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 25, 2020

Pediatric Surgeon Dr. Paul Minifee has worked at Texas Children’s for almost three decades. Over the years, one of his primary focuses has become educating and mentoring residents and medical students on rotations in pediatric surgery.

“I have always enjoyed sharing my knowledge and experience with others, especially young people who are early in their medical careers,” Minifee said. “It’s been one of the most fulfilling parts of my career.”

Recently, Minifee got the opportunity to teach and operate with a very special student – his son, Dr. Chris Minifee, a third-year surgical resident at the University of Texas Medical Branch. Chris is spending two and a half months at Texas Children’s on rotation with the Orthopedic Surgery Department.

The day he collaborated with his dad in the operating room he was performing an anterior scoliosis repair with Dr. Brian Smith, Texas Children’s chief of orthopedic surgery. Paul came in at the beginning and the end of the surgery to open and close the patient’s chest. Chris assisted him with the procedure, a common practice for orthopedic surgeons in cases such as the one they were working on.

“I immediately went to the coaching skills I learned in baseball,” Paul said about how he handled guiding his son in the operating room. “They worked back then and they seemed to work that day too.”

Paul said his son did a great job and that he executed his part of the procedure very well. What made him most proud was the positive comments from his colleagues about his son’s work in the operating room that day and on other occasions during his rotation.

“It was truly a joy to be there with him and to hear from others what good work he’s doing for others,” Paul said. He added that the father-son duo was making history that day in that he, the first Black pediatric surgeon trained in Texas and the second to be licensed in the state, was operating with his son, who is one of a small but growing number of Black surgeons in the state and the nation. “We were making history in there,” Paul said. “I’m glad it was at Texas Children’s, a place where I have always felt comfortable, accepted and able to grow in my career.”

Chris said operating with his dad has thus far been the proudest moment of his medical career. The operating lounge they were in after surgery, Chris said, was the same lounge he saw his dad in years ago when he shadowed him during junior college. It was around then that he decided to pursue medicine instead of his first love – baseball.

“I wanted to be a professional baseball player but that didn’t pan out,” Chris said. “I’m glad I had a backup plan (orthopedic medicine) and that I have come to love it as much as or more so than baseball.”

Chris said a lot of what his dad taught him on the ballfield translated over to the classroom and now the OR. Some of those things include team work, persistence, and the desire and drive to be your best.

Throughout his rotation at Texas Children’s and from what he’s seen and heard through his dad over the years, Texas Children’s is a place where people’s best is exhibited across the board. He said that includes diversity among the organization’s workforce.

While operating at Texas Children’s, Chris said, the OR has been filled with people from different ethnicities and walks of life. “You probably didn’t see that 20 years ago, but things have changed, which is refreshing.” he said.

August 11, 2020

Thanks to Texas Children’s Hip Preservation Program, eighteen-year-old Mallory Sweeney is back to doing what she loves – dancing. Read more

June 8, 2020

Texas Children’s is excited to announce that the trauma centers at Texas Children’s Hospital West Campus and Texas Children’s Hospital The Woodlands have been designated Level IV trauma centers by the Department of State Health Services.

“This is a tremendous accomplishment that will officially put our community hospitals on the map in terms of places trauma patients can go to receive care,” said Dr. Sohail Shah, West Campus’ chief surgical officer. “It’s a move that will ensure patients receive the right care, at the right place at the right time.”

Dr. Jeffrey Shilt, chief of community surgery, agreed, and said this tremendous effort really highlighted the collaboration between both community campuses and Texas Children’s Hospital Medical Center Campus leadership.

“Every planning meeting was the epitome of system coordination between the departments of nursing, surgery, emergency medicine, and the executives,” Shilt said. “We had a goal in mind and everyone came together to accomplish it for the greater good of our patients and their families.”

A Level IV trauma center is capable of stabilizing any trauma patient it receives, handling onsite single-system orthopedic injuries and superficial lacerations. More complex cases are stabilized and then transferred to a higher level trauma center such as our Level I trauma center in the Medical Center.

