September 10, 2019

As part of Texas Children’s Patient Access Initiative, the organization has made major progress to ensure our patients easily and conveniently get in the door to receive the care they need, when they need it.

“Our objective has been to lay a solid foundation and layer on additional patient access solutions now that we have a sturdy infrastructure to build from,” said Texas Children’s Surgeon-in-Chief Dr. Larry Hollier and co-chair of the Access Executive Steering Committee. “Because we really care about our families, we have to pay attention to their needs and do more to help them out. We have to keep the doors open to our patients and their families.”

Last year, Texas Children’s Patient Access Committee evaluated 944 provider templates and found additional slots where physicians could see patients for a duration of four hours, which resulted in the organization adding 53,000 new appointments to the system that had not existed before. In addition to this, the 72-hour flip helped the organization maintain flexibility and open schedules. If an appointment slot for a specific patient type was not filled 72 hours out, the slot automatically opened to a broader group of patients.

7-3-1 strategy: Building on our previous successes

After expanding appointment availability with four-hour clinic sessions and 72-hour flips, the Capacity Management Team this year was tasked with deploying a strategy to ensure these slots were filled.

Led by leaders in Ambulatory Operations and Central Scheduling, the team identified the largest area of opportunity was to work to decrease no shows – particularly for appointments scheduled more than 30 days in advance – and to implement a standardized way to recapture patients following a no show.

Focusing efforts on automated solutions, the team partnered with Information Services (IS) to optimize the hospital’s text message reminder system for appointments. Previously, patients only received a three-day reminder message for their appointment, which particularly for appointments scheduled three months – or even a year – in advance, is not enough of a reminder notice to arrange for time off, childcare or transportation. Now, patients receive their first request to confirm or cancel their appointment via text message at seven days, with additional 3-day and 1-day reminders prior to the appointment date.

The impact has been immediate after going live with the “7-3-1 strategy” at the end of May. In July, the hospital hit the system goal of a 10 percent no show rate for the first time ever, down from a three year average of 11.5 percent. While this change may seem small, a 1.5 percent decrease in no shows represents about 1,000 completed appointments a month.

Because we will never be able to completely eliminate patient no shows, the team also implemented an automated text message that will go out to patients the day after their missed appointments, offering the opportunity to be connected with a live scheduler to get another appointment scheduled. Historically, only 20 percent of patients that miss an appointment get rescheduled. Since launching recapture messaging in July, that number has already started to increase steadily.

“Overwhelmingly, our patients and families tell us that they prefer to engage with us via text message and on their phones,” said Grace Karon, Assistant Director of Business Operations and Strategic Planning for the Department of Pediatrics. “By focusing on technology rich solutions, we are giving families the customer-obsessed experience that they have come to expect from other services they receive, while working to ensure that patients who miss appointments do not fall through the cracks.”

Other patient access improvements

Texas Children’s patients and their families continue to benefit from the hospital’s patient access improvements that were implemented over the past year and a half.

Click here to watch this recent video on other patient access solutions we’ve implemented across the system to improve access, care coordination and patient experience at Texas Children’s Hospital.

Texas Children’s Cancer and Hematology Centers is one of the largest cancer and blood disorder centers in the country, diagnosing more than 4,000 new patients a year. Over the past decade, patients from all over the world have traveled to Texas Children’s because they know we are a leader in family-centered care and provide personalized, comprehensive services that address both the physical and emotional aspects of the disease.

Named No. 3 in the nation by U.S. News & World Report 2019-2020 Best Children’s Hospitals rankings, Texas Children’s Cancer Center comprises a multidisciplinary team of dedicated and compassionate physicians, advanced practice providers, nurses, child life specialists, social workers and other subspecialists who care for the physical, emotional and psychosocial needs of young patients.

Our world-renowned staff of nearly 200 faculty and more than 1,000 employees have pioneered many of the now standard protocols for treating and curing pediatric cancer and blood disorders. In addition, we provide a full range of pediatric subspecialty care available in-house 24 hours a day and treat all pediatric cancer and blood disorders, even the rarest disorders.

In addition to providing world-class, comprehensive patient care, our hematologist/oncologists are leading the way in advancing pediatric cancer and hematology research. The Cancer and Hematology Centers have 47 laboratories and more than 350 people who are engaged in research to help revolutionize cutting-edge therapies for treating and ultimately curing all childhood cancers and blood disorders.

“Texas Children’s Cancer and Hematology Centers, world renowned for its clinical care, research and education, offers innovative therapies for all forms of childhood cancer and blood disorders,” said Dr. Susan Blaney, director of Texas Children’s Cancer and Hematology Centers. “In addition, physicians-scientists at Texas Children’s Cancer and Hematology Centers are working relentlessly to improve the outcome for all patients afflicted with these diseases and to develop and perfect new treatment approaches that emanate from some of their most extraordinary scientific insights and discoveries.”

