September 21, 2020

Like most parents, the Harts were nervous about their 10-month-old son’s surgery scheduled with Texas Children’s Division of Urology. In addition to regular jitters, they were especially concerned about their son undergoing general anesthesia.

“My husband did some research and found that it can be dangerous for young children,” Kayla Hart said. “So, needless to say, we were a little worried.”

Those worries were put to ease when their son’s pediatric anesthesiologist, Dr. Kevin Chu, and surgeon Dr. David Roth, explained the information the couple found online and offered another option, spinal anesthesia. Spinal anesthesia, numbs the lower part of the body to block pain versus general anesthesia, which puts a patient to sleep.

Texas Children’s Department of Anesthesiology and Department of Surgery recently started offering spinal anesthesia, when appropriate, to parents of young children. Rowan Hart was one of the hospital’s first patients to receive spinal anesthesia as an alternative to general anesthesia.

“When I went back to recovery, he woke up from the nap he was taking throughout surgery and was totally normal,” Hart said. “He wasn’t groggy at all and was even smiling.”

General Anesthesia Division Chief Dr. Olutoyin Olutoye said spinal anesthesia is a safe alternative to general anesthesia in patients under one year of age who are having surgery on the lower part of their body. She said if needed, the patient may receive a light sedative to make them relax but otherwise, they are awake during their procedure. There is no need for a breathing tube when a child receives spinal anesthesia and patients, like Rowan Hart, are alert and in good spirits post operatively.

“Even though anesthesia is much safer today than ever before, every anesthetic exposure and surgical encounter, has an element of risk and we must remain vigilant about communicating such risks to our patients and their families,” Olutoye said. “Offering an alternative to general anesthesia when appropriate is another way we can serve our patients and families in this capacity.”

On December 14, 2017, the U.S. Food and Drug Administration (FDA) released a drug safety communication about prolonged or repeated anesthetics in young children and pregnant women in their third trimester.

The FDA’s communication states:

  • A single, short exposure to anesthesia appears to be safe.
  • There is some evidence that longer (>3 hours) or repeated exposures could have negative effects on behavior or learning.
  • Much more research is needed.

As a result of the communication Texas Children’s Hospital changed its anesthesia practice and started discussing the warning before surgery with the parents of all children 3 years of age and younger.

In addition, Texas Children’s Hospital adopted the warning’s recommendation that a discussion occur among parents, surgeons, other physicians and anesthesiologists about the duration of anesthesia, any plan for multiple general anesthetics for multiple procedures, and the possibility that the procedure could be delayed until after 3 years of age. Parent-education materials that cover these topics are available to our patients and their families.

“I think offering spinal anesthesia is another way we can remain on the leading edge of this issue,” said Roth, who helped spearhead the use of spinal anesthesia together with the Department of Anesthesiology, and who has operated on the patients who have received it thus far. “It’s a safe alternative that we can use to reduce any potential risks of general anesthesia in our younger population.”

Anesthesiologist-in-Chief Dr. Dean B. Andropoulos agreed and said the benefits of anesthesia must always be weighed against the risks of anesthesia itself and Texas Children’s does a good job at doing that.

“We are very serious about educating our patients and families prior to surgery about any risks and any options that can be taken to mitigate such risks,” Andropoulos said. “Using spinal anesthesia is a nice addition to what we already are doing to mitigate potential risk.”

August 31, 2020

Expecting mothers will soon receive even higher quality service when they visit The Center for Children and Women.

In response to patient feedback, the obstetrics services at both the Greenspoint and Southwest locations will treat patients with a new personal care team model. This will prevent families from seeing up to 10 different providers and instead offer them their own team of no more than four providers.

“We are excited about this change, especially because it has been made in direct response to one of our most common patient complaints,” said Dr. Faunda Armstrong, assistant medical director for The Center at Greenspoint. “The smaller team model will allow providers to develop a patient plan together, build a closer relationship with families and increase trust at every appointment.”

To ensure that this change – set for mid-September – achieves the intended results, The Center will continue to use the patient satisfaction firm, Press Ganey. The firm’s annual survey results will show the effects of the change.

Additional recent changes include an increased use of telemedicine appointments to keep patients and families safe amid COVID-19 concerns. For more information about The Center for Children and Women visit https://www.jointhecenter.org/.

August 24, 2020

2020 has been an unprecedented year filled with many challenges. We’ve engaged in social distancing practices like we have never done before. We are wearing protective face masks, both at work and in public, in an effort to protect ourselves, each other, and prevent the further spread of the coronavirus.

But despite the uncertainty and daily disruptions caused by the COVID-19 pandemic, this health crisis has prompted our physicians, nurses and other patient care staff to explore innovative, non-traditional approaches to patient care processes – like e-rounding – to enhance the provider/patient experience.

Daily patient rounding has been around for centuries, and is an important part of the patient care process. Before COVID-19, a group of multidisciplinary staff would gather in or outside a patient room to discuss the patient’s condition and plan of care with the patient’s family, taking into account the experience, concerns, questions and needs of the patient. Through this multidisciplinary, family-centered approach, each team member would then contribute their expertise to support the best possible care/outcomes for the patient.

To adapt to COVID-19 and to ensure social distancing practices are followed, our critical care teams began conducting patient e-rounding in April, which has been a beneficial change from the norm.

“E-rounding has been a big change for us,” said Dr. Jordana Goldman, attending physician in Critical Care. “Rounds are as old as time in medicine and so it takes a little bit of practice to get use to it. But once you get the flow of it, it really works well. Our physician and nursing leaders, and the e-Health and IS teams have been very supportive in helping us leverage new technology to make e-rounding possible.”

Through the VidyoConnect platform, virtual “rooms” are created that are then available for all rounding team members to join. During e-rounding, an attending physician, bedside nurse and family member, can be outside the patient’s room in front of a computer screen while maintaining social distancing, and can communicate virtually with remote team members including our consultants, the provider team (consisting of APPs, fellows and residents) dietitian, pharmacy, Respiratory Therapy support and other members.

“We facilitated the implementation of e-rounding by working with Dr. Goldman and Dr. Aarti Bavare to integrate their ideal workflow using the software and hardware that we already had available,” said Dr. Robert Ball, medical director of e-Health. “It was the team work of Information Services, e-Health and the physician champions that made it a reality. When you have amazing innovators in every corner of our organization working together to enhance this process, there are no obstacles that cannot be overcome.”

Since e-rounding was first introduced in the PICU and CICU in April, e-rounding has expanded to other parts of the hospital including the acute care cardiology floor. PHM has been working on the acute care side on a version of e-rounds to help with the education of the residents and medical students. Plans are underway to expand e-rounding capabilities to the Pavilion for Women and NICUs with the option of e-rounding being made available to all inpatient areas at our three hospital campuses in the coming weeks.

Our e-Health teams are also working on the ability to leverage VidyoConnect to communicate with families in a HIPAA compliant way so they can join rounds when they are not able to be at the bedside.

“The disruption of COVID-19 has allowed us to take a closer look at our rounding practices and see how we can improve them for our patients, team, learners and consultants,” Goldman said. “This is a very new process for us, but our team’s willingness to engage in this novel approach has been pretty phenomenal.”

August 17, 2020

For patients like 5-year-old Legend Pruitt, a visit to the doctor’s office can be a scary place for a child, especially if they don’t know what to expect when they come in for a medical procedure. A few months ago, when Legend had his MRI at Texas Children’s, his mother was surprised by how well he did, and how calm he was during the scan.

“He didn’t move at all because he knew he had to stay still for the MRI,” said Legend’s mother Niayeshua Joseph. “When my son had MRI scans before, he would have to be placed under anesthesia, because he could not stop moving. He is now more comfortable and the noises from the MRI machine don’t bother him.”

In an innovative effort to decrease the need for anesthesia in our MRI patients, Texas Children’s Radiology team bought the organization’s first mock MRI scanner last year thanks to a generous donation from one of our patient families. The mock MRI scanner provides a realistic simulation of what patients can expect before the real exam.

“This innovation allows patients to practice their scan before they enter the real scanner so they can understand their role (to lie still) and are more comfortable with something that is unfamiliar to them,” said Texas Children’s Radiologist-in-Chief Dr. Thierry Huisman. “Mock MR scanner training and familiarity with the MR imaging procedure enhances patient experience, reduces patient and family anxiety, and optimizes patient cooperation which can improve image quality or may allow for imaging without the need for patient sedation or general anesthesia.”

