  • Gene therapy offers exciting opportunities to develop treatment for Rett syndrome and is an area of active research. However, there are challenges to overcome including controlling the level and distribution of the delivered gene.
  • While the ultimate long-term goal of researchers is to find a lasting cure using gene therapy, clinicians in the audience weighed in on the benefits of also developing short-term strategies to treat specific behavioral or motor issues and/or how to delay the age of symptom onset. This would be a huge step forward for patients, their families and caregivers who cope with this debilitating condition on a daily basis. Participants in the discussion also drew parallels to the field of breast cancer, where non-targeted treatment modalities serve as the workhorses to treat the majority of patients.
  • There is a dire need to develop early screening/diagnostic methods for Rett syndrome among newborns. Early diagnosis, in combination with specialized therapies – such as neuromodulation physical therapy, speech therapy or psychotherapy may provide maximal improvements in the quality of life of the patients.
  • Building collaborations between academia and industry, with a focus on multidisciplinary team science and data-sharing, is critical to facilitate the development of superior reagents (i.e., better viral vectors for gene therapy), biomarkers (i.e., meaningful measures of clinical outcomes) and therapies. Moreover, there was a general agreement that close partnerships between various key stakeholders, such as scientists, physicians, pharma/biotech industry, families, caregivers and advocacy groups, are crucial for developing effective therapies.

Learn more about Texas Children’s research efforts at the Jan and Dan Duncan Neurological Research Institute and world-class clinical expertise provided at the Rett Center.