The Level IV designation sends a clear signal to first responders that our community hospitals are equipped to handle such trauma patients. West Campus and The Woodlands have been caring for such patients since the hospitals opened their doors, however the designation formalizes that process and holds the centers to certain quality and process improvement standards.

Preparation for the designation process took a little over a year and was a collaborative effort between Nursing, the Department of Surgery, Emergency Medicine and leaders at the community hospitals. During the designation process, trauma medical directors and nursing coordinators were named at each campus.

Dr. Ruben Rodriquez is the trauma medical director in The Woodlands and Shah serves as the trauma medical director, in addition to his role as chief surgical officer, at West Campus. Julie Hollan is the trauma nursing coordinator in The Woodlands and John Coley is the trauma nursing coordinator at West Campus.

“Trauma care demands committed teamwork, beginning in the Emergency Center with the physicians and staff playing a critical role in receiving trauma patients and working with the surgeons in managing their care,” said Dr. Bindi Naik-Mathuria, medical director of our Level I Trauma Center at Texas Children’s Hospital Medical Center Campus. “The teams at West Campus and The Woodlands are equipped and ready to serve our Greater Houston community in this very important way.”

May 18, 2020

As Texas Children’s begins its fifth official week of phased reopening and redesign, the organization continues to focus on a careful, strategic plan that supports family-centered care for our patients and meets our organizational expectations around quality and safety.

What this means for our patients and families is that services will open in phases, not all at once. For employees, a phased reopening means some of us will resume a full work schedule either at home or at one of our Texas Children’s facilities sooner than others.

“Patience and prudence are key,” said Chief Information and Innovation Officer Myra Davis. “We want to ensure everything we do operationally is safe and volume-driven. This means that just as we flexed down to demand, we will also flex back up to demand, where appropriate. The next few weeks and months ahead will be a thoughtful balance between the two and will help pave the way toward a successful future.”

Davis, along with Surgeon-in-Chief Dr. Larry Hollier and Executive Vice President Dan DiPrisco, are leading the Phased Reopen and Redesign Command for Texas Children’s.

Signs of success

Two areas of our system that have seen early success during the phased reopening and redesign are Surgery and Radiology. Since reopening in late April, the Department of Surgery, Anesthesiology and Perioperative Services have opened schedules in operating rooms across the system to nearly 50 percent capacity. To date, 700-plus cases have been completed at our community locations and more than 1,000 pediatric and women’s cases have been conducted at the Texas Medical Center Campus.

Two weeks ago, Radiology began its phased reopening and redesign, aiming for 50 percent of pre-COVID-19 imaging volume that week. The service line exceeded that goal, completing more than 640 studies per day. Pre-COVID-19, daily activity across the system was about 1,100 studies per day. During COVID-19, daily activity dropped to 350-400 studies per day. As a result of the steady uptick in patient volume, Radiology has completely reopened all of its appointments.

“We are encouraged by the quick response from the community to our thoughtful and agile reopening and redesign plans,” said Radiologist-in-Chief Dr. Thierry Huisman. “We are committed to continuing to serve our patients and families while keeping them and our staff safe and healthy during this pandemic.”

Hollier said his department plans to thoughtfully open additional ORs to match demand, all while maintaining social distancing protocols and other rigorous safety measures.

“Our primary goal has been and always will be to keep our patients and families safe and healthy,” he said.

Safety first

Safety measures and protocols have been put into place to protect our patients and families during their entire experience with Texas Children’s. This experience begins before they walk into one of our facilities and doesn’t end until long after they leave.

Before anybody comes into our facilities, they’re screened, to the best of our ability to make sure they are safe and healthy. This means all doctors, nurses, staff, patients and family members. Once they’re inside, everyone is required to wear a mask and adhere to social distancing.

“We want to respect these rules because we feel they protect patients from contracting the virus,” Hollier said. “We also feel it’s very important to test patients who are undergoing surgery and other procedures for COVID-19.”

No more than 48 hours before a surgical procedure, patients will receive a COVID-19 test, typically at one of our drive-through facilities for convenience. If the test is negative, the surgical procedure will proceed. If a patient tests positive for the coronavirus, the procedure will be delayed and retesting will occur to ensure the patient is negative before they undergo surgical or any other procedure that deems prior testing.

Radiology implemented a new process that allows patients to wait in their vehicle and call from the parking lot/garage upon arrival at our community locations, rather than entering the building and having to sit in the waiting area. Radiology services at Texas Children’s Hospital The Woodlands went live with pre check-in for patients who have a MyChart account. After a brief trial period, Radiology will implement this at West Campus and at our Medical Center Campus as well.

A mom who had rescheduled her daughter’s MRI due to safety concerns related to COVID-19, said she was relieved to learn about all of the safety measures and protocols Texas Children’s has in place to protect patients and families.

“Everything was easy and very smooth,” the mom said. “I appreciated calling from the garage, and I felt very safe.”

To learn more about additional precautions Texas Children’s is taking to protect our patients, families and staff click here.

Moving forward

This week, we launched plans for the reopening of our Ambulatory services and are working to ensure our facilities can accommodate increased activity while maintaining infection control guidelines.

Ramping our services back up at Texas Children’s is a welcoming indicator. It’s exciting, but this is merely the start for us. We are reopening thoughtfully and in phases, based on where we have the most demand for our services.

It will take much more time and careful planning to reopen completely. But moving strategically is what will restore us for the long-term, and what will ultimately ensure our organization’s future success and sturdiness.

“Thank you for all you are doing,” DiPrisco said. “The care you are providing for our patients and their families through this evolving situation is outstanding and proves that our challenges of the past few months have made us even better equipped for what’s ahead.”

April 28, 2020

Throughout the COVID-19 pandemic Texas Children’s has remained focused on caring for our patients and their families while preserving their safety and the safety of our workforce. One area where this is especially important is in the operating room where the risks of contagion could be higher than the average hospital setting.

“The operating room is a high-risk environment because of the potential to need to intubate and extubate patients,” said Children’s Surgery Program Manager Joyce Enochs. “Both of these procedures generate aerosolized particles, which can put medical workers at a greater risk of contracting COVID-19 from an infected patient.”

To protect the perioperative staff from any undo exposure or risk, the Departments of Surgery and Anesthesiology, Perioperative and Pain Medicine have taken a two-phased approach in protecting families and staff alike. The first phase entailed creating a training program for a new care paradigm for potential COVID patients. Dr. Chris Glover, medical director of Perioperative Services, in conjunction with Department of Anesthesiology and Perioperative and Pain Medicine Simulation Committee Members – Dr. David Young, Dr. Lisa Caplan, and Dr. Kathleen Chen – created the program from the ground up to reinforce this new workflow.

The program includes an information session where team members learned about COVID-19 and how Texas Children’s employees are protecting themselves from the disease; a simulation where team members learn how to don and doff PPE appropriately and confidently; and a simulation where team members transport a mock patient from an intensive care setting into the operating room, intubate them, return to the intensive care unit.

In addition, the training covers additional precautions to limit transmission risk in the operating room. These precautions include modifications during intubation and extubation, such as the use of N95 masks and goggles, as well as the incorporation of High Efficiency Particle Air or HEPA filters on the anesthesia circuits to filter out particles and ensure that none are emitted into the air. Another effort to mitigate aerosolization in the operating room is modifying induction techniques by using plastic barriers for patients.

The second phase of this new care approach is the incorporation of expanded testing so that every patient presenting for surgery receives COVID-19 testing prior to arrival. This further answers concerns on potential exposures of our perioperative staff as well as taking a judicious approach to appropriately utilize PPE.

“This is an overarching effort to ensure our health care workers, our folks who are on the frontlines, are protected as we’re dealing with this unprecedented event,” Gover said “For us to proceed along this pathway, we’ve had a lot of support and guidance throughout the organization.”

