February 24, 2015

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During the early morning hours of February 17, Elysse Mata sat holding her babies tightly, kissing them as tears ran down her face. She was saying goodbye to her girls, conjoined for the last time before undergoing a historical surgery that would offer them their first chance at separate lives.

“We’ve been waiting for this moment for a year,” Elysse said. “Ever since we found out the twins were conjoined, we’ve been praying and hoping this day would come.”

Conjoined twins Knatalye Hope and Adeline Faith Mata – known by their family simply as Hope and Faith – were born at Texas Children’s Pavilion for Women on April 11, 2014 via Caesarean-section at 31 weeks gestation after weeks of extensive prenatal imaging, multidisciplinary consultation and planning at Texas Children’s Fetal Center. The babies each weighed 3 pounds, 7 ounces.

Surgeons allowed the girls to grow and gain strength for 10 months before undertaking the difficult task of separating them. During that time our comprehensive team of surgeons, physicians, nurses and support staff prepared for the day that had finally arrived. The lead surgeons had met and thoughtfully examined every aspect of their procedure, the simulation staff prepared the team for complications, and Critical Care nurses were readying the PICU for the girls post-surgery.

Letting go

In those quiet, prayerful moments before the surgery, Elysse’s husband, John Eric, and their 5-year-old son, Azariah, were also near, kissing the girls’ foreheads and squeezing their tiny hands while they anxiously awaited the start of the surgery that would change the girls’ lives forever. