October 13, 2021

From nurse practitioners, physician assistants and nurse midwives to certified nursing specialists, certified registered nurse anesthetists and clinical nurse specialists – advanced practice providers (APPs) are elevating the field of medicine and ensuring Texas Children’s delivers high-quality, evidence-based care to our patients and their families.

Set for Oct. 11-16, National APP Week is an opportunity to recognize the hard work of these professionals and raise awareness of the unique role they play in providing increased access and enhancing care for a rapidly growing patient population.

APPs are trusted medical professionals with advanced education and training at the post-graduate and doctoral level. These providers work hand-in-hand with physicians to create a seamless environment of care, making more appointments available for patients. They also support a team-based approach.

“When I started at Texas Children’s, many barriers had to be broken down,” said Veronica Victorian, assistant director of Surgical Advanced Practice. “Signs were placed in clinic to explain what an APP is and how they function – not only for patients, but for staff.”

The growth in the number of APPs across the organization and our various service lines since those early days is a strong reflection of their significant contributions and continued impact.

Ryan Krasnosky, chief of Wound Care, remembers starting his Texas Children’s career as one of less than five Surgical APPs. “The Department of Surgery alone now has over 130,” he said.

What do APPs do?

APPs are now a fixture in many areas of medicine and locations throughout our institution: at our primary care clinics, in acute and critical care, emergency medicine and subspecialty and perioperative services. But when Shannon McCord started at Texas Children’s in 1991 as a clinical nurse specialist in the pediatric intensive care unit, the role was so new she had to write her own job description.

“I went on to become a pediatric nurse practitioner specializing Wound, Ostomy and Continence Care,” said McCord, director of Advanced Practice Providers and Nursing Clinical Support Services, Community. “Now, 30 years later, we have more than 400 advanced practice providers delivering care across our system – serving not only in the hospital setting, but in our community locations that include the Centers for Women and Children, Subspecialty Care Clinics, TCP, Urgent Care and Austin.”

The scope of the APP’s duties finds these providers completing many tasks that doctors would complete – minor office procedures, management of routine diagnoses, providing medical education, assisting in the operating room and writing prescriptions. Yet rather than replacing doctors, APPs instead work collaboratively, under the supervision of a physician.

“As the profession has grown, we’ve seen a higher prevalence of APPs in subspecialized care,” said Angela Gooden, director of Advanced Practice at Texas Children’s. “This collaborative relationship often develops into a very autonomous APP role.”

Given the rising demands of health care delivery and shortages in the number of physicians to meet them, it has become widely accepted that important work could not be accomplished for patients and families without the partnership of APPs.

The APP role during the pandemic

The essential nature of our APPs has been even more apparent since the onset of the COVID-19 pandemic, which has required frontline team members to be nimble to care for our patients and their families amid an uncertain and rapidly changing situation.

Texas Children’s versatile APPs aided vaccine clinics, filled roles in numerous departments, participated in COVID-19 testing and worked together to coordinate care. Every time they were asked to step up to a new challenge, much like those in other team-centric departments, these providers responded in remarkable fashion – paving the way for many initiatives adopted during the pandemic to stay in place long-term.

Join the celebration!

There is no doubt Texas Children’s APPs have proven through their dedicated service over the years that they are adaptable, flexible and collaborative members of our One Amazing Team.

Join us in thanking our APPs for their commitment and contributions during National APP Week and all year-round! A planning committee comprised of Danielle Comeaux, Caitlin Justus, Karen Hizon, Jordan Rodriguez and Vianey Ruiz will be hosting special events and activities throughout the week. Look for photos from the celebrations on the @texaschildrenspeople Instagram.

November 12, 2018

Eighteen-year-old Angeles Vasquez was anxious and scared. For months, a painful wound had lingered on her right ankle. No matter what remedy she and her family tried, it just wouldn’t heal. Unable to find answers or relief elsewhere, they turned to Texas Children’s Hospital and our new pediatric Wound Care Clinic, a new initiative spearheaded by Chief of Plastic Surgery Dr. Edward Buchanan and Director of Surgical Advanced Practice Providers Ryan Krasnosky.

“Dr. Buchanan and Ryan were awesome,” Vasquez said “They gave me the medications I needed and taught me how to properly clean and care for the wound. It’s finally healing and they’re still checking in with me all the time to make sure I’m okay.”

The new Texas Children’s Wound Care Clinic – one of only a few in the country, and the first and only one of its kind in Texas – is a comprehensive center where patients can have a variety of wounds evaluated and treated by an experienced, multidisciplinary team of dedicated medical, surgical, nursing and advanced practice providers.

The team uses evidence-based, standardized treatment protocols – which are under constant scientific scrutiny – to develop individualized treatment plans for each patient. These care plans take into account factors such as wound origin and location, as well as patient and family lifestyle, to determine the best approach to maintenance and to prevent future wounds. Additionally, data from each case is carefully analyzed with the dual goals of improving clinical processes and ensuring care protocols provide the best possible outcomes.

“There is a huge need for this kind of care in Houston and across the United States,” said Buchanan. “We want to lead the way in pediatric wound care on the national level, developing scientifically supported protocols that become the standard of pediatric wound care. With our clinical volume and our dedication to treating these patients, we’re strategically positioned to accomplish this goal.”

Experts in the Wound Care Clinic currently see patients from across the Texas Children’s system at our Texas Medical Center campus, providing high-quality care for a wide range of conditions, including:

  • Animal bites
  • Chronic wounds
  • Deep pressure wounds and ulcers
  • Fragile skin and other skin issues
  • Gastrostomy or other tube issues
  • Soft tissue infections
  • Thermal skin injuries (that do not meet criteria for burn transfer)
  • Trauma
  • Wounds in babies with congenital anomalies

“These wounds are often complex and can take quite some time to heal,” said Surgeon-in-Chief Dr. Larry Hollier. “It’s wonderful for a patient to be able to see a team that has all the expertise and products available to heal these wounds in a timely fashion. Additionally, we have the ability to perform minor procedures to speed along the healing and are also able to directly schedule surgeries from the clinic if necessary.”

Still in its beginning phase, the clinic is currently held one day a week. However, in the months since the clinic’s opening, there has been a rapid increase in patient volume, and preliminary plans are already being made for expansion to West Campus and The Woodlands.

“The growth in volume is a testament to the high-quality care our patients are receiving,” Krasnosky said. “Families have been extremely pleased with the care we’re providing and they’ve voiced their appreciation for having a consistent ‘home’ for wound care.”

As the clinic grows, teams will continue to analyze data and lessons learned in order to further standardize clinical processes and care protocols. Long-term goals include the introduction of same-day surgical interventions, for wounds that require more invasive treatment. There are also plans for the integration of a comprehensive research component, with a basic science emphasis on wound healing and clinical research efforts focused on developing evidence-based wound care guidelines, as well as the creation of novel wound treatments and care assessment tools.

In the meantime, clinic care teams are laser-focused on providing the best possible wound care and improving outcomes for every patient who comes to us.

“The Wound Care Clinic is open to any and all wounds that practitioners need assistance with,” Buchanan said. “We hope to get involved early in the care of pediatric wounds within the Texas Children’s system, so as to decrease the time to healing and improve the quality of life of our patients. As our clinic expands, our capacity will expand, and we will be able to provide services to all patient populations. No wound is too trivial or small for an evaluation.”

March 11, 2014

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Texas Children’s Advance Practice Providers hosted their first International Conference recently. It was a huge success with more than 130 attendees from across the world. The conference started with two days of pre-conference seminars focusing on pharmacology, skills labs and palliative care. The main conference included attendees and speakers from across the nation to equip advance practice providers with acute and subspecialty care knowledge, as well as to connect with experts for collaboration.

The mission of the Texas Children’s Hospital Advanced Practice Provider Conference (TCHAPP) was to empower advanced practice registered nurses (APRNs) and physician assistants (PAs) through state of the art education, training, innovation, collaboration and professional development. The conference curriculum was diverse and allowed attendees to tailor their learning experience to their own unique practice needs.