Lauren Cavallaro shares how the challenges brought on by COVID-19 has helped her and her colleagues in the Emergency Center become a stronger team as they continue to adapt to new patient care processes during this unprecedented time. Read more
The Child Life team at Texas Children’s has a pretty special job. Through a variety of educational and therapeutic interventions, they strive to alleviate stress and anxiety, while promoting positive coping skills for patients and families during their time at the hospital.
Made up of a variety of teammates – including child life specialist, art, music and animal-assisted therapists along with media professionals and activity, school, library and gaming coordinators – the department focuses on the psychosocial needs of children while collaborating with parents and other health care staff.
The need for such services and expertise has grown exponentially during the pandemic with anxiety and stress among patients and parents at a peak. Texas Children’s Child Life team has stepped in to do their part in calming these new nerves and making patients’ experiences at the hospital the best they can be during these unprecedented times.
“We are glad we are able to be in the room to support patients and families during this challenging time,” said Diane Kaulen, manager of the Texas Child Life Department. “We are there in PPE (personal protective equipment) helping support patients and families through all the emotions that come with illness and hospitalization. Our team is happy to still be working with them.”
The power of play
One way child life team members help children express and process difficult emotions is through play, the power of which can be amazingly strong. Audrey McKim has seen play work wonders time and time again during her tenure as an activity coordinator with Texas Children’s Cancer and Hematology Centers.
“As a child life team we make it a priority to bring patients together through intentional programming anchored by play,” McKim said. “We understand the significance of creating connections and building a community among people who are mere doors apart from each other but have the opportunity to share so much more than a diagnosis.”
Creating these connections during the pandemic has been challenging, but not impossible. McKim said an average day for her begins with huddles in the morning and looks over the census. Based on all the things she and her colleagues know about their patients and their needs, interests, strengths and diversity, they create a new daily challenge game.
Cup stacking and collapsing, ping pong challenge, Play Doh sentences, speed Spot-It, balancing building and trivia are just a few of the games the child life team play with patients in their rooms. To ignite competition among the other patients on the floor, scores reflecting speed and number of questions answered correctly are posted on a giant “Leader Board.”
“Imagine the show ‘Minute to Win It’ happening every day inside patient rooms,” McKim said. “We didn’t even need prizes, bragging rights and Leader Board ranking was enough.
McKim and members of her team also have incorporated photo projects into their repertoire and utilized creative themes burgeoning from social media. They have marked holidays with events like timed St. Patrick’s Day gold coin hunts, Mother’s Day interviews and photos from patient beds, individual egg hunts in rooms, Earth Day and super hero day art.
“What we found is how much patients started looking forward to visits from someone bringing something purposeful and fun that tied people and days together,” McKim said. “In the absence of so much, we have discovered a beauty in the challenge of creating and sustaining community through play all while staying apart from each other.”
Chandler Townsend, a child life specialist in the Emergency Center, said she quickly learned that COVID-19 has more than just medical side effects.
“A hospitalized child within this pandemic is not just experiencing stressors related to hospitalization,” she said. “Our tiny heroes and their caregivers are now walking through our doors with a whole new set of external stressors, already altered from their baseline.”
Children miss their communities of classmates and playdates. Parents find themselves on a seesaw, balancing their work as professionals and as nurturers. The disappointment of a favorite park being closed, a postponed celebration or a canceled trip to see grandparents is felt by all. And, on top of everything, a visit to the hospital.
It takes extra, special intentionality to address kiddos’ fears and foster resilience, and Townsend and colleagues are doing just that and more. They are engaging family members in supportive conversation, recognizing that due to visitation protocols, they may not have their spouse’s hand to squeeze and may benefit from that extra check in.
They are allowing opportunities for control/mastery over a child’s day through procedural preparation, the dissemination of honest information, validating emotions, re-shaping perspectives, being a supportive presence and creating chances for control and facilitating play.
“Child Life is striving to adapt creatively while still keeping patient-and family-centered care at the center of our minds,” Townsend said. “I’ve been so encouraged by my coworkers and their drive to allow kids to be kids.”
Texas Children’s Hospital was recently re-verified as a Level 1 Pediatric Trauma Center by the American College of Surgeons and the Texas Department of State and Health Services.
During the re-verification process, the American College of Surgeons evaluated whether Texas Children’s Hospital met criteria put forth in its Committee on Trauma’s manual, Resources for Optimal Care of the Injured Patient. The evaluation included a lengthy and through questionnaire as well as a site visit.
The evaluation found no deficiencies and listed multiple strengths highlighting the excellent multidisciplinary efforts, leadership, quality improvement, and commitment to research by the hospital and its staff.
The trauma center is led by Dr. Bindi Naik-Mathuria, medical director, and Christi Reeves, the director of trauma services.
There are only 49 Level 1 pediatric trauma centers nationwide. Texas Children’s Hospital was first verified as one in 2010. The re-verification process occurs every three years.
Chief Safety Officer Dr. Joan Shook received the 2016 Jim Seidel Distinguished Service Award from the American Academy of Pediatrics Section on Emergency Medicine at the AAP National Conference on October 22 in San Francisco. The award recognizes members who have provided exceptional service to the section and to the field of pediatric emergency care.
To meet the growing need for pediatric inpatient acute care beds, the Acute Care Nursing Team has opened a temporary Acute Care Holding Unit (ACHU). The unit is located in the West Tower on the fourth floor (across from the NICU Sibling’s Playroom-Old NICU pod S) and can hold up to 10 non-complex, low acuity care patients.
The purpose of the ACHU is to improve patient flow through the Emergency Center (EC) by moving patients from a bed in the EC to an area where they will be cared for by an Acute Care RN. This move will free up high acuity EC beds which are currently being occupied by low acuity care patients.
“Texas Children’s has been experiencing unprecedented patient volumes,” said Monica Simmons, assistant clinical director of nursing for the ACHU. “This morning there were 25 patients holding in the Emergency Center waiting for a bed to open in the Acute Care units. This creates a backlog in the EC because the beds are occupied and new patients cannot be seen.”
By moving acute care patients to this new area, the beds in the EC will be used to see additional patients which will help reduce wait times in the EC and improve patient flow and patient satisfaction. It will also free the EC staff to care for the EC patients (which is their practice specialty) and allow acute care patients to be cared for by Acute Care staff.
The ACHU at West Tower is a temporary holding unit until the new 16-bed inpatient acute care unit opens on 5 North Abercrombie in March 2016. The unit will see primarily Pediatric Hospital Medicine patients of all ages and all diagnoses. The unit is currently under construction.
From now until March 2016, the ACHU will be open Mondays at 7 p.m. to Fridays at 7 p.m. to reflect the hospital’s highest census times.
On December 1, Texas Children’s opened an urgent care clinic on Main Campus, creating a system-wide solution to effectively manage the Emergency Center’s low acuity patient population.
The 4,100-square-foot facility is located on the second floor of the Abercrombie Building and has a dedicated staff of physicians, advanced practice providers, nurses and clinical support staff, all of whom have previously worked in either emergency or urgent care settings. The walls of the clinic’s 11 exam rooms, X-ray room and waiting area are covered in space-themed murals, providing a relaxed, child-friendly atmosphere.
To be seen at the clinic, patients may self select urgent care, or may initially present to the EC, where they will be assessed and then, if appropriate, transferred to the urgent care clinic. If they are transferred, the patient and their family will be escorted to the urgent care clinic’s location.
“Having this option to send low acuity patients to our onsite Texas Children’s Urgent Care clinic permits our EC faculty and staff to devote all of our time, effort and resources to providing the highest quality care to the sickest patients without inconveniencing our lower acuity arrivals,” said EC Medical Director Dr. Paul Sirbaugh. “To put it simply, the clinic will allow us to provide the Right care, at the Right place, at the Right time, for the Right price.”
After just two weeks of being open, the clinic already is lightening the load of the EC, seeing, on average, about 30 patients, or 25 percent of the EC’s patient volume, a day. In addition, wait times for patients with a low-acuity illnesses has decreased dramatically.
“Some low-acuity patients would wait 10 plus hours in the EC before being seen,” said Jeremy Trainer, the manager of the new urgent care clinic. “Now, these patients can be seen at the clinic in an hour or less.”
Karrianna Yu, a physician’s assistant who works in both the EC and the Main Campus Urgent Care Clinic, said the response from everyone – patients, their families and caregivers – has been overwhelmingly positive.
For the patients and their families, Yu said they are pleased because they are seen sooner, they get more time with their caregiver and they are treated quicker in a lower stress environment than the EC. For caregivers, it allows them to focus on what they really need to be doing, which is taking care of high-acuity patients in the EC and low-acuity ones in the urgent care clinic.
“It’s a win for all involved,” Yu said.
Hours of operation
Monday through Friday, 4:30 p.m. to 11 p.m.
Saturday through Sunday, noon to 8 p.m.
Types of conditions treated
What types of procedure can be performed?
Intense study focuses on critical needs of main campus core areas
At the beginning of this year, some pretty exciting things happened at Texas Children’s: a new system-wide mission statement announcement, celebration of the organization’s 60th birthday and the groundbreaking of the new Texas Children’s Hospital The Woodlands. But something even bigger and more imperative was going on behind the scenes: CareFirst.
In January, Texas Children’s launched CareFirst, an intense study of the core areas throughout the main campus. It involves a rigorous, eight-month planning process to help evaluate the hospital’s critical needs and set the right course for the future.
CareFirst initially will center around the needs of three areas:
View this video to see why these areas need our attention.
“In the past several years, we’ve grown our programs and our physical footprint in the community to provide care where there was growing need,” said President and CEO Mark A. Wallace. “CareFirst is about focusing on the pressing needs at our main campus and reinvesting in the core clinical areas.”
In a video Wallace distributed last week, he documented a recent visit to the three core areas. In the videos, Dr. Paul Sirbaugh takes Wallace through the Emergency Center, which receives 50 percent of all 911 and EMS transports in Houston. In the Operating Rooms/PACU, Dr. David Wesson and Judy Swanson explain how some rooms barely accommodate the advanced technology required to take care of our patients. And in Critical Care, Dr. Lara Shekerdemian and Dr. Paul Checchia describe the balancing act involved in taking care of patients who now are surviving because of the care we provide and subsequently requiring longer hospital stays in our over-crowded ICUs.
CareFirst is such a high priority that Texas Children’s Board of Trustees, administrative leaders at all levels, physicians and many Texas Children’s employees have been engaged in the effort. The work teams are dedicating considerable time to CareFirst to move thoughtfully, but swiftly, and Wallace plans to unveil the findings and plans for the next stage of CareFirst at the beginning of fiscal year 2015.
“This will be one of the most difficult initiatives we have ever undertaken,” Wallace said. “Many areas will be impacted, and at times, this is going to challenge us. But I know it is the right thing to do for our patients and their families. It’s about ensuring that exceptional care continues to be first and foremost at Texas Children’s.