All of this and more is why Texas Children’s Cancer Center is continuously ranked by U.S. News as one of the best places in the nation to receive pediatric care. The rankings use a well-accepted framework for evaluating quality of health care, which factors in patient outcomes, such as mortality and infection rates; available clinical resources, such as specialized clinics and programs and external accreditations; and compliance with best practices. Improved rankings demonstrate a health care organization’s commitment to not only providing high-quality care, but also to identifying gaps where improvements are needed.

Big wins for patients and families

This past year, the Cancer Center built on its legacy of success and implemented new initiatives to increase transparency, reduce risk of infection and improve the quality of care. Here are some of the center’s big wins for patients and families:

  • Made significant improvements to reduce Central line-associated bloodstream infection rate

Texas Children’s Cancer and Hematology Centers’ leadership team identified high-risk central line-associated bloodstream infection (CLABSI) patients and increased rounding with the Centers’ infection control medical director, infection control practitioner and leadership team. Beginning in 2019, the Clinical Operations Team also partnered with nursing, pharmacy and physicians within the Centers, as well as with other departments, including but not limited to, Pediatric Surgery, Infectious Disease, Interventional Radiology and Anesthesia to develop a standardized central line placement and removal practice to decrease variations in line placement and care. These efforts have facilitated a reduction in Texas Children’s Cancer and Hematology Centers CLABSI rates from 1.31 in 2018 to 0.82 in 2019. Leaders anticipate the rate will lower next year.

  • Implemented computerized provider order entry system for chemotherapy orders

In partnership with Information Services, Texas Children’s Cancer and Hematology Centers implemented Epic Beacon, which is the oncology module in Epic that allows physicians to input orders for services, such as chemotherapy, electronically. Adopting such technology is considered best practice as it provides clarity and automated calculations to enhance safety. It also allows these orders to be created and queued up in advance of patient visits for cancer treatment, which should improve patient satisfaction by decreasing wait times.

  • Increased the percentage of patients who received intravenous treatment of antibiotics within an hour of initial triage

The Texas Children’s Cancer Center maintained >95 percent compliance the administration of intravenous antibiotics within an hour of initial triage for oncology patients who were seen in the Texas Children’s Emergency Center and Texas Children’s Cancer Center’s Urgent Care Bay across Texas Children’s three hospital campuses. The Centers’ data tracking over the past year improved greatly due to the strong work of Warren Boudreau, director of Quality Outcomes and Impact Service, and his team. In partnership and collaboration with the Emergency Department, the Centers were able to decrease its antibiotic administration time by an average of 20 minutes. This timely administration of antibiotics in our pediatric patient population is a national standard for decreasing the incidence of sepsis, morbidity and mortality.

  • Increased five-year survival of patient with neuroblastoma

Neuroblastoma is one of the most common solid tumors in children, and approximately 700 patients are diagnosed each year in the United States. Texas Children’s Cancer Center cares for patients of all ages diagnosed with neuroblastoma, which in the later stages is a highly aggressive tumor. For localized, low stage neuroblastoma Stage L1, the Center’s survival rate was 100 percent. For metastatic neuroblastoma, the survival rate was 53 percent, a 10 percent improvement from the previous year. Metaiodobenzylguanidine or MIBG therapy is likely a contributing factor to the Center’s increased success as well as the availability of varying molecular and targeted therapies, and new treatment protocols.

  • Closed out all structural related metrics

As described in the methodology section of U.S. News & World Report’s Best Children’s Hospitals’ publication, structure refers to hospital resources directly related to patient care and includes the ratio of nurses to patients, the presence of specialized clinics and programs and the certification by recognized external organizations. The Cancer and Hematology Centers were able to successfully demonstrate that each of these services were available, including molecular oncology/targeted therapy programs, an on-site inpatient pediatric rehabilitation unit with individualized dedicated cancer rehabilitation programming, participation in the Solutions for Patient Safety Hematology/Oncology CLABSI Working Group and maintenance of a quality committee with an identified medical director/leader.

Cancer survivor Sophia Sereni took center stage last week at one of the three Going Gold celebrations held at Texas Children’s hospitals in honor of National Childhood Cancer Awareness month.

Standing before a packed conference room in the Pavilion for Women, the curly-haired teen sang “Be Golden,” a gentle but strong song she wrote with Purple Songs Can Fly following treatment for T-cell acute lymphoblastic leukemia at Texas Children’s Cancer Center. Click here to listen to the full song.

“This has been an amazing experience,” Sophia said. “I’m so glad I could be part of such an important cause.”