The mock MRI scanner on the fifth floor of Texas Children’s Lester and Sue Smith Legacy Tower, looks and sounds like a real MRI scanner. It has a bed that patients can lie on and travel into a tunnel similar to a real MRI scanner. The MRI scanner makes loud noises while the pictures are being taken. The mock MRI scanner simulates those noises and prepares a child for what to expect before they are scanned using the real machine. One additional advantage is that the mock MRI scanner does not include the “big magnet” and allows patients and families to attend without limitations. Furthermore, the mock MRI scanner does not use costly time as the real MRI unit.

Patients can get prepped with the mock MRI scanner in two ways. If the radiology pre-call nurse identifies a patient through their screening, they can schedule an appointment with a child life specialist several days before their procedure. Patients can also test out the mock MRI scanner immediately before their MRI appointment.

After introducing the mock scanner in July 2019, Radiology has seen amazing conversion results. Since June of this year, 67 patients have used the mock MRI scanner and 39 MRI patients scheduled for general anesthesia were converted to non-sedate procedures.

“We are really excited about our initial success,” Dr. Huisman said. “We are grateful to have this resource available to our patient families, and incredibly grateful to the Cook family’s philanthropic donation to make this all possible.”

A generous gift to help others

Brady and Nancy Cook know first-hand the challenges patient families face when a young child has to undergo an MRI especially for the first time. When their daughter, Alyssa, was in kindergarten, she started having complex partial seizures and was later diagnosed with a brain tumor. The brain tumor was believed to be in the area of the brain where speech is generated but doctors didn’t know for sure unless they performed a functional MRI on her.

“With a functional MRI, the patient has to be awake in the MRI machine and respond to images that flash up on the screen inside the MRI without moving because it would distort the quality,” said Brady Cook. “For that reason, it’s typically not done on 5-year-olds, because they are unable to hold still for an hour and follow instructions like that.”

But everything changed when the couple came across a research study on the use of mock MRI scanners that taught kids how to be more comfortable around the MRI machine to the point where young children could endure it. Out of desperation, they got creative and built a mock scanner in their garage. They used a big refrigerator box, a dolly that you lay on to get underneath a car, a softball mask to simulate the cage that goes over the patient’s head, a school locker sized mirror, age appropriate flash cards, and downloadable sound effects mimicking an MRI machine.

“We practiced this on our daughter so she could get comfortable with the MRI machine,” said Cook. “Soon after, she was able to successfully complete a functional MRI without moving. Her MRI scans showed us that the tumor was nowhere near the area of her brain that generates speech, and therefore the tumor could be removed safely.”

Since the mock MRI scanner helped their daughter, the Cook family wanted Texas Children’s to have the capability of helping patients become more comfortable with the MRI machine. Through their generous donation to Texas Children’s, the family is grateful that the mock MRI scanner is making a positive impact on patients and families.

“As parents who have been through this before and the desperation we felt at the time, we would do anything to ensure patients are comfortable during this process leading up to surgery,” Nancy Cook said. “Now that we have a mock scanner here, we hope that it will continue to give parents and children added comfort and reassurance.”

August 4, 2020

Five years ago, Texas Children’s Special Isolation Unit (SIU) opened at Texas Children’s Hospital West Campus to provide safe, effective care to patients with highly contagious infectious diseases. The decision to build the SIU came shortly after an unprecedented Ebola outbreak, resulting in the realization that Texas Children’s must always be prepared as an organization to handle any emerging infections that come our way.

Texas Children’s Special Isolation Unit at West Campus – the only one of its kind in Texas and among only a few in the United States – allows our teams to treat pediatric patients who are infected with highly contagious diseases in a state-of-the-art environment. The SIU is fully equipped with all of the latest scientific and technological approaches to biocontainment to assure the safety of the health care team, other patients and their families. The types of highly contagious pathogens that can be treated in the SIU include Ebola, influenza, measles and respiratory illnesses like MERS, SARS and RSV. Today, as many health care organizations face another global health pandemic, the SIU team at West Campus has been busy over the last several months providing care to COVID-19 adult and pediatric patients.

“As a virologist, I always thought in the back of my mind that we would possibly face a pandemic one day whether it be avian influenza or another coronavirus like SARS or MERS,” said Dr. Amy Arrington, medical director of the SIU at West Campus. “But I think until you’re really in that moment, it’s hard to imagine what responding to a pandemic like COVID-19 would be like for our team and the organization.”

Housed on the fifth floor of West Campus, the SIU has eight dedicated beds and up to 18 overflow beds on the fourth and fifth floors to care for COVID-19 patients, with the potential of expanding bed capacity as the need arises. The SIU is activated when patients meet a specific criteria, and in this case, are COVID-19 positive.

“We have nurses and doctors embedded in many clinical areas across our campuses who serve as clinician reservists on standby,” said Denise Tanner-Brown, Assistant Vice President of Nursing of Community and Ambulatory Nursing. “Once we activate them, they are pulled out of their home clinical areas to support the SIU.”

Since the pandemic began in early March, the West Campus SIU has been activated 12 times. The last time the SIU was activated was on May 30 and has remained open since then. As of July 31, 184 patients have been admitted to the SIU and 75 of those patients were admitted in June. West Campus has had 13 COVID-19 positive adult patients admitted to the SIU since it started taking care of adult COVID-19 patients on June 24. In May and June, the SIU saw a 48 percent increase in the average daily census.

Tanner-Brown says the SIU is on the downswing compared to previous months. Texas Children’s has seen a recent decline in COVID-19 admissions which demonstrate that masking protocols are working to curb the spread of the virus. However, the SIU team remains ready to care for increased patient volumes if warranted.

“When we began accepting adult patients in our SIU on June 24, we were a little worried about how they would perceive us as they came into a pediatric hospital setting for care,” Tanner-Brown said. “They have been more than grateful and extremely appreciative of our willingness to take good care of them.”

Since many of the adults who have COVID-19 or who required admission had some underlying disease presence, the SIU team collaborated with education coordinators from Houston Methodist West who provided guidance on general and COVID-19 specific care to ensure the best outcomes for these patients.

View a photo gallery of inside the SIU at West Campus below.

Preparing for a potential second wave

While some school districts are reopening campuses and others are sticking to virtual learning at least for the time being, Texas Children’s is ready and prepared to respond if the Houston area experiences another surge in COVID-19 cases after school starts and into the fall months during flu season.

“We are always in a constant state of readiness and we are not letting our guard down especially with the mounting uncertainty surrounding this unprecedented pandemic,” said Tanner-Brown. “As patient volumes decrease, we have a deactivation strategy where we can temporarily close down units. But we also have an activation strategy in place where we can turn it back on really quickly should the situation change. In general, many people are getting COVID fatigue, and may not feel the need to continue practicing social distancing or taking other safety precautions, so I anticipate that we may see more new cases emerge.”

For the 70 days and counting that the SIU at West Campus has been activated, the recent milestones achieved would not have been possible without the 100 percent collaboration from our team members across the system.

“I think as an organization, we have just really stepped up to the plate to provide good quality and safe care for these patients and our staff,” said Arrington. “It takes a huge village to put this together and to carry this out day after day. And it’s exhausting work, but it is work that is incredibly rewarding too.”

August 3, 2020

Aimee Martin’s two-year-old daughter Hope is extremely social. She chats up anyone she sees whether they are a stranger or a friend, and she does so at close range. Telling her to keep her distance to protect herself and others from COVID-19 is something she has a hard time comprehending to say the least.

So, when a routine trip to the ophthalmologist popped up on Amiee’s calendar, she cringed because she knew Hope’s eyes would need to be dilated and that they would have to spend at least 30 minutes in the waiting room of Texas Children’s Ophthalmology Clinic.

“Sitting in the waiting room with Hope during a pandemic or not is a train wreck,” Amiee said. “She wants to hug and talk to everyone she sees.”

To help prevent situations such as these and ease people’s anxiety about coming to the hospital during a challenging time, a handful of departments, including Ophthalmology, are offering some of their services via Patient Express, a drive-thru service at Texas Children’s Hospital’s Medical Center Campus.

Set up near the ambulance bay at Wallace Tower, patients call about five minutes before arriving for their appointment, pull up and are seen by a clinician. To ensure everyone’s safety, all patients and family members are asked a series of COVID-19 screening questions, their temperatures are taken and they are required to wear a Texas Children’s-issued mask. Texas Children’s employees participating in Patient Express are required to wear personal protective equipment including a mask, gown, gloves and facial shield.

“It’s great to be part of a project that is good for everyone,” said Ophthalmology Clinic Supervisor Veronica Gonzalez. “I feel like we are taking an extra step to make everyone feel safe – staff, patients and family members.”

Gonzalez’s team is using Patient Express to treat otherwise healthy patients who need to come in for a routine eye exam that requires dilation. Before going into the clinic for their exam, patients get their eyes dilated car side at Patient Express. By the time they park and make their way up to the clinic, it’s about time for their appointment.

Most patients are in and out of the clinic in 30 minutes. Prior to using Patient Express, they would spend an hour to an hour and a half in the facility, half of which was spent in the waiting room during the dilation process.

“Patient Express is a much better alternative,” Martin said. “I appreciate Texas Children’s coming up with the idea and for making our safety and health a priority during such challenging times.”

The drive-through or car side concept began in May when Texas Children’s Pavilion for Women opened a drive-through prenatal clinic at our Medical Center Campus to reduce the anxiety of expectant moms and to lower their risk of COVID-19 exposure and infection.

The clinic, which was recently phased out due to an increase in telemedicine and in-person visits, allowed pregnant women who do not need to be seen in the clinic to remain in their vehicles while being assessed by a health care professional. The drive-through visits included key elements of a prenatal exam such as blood pressure measurements for evaluation for hypertensive disorders of pregnancy, fetal heart rate assessment, and selected ultrasound-based measurements or observations, as well as face-to-face patient-health care professional interaction.

In June, Texas Children’s Dermatology started offering drive-through service via Patient Express to patients who need basic dermatological treatments for conditions such as warts and/or molluscum. The service is being offered every two weeks and has been very successful with both patients and clinicians.

Ophthalmology offers dilating services via Patient Express daily. Pulmonology offers services every other week through Patient Express to cystic fibrosis patients who are undergoing eradication treatment for two types of bacteria they are susceptible to getting and possibly having complications from.

“There is no need to bring them on site and expose them if we don’t have to,” said Caroline Hanson, who manages the outpatient nursing team for Pulmonology. “Our parents have been very appreciative of our efforts to best care for them and their children.”

To help create a fun environment at Patient Express, Hanson said she plays kid-friendly music when appropriate and hands out stickers any time she can. She said her staff forms a special bond with their patients since they tend to come in frequently and that being able to serve them in this way has been very fulfilling.

Valdemar Garza, practice administrator for Ophthalmology, said he has been impressed with the success of the drive-through service and with the collaboration between several teams to make it happen.

“We received a lot of help from Pulmonology, Dermatology and Women’s Services to come up with our Patient Express plan,” Garza said. “I’m grateful to work for an organization that values such creativity and innovation. It goes a long way in forwarding patient care.”

Click here to watch a video of Patient Express when it began with Dermatology.

July 27, 2020

If you ask Michael Pickett, a nurse practitioner in the Pediatric Cardiovascular Anesthesia Section at Texas Children’s, what he enjoys most about his job, he’ll be quick to say – his passion for innovation and the interdisciplinary collaboration with his colleagues. Pickett says no matter how big the challenge, staying focused on the end goal is what keeps him going.

“What I like about innovation is you have to expect the unexpected,” said Pickett, who also serves as an innovation mentor for the Texas Children’s Hospital Global Hematology-Oncology Pediatric Centers of Excellence and Nursing Innovative Solutions Council (ISC) at Texas Children’s. “There’s no guarantee that you’re going to be successful. But the hope is that you will be, and you just have to keep working at it.”

When Pickett was a graduate nurse 22 years ago, he says he faced many of the same challenges new nurses encounter when inserting a peripheral intravenous (PIV), performing central venous catheter (CVC) care and maintenance, and accessing a port on a patient for the first time. Back then, he wished there were more simulation training tools available when he was a new nurse.

As a natural innovator at heart, Pickett was determined to turn this vision into reality. Sharing his concepts with frontline innovators at Texas Children’s, Pickett gained the support from nursing colleagues and leaders across the organization who provided continual feedback throughout the innovation process. It quickly became the team’s goal to develop and implement novel skills technique videos partnered with the PIV, CVC and Port Task Trainers designed by frontline innovators that are wearable, cost-effective, durable, realistic and allow all procedural steps trainees would perform. A secondary goal was to document and open-source the innovation process utilized to develop these proof-of-concepts.