Anesthesiologist-in-Chief Dr. Dean Andropoulos agreed and said the efforts and countless hours from the anesthesiologists who led this simulation training should be commended. “Not only are they leading at Texas Children’s Hospital, but they are setting standards for potential future outbreaks at all Children’s hospitals,” Andropoulos said.

The training positions the team well as it continues to prepare to care for those diagnosed with COVID-19 and as the team begins to take on elective surgeries again. In light of Gov. Abbott’s decision to loosen restrictions put in place for elective surgeries, the Department of Surgery is prioritizing cases that initially may not have been urgent, but are now more important due to the several week delay.

“Through a phased approach, our surgical team is working through the large number of cases that are pressing, primarily outpatient cases, and prioritizing them appropriately based on a variety of factors,” said Surgeon-in-Chief Dr. Larry Hollier. “During the previous order, Texas Children’s continued to serve patients who needed us while remaining mindful of the impact elective surgeries may have had on critical supplies and resources. We remain prepared to care for those diagnosed with COVID-19 and cognizant of our supply levels while providing the best care possible to all patients, as we are here for them during this time and beyond.”

February 10, 2020

Texas Children’s and Baylor College of Medicine pediatric ophthalmologist Dr. Evelyn Paysse and Baylor College of Medicine refractive surgery specialist Dr. Mitchell Weikert have spent nearly two decades giving children with certain eye conditions hope of better vision.

The work they are doing focuses on children with amblyopia, a condition that if left untreated can lead to permanent vision loss.

“Amblyopia is a condition where the vision, in either one eye or both eyes, does not develop normally,” Weikert said. “If one eye has a lot more need for glasses, the brain may ignore that eye, and focus on the eye that’s creating a clearer image. If that happens, and it’s not discovered, or isn’t treated optimally, a child may never develop the vision they could have had in that eye and might end up with what we call a lazy eye, or amblyopia.”

The solution Paysse and Weikert are offering to patients who have not had success with traditional therapies such as wearing glasses or contacts, and patching the better-seeing eye, is a procedure called photorefractive keratectomy or PRK.

“Photo refractive keratectomy is a surface ablation of the cornea using an excimer laser,” Paysse said. “The laser shaves away, or somewhat sculpts, the cornea, taking away a certain amount of it to reduce the refractive error.”

The desired outcome of PRK is that the child’s refractive disorder will be improved or corrected and that their brain will then be able to better develop the vision in the weaker eye. Thus far, the majority of the more than 180 patients Paysse and Weikert have operated on have had excellent results.

“We find that the patients respond better if they are treated at a younger age,” Paysse said. “The reason is that amblyopia is a time-sensitive problem that you really must treat before the patient is visually mature in the brain.”

One patient who had success with PRK is 8-year-old Lila McLaughlin. Lila was born three months early with a myriad of vision problems that eventually led her and her mother, Laura, to Paysse, who performed PRK surgery on Lila just before her second birthday. The surgery, and a subsequent procedure, changed Lila’s life.

“She went into surgery and came back with what I say was a new set of eyes,” said Lila’s mother, Laura McLaughlin said.

Prior to PRK surgery, Lila’s vision was deteriorating quickly causing the toddler to become legally blind in one of her eyes. After undergoing PRK, Lila could see almost perfectly.

“This surgery has given her a healthy outcome,” Laura McLaughlin said. “Lila has blossomed into a phenomenal, fun-loving, feisty firecracker of a third grader.”

Lila herself is extremely thankful for the care she received from Paysse and others at Texas Children’s who have participated in her care.

“She’s a really great doctor,” Lila said. “She successfully helped me see way better than I used to.”

Currently, PRK surgery is not approved by the Federal Drug Administration in children. All the patients Paysse and Weikert have treated are part of a study led by the Institutional Review Board of Baylor College of Medicine, a consortium of committees that checks doctors’ protocols making sure they are designed safely.