Following Sophia’s performance and dressed in bright gold shirts and other festive gear, fellow survivors, current patients, families, Texas Children’s Cancer Center employees and others marched for childhood cancer awareness, ending their short trek on The Auxiliary Bridge where they participated in a ribbon tying event and received information from various support organizations.

View photos from the events below.

Sponsored by The Faris Foundation, similar events and parades were held last week at Texas Children’s Hospital West Campus and Texas Children’s Hospital The Woodlands. A celebration will be held this week at Vannie Cook Children’s Cancer and Hematology Clinic in McAllen, Texas.

“Each year, the events get bigger and better,” said Asha Virani, founder of The Faris Foundation and the mother of Faris D. Virani, who lost his battle with Ewing sarcoma and inspired Texas Children’s to “Go Gold.” “It’s a golden opportunity to spread awareness and love. Texas Children’s has been a leader in making this cause so visible.”

Khole Henry, an 8-year-old cancer patient, said she attended the event last year and was so excited to hear that it was going to happen again this year.

“My favorite part is the snacks!” Khole beamed as she grabbed a couple of bite-sized bags of M&Ms for later. “I’m glad I got to come.”

Director of Texas Children’s Cancer and Hematology Centers Dr. Susan Blaney said she is glad so many people turned out to raise awareness for such an important cause and that even though great strides have been made in combatting childhood cancer, there is still work to be done.

“We need a cure for every child diagnosed with cancer,” Blaney said. “That’s why we have to keep doing laboratory and clinical research, keep developing novel treatment approaches and continue raising awareness about childhood cancer.”

Last year alone, almost 600 children were diagnosed with cancer at Texas Children’s. The disease remains the leading cause of non-accidental death in children. Help spread the word that pediatric cancer is a serious disease and that Texas Children’s Cancer Center is here to help. For more information about the Cancer Center, click here.

Click here to view a preview of the next installment of “This is Cancer: Reflections from our patients.” This installment focuses on Owen, who was barely 2 years old when doctors found a mass the size of a grapefruit surrounding his heart and cutting off his airway. Since then, his tiny body has been through a lot. But, as his mom Emily says, not even cancer can slow this energetic toddler down. The “This is Cancer” series documents the journeys of several families receiving care at Texas Children’s Cancer and Hematology Center. Their stories illustrate in intimate detail what they’re experiencing and how to better support them. Click here to learn more.

Jennifer Werner, a wound ostomy nurse at Texas Children’s, sees roughly 10 patients and their families each day at our Medical Center campus. With 11 years of wound care experience under her belt, Werner assesses, treats and develops care plans for patients with wounds, ostomy and continence conditions.

“I always put myself in my patient’s shoes and share an understanding of their anxieties,” Werner said. “Sharing my experience can help put a family at ease and help build a strong relationship in the process. After all, care for their child’s wounds should be as gentle and compassionate as care for my own.”

Before becoming a wound ostomy nurse, Werner served as a fitness director for the U.S. Navy. But it was her young daughter who inadvertently inspired her to go back to school to pursue a different career path.

“As the mother of a daughter with spina bifida, Amanda has taught me so much about surgical wounds, pressure injuries and ostomy problems, enough to grow a passion for care,” Werner said. “It has been 11 years since I made the career change and I have never looked back. This is truly a rewarding field.”

While every nurse will tend to a wound at some point in their nursing career, certified wound ostomy nurses demonstrate a higher level of knowledge, skill and expertise in this highly specialized field and often act as educators and consultants to staff nurses and other members of the health care team. Understanding the underlying etiology of wounds, this rare breed of nurses play an integral role in the healing process, and their jobs require ongoing training, lots of patience and a great deal of compassion for their patients.

From our three hospital campuses at the Medical Center, West Campus and The Woodlands, to our inpatient and outpatient clinics for pediatric and women’s health, Texas Children’s wound ostomy nurses use evidence-based practices to assess, treat and care for patients with simple to complex wounds. These include wound debridement (a process that removes dead tissue and contaminants), dressing wounds, treating and preventing pressure ulcers, and caring for patients with continence conditions and ostomies, where proper pouching techniques are necessary to improve outcomes.

In addition to providing direct patient care, our wound ostomy nurses educate patients and their families on how to care for wounds at home and how to prevent infection and further injury. Furthermore, the team also collaborates with our multidisciplinary partners on ways to enhance skin care management and prevent pressure ulcers, especially in high acuity areas of the hospital like our intensive care units.

While every patient is different, and the healing process takes time, the satisfaction of seeing a patient’s wound heal, witnessing their ability to self-manage their condition while maintaining their dignity and self-esteem – and realizing that you played a role in this – makes this nursing specialty extremely rewarding.