After nearly four years of development including more than 20 prototype iterations and pilot surveys, two international presentations and an international SimVentor award, the RediStik Wearable PIV, CVC and Port Trainers were finalized and produced in collaboration with Sawbones®, the leader in medical models for orthopedic and medical education, along with the support from ISC, Entrepreneurship and Innovation teams, Marketing and Legal departments, and hundreds of frontline innovators representing more than 20 different clinical areas at Texas Children’s Hospital.

The Redistik Wearable PIV, CVC and Port Trainers are portable, light weight, skin models that can be placed on a live person, table top or mannequin. The trainers help clinicians master various procedural skills like how to insert a PIV line, access and de-access a port, and how to perform sterile techniques for dressing application and cap changes to prevent pressure injuries and central line associated bloodstream infections.

“When we designed the task trainers, we wanted the experience to be realistic as possible,” said Pickett, lead inventor of the Redistik Wearable PIV, CVC and Port Trainers. “With many of the current simulation task trainers on the market, once they are used a few times, you can see where to stick and it’s just not as realistic. Our task trainers have a needle proof backing to prevent accidental needle sticks and resilient material that allow for over 1,000 punctures per task trainer that can’t easily be seen on the skin model.”

The RediStik PIV, CVC and Port Trainers were piloted in 2019 and are now being used throughout the Texas Children’s system. The nurse residency program has implemented PIV insertion skills training during new nurse orientation using the Redistik PIV trainers. Prior to training, 15 percent of nurses surveyed said they were “confident” on starting PIV lines. After completing training, their confidence level rose to 96 percent.

“We used the PIV and Port Trainers during our annual training and everyone appreciated the hands-on practice,” said Kate Jones, a decentralized education coordinator. “The ability to move the port placement around to increase the difficulty of access and the ability to get blood return made it much more realistic.”

The impact of Pickett’s innovation can also be felt around the globe. The RediStik PIV, CVC and Port Trainers have been piloted at Texas Children’s Global HOPE clinics in Sub-Saharan Africa where the PIV trainer has had a significant impact on improving their rates of PIV extravasations and reducing PIV attempts.

Far reaching impact

Global HOPE Director of Nursing Education Dr. Marilyn Hockenberry said when she learned about the RediStik PIV Trainer she was ecstatic because the rate of PIV attempts was high in her clinics as well as IV extravasation, which is when you are administering a drug, such as chemotherapy, and it seeps into the outer tissues surrounding the injection site causing painful inflammation.

“Children with cancer in Africa don’t have the benefit of a central line,” Hockenberry said. “All chemotherapy is done through a peripheral vein, creating challenges for both our patients and our providers.”

The use of the RediStik PIV Trainer has greatly reduced these challenges, lessening both the number of PIV attempts and IV extravasation incidents. Hockenberry introduced the innovation to her clinics in Botswana, Malawi and Uganda more than a year ago holding regular hands-on training workshops, many of which are still being held today.

During the workshops, clinical staff learn how to put in a peripheral intravenous line, care for the line and confidently administer chemotherapy. Prior to the trainer, staff learned as they cared for patients. There was no way to do hands-on training.

Competencies learned on the PIV trainers have decreased extravasation rates from 42 percent to 5 percent in less than a year’s time. Prior to using the task trainer, only 19 percent of PIVs were obtained with three or fewer attempts compared to 99 percent after the post task trainer assessments.

“If you want to cure cancer in Africa you have to improve IV use, PIV use and the administration of medication,” Hockenberry said. “These devices are great for making that happen.”

Hockenberry added that without people like Pickett and the team of innovators, the progress made in Africa would not have been able to happen. She said Pickett and the innovation team are crucial to the clinical process and have made a significant difference in the lives of our patients around the globe.

“It’s just a great feeling to see how these innovative training tools have benefited our staff and our patients,” Pickett said. “It took a lot of hard work to finally get to this point, but it was all worth it.”

About Redistik

Visit www.texaschildrens.org/redistik to access product details, skills video tips/techniques and data outcomes. Click here to learn more about Sawbones®.

Contact Michael Pickett at mtpicket@texaschildrens.org if you would like to check out one of the RediStik products for staff training.