“In addition to working in collaboration with an amazing hospital staff, knowing that I helped my patients in some small way to improve their quality of life is what makes this job rewarding,” said MaryAnne Lewis, a wound ostomy continence nurse serving Texas Children’s community hospitals and outpatient nursing clinic in The Woodlands. It often takes a village to heal some of these complex wounds, and the incredible synergy at Texas Children’s makes it possible.”

Lewis uses her more than 30 years of wound/ostomy care experience to help ostomy patients overcome the physical and emotional burdens of their medical condition. She created a support group that offers helpful resources for these patients and opportunities to meet other families facing similar challenges.

“The support group is probably the single best thing I’ve been a part of to promote ostomy care in the past 30 years,” Lewis said. “I can apply and recommend specific pouches for patients but only someone with a similar diagnosis or situation can truly understand what the other person is going through.”

At Texas Children’s Hospital, our seven wound care nurses have over a century of combined nursing experience in wound care, ostomy and continence care with varying levels and areas of certifications.

Houston Texans Mascot TORO made a special visit to Texas Children’s Pavilion for Women Labor and Delivery Unit on August 28. While there, TORO welcomed a handful of little ones to the Texans family and offered the newest members of the Homefield Advantage Texans-branded birth certificates. The visit was a nice surprise for some of the hospital’s newest additions and was made possible by the partnership Texas Children’s has with the Texans to inspire children to lead healthier, more active lives.

Texas Children’s recently hosted the Patient Access Collaborative’s Pediatric Patient Access Symposium held on September 5 and 6. This two-day conference provides a forum for the nation’s largest and most prestigious health systems to discuss, collaborate and advance initiatives that can vastly improve patient access to ambulatory care.

Each year, industry leaders from across the country come together to share ideas on solving some of the most challenging aspects of patient access. Approximately 50 attendees representing 20 of the largest pediatric hospitals in the country convened at Texas Children’s Pavilion for Women to attend this annual conference. “The Patient Access Collaborative offers us a forum – year round – to collaborate with our peers and move towards the shared goal of advancing access to care for children across the country,” shared Grace Karon, Assistant Director of Business Operations and Strategic Planning.

Highlights from the first day of the symposium included opening remarks from Texas Children’s Surgeon-in-Chief Dr. Larry Hollier, who shared this video of our hospital’s patient access journey, and the incredible strides our organization has made in the last year to improve access for our patients and their families system wide. Guests also had the opportunity to tour our state-of-the-art Lester and Sue Smith Legacy Tower and Mission Control.

The Patient Access Symposium also included several insightful workshops and presentations on patient access-related topics including scheduling optimization, national benchmarks, and referral management, to name a few.

Discussion groups run by Texas Children’s leaders offered attendees the opportunity to transparently share barriers and lessons learned from their own access journeys.

  • Challenges of Governance, Sustainability, Leadership and Change Management in Access Journey

Trent Johnson, Assistant Vice President

Ramzey Ibrahim, Manager – Business Process Transformation

  • Patient Access Technology Opportunity: Reducing No Shows, Call Center Optimization, Patient Portals

Julie McGuire, Director – Enterprise Systems

Colleen Julien, Manager – Enterprise Systems

Martin Wortley, Assistant Director – Customer Care Contact Center

Dr. David Bank, Vice Chair for Clinical Affairs – Ambulatory Services and Network Development at Texas Children’s Hospital and Baylor College of Medicine, delivered the welcome address for day two of the annual symposium. “As a result of the efforts of everyone involved in the Access initiative, Texas Children’s national reputation will become even stronger as we emerge as “THE” leader in the national effort to improve access to care for children and their families.” Dr. Bank is the founder of the Pediatric Access Collaborative and also serves on the Board of Advisors for the Patient Access Collaborative.

Day two of the symposium highlighted some of the recent milestones of two major Access initiative ventures that leveraged technology solutions to solve complex operational problems:

  • Texas Children’s Space Utilization Program

Sara Montenegro, Assistant Vice President – Texas Children’s Pediatrics

Taylor Pierce, Business Process Engineer

  • Texas Children’s Move to Online Scheduling

Diesa Samp, Director of Transplant and Ambulatory Nursing

Martin Wortley, Assistant Director – Customer Care Contact Center

Elisa Lange, Lead – Marketing Special Projects

“We are so honored to have this opportunity to host this year’s symposium at Texas Children’s Hospital,” said Texas Children’s Assistant Vice President Carrie Rys. “It was a tremendous opportunity to share our access improvement journey as well as gain valuable insight on improvement ideas from our peer network.”

Aaron Mansfield shares how a mobile end-of-treatment bell that he designed and built is helping our cancer patients and their families celebrate this memorable milestone in their cancer journey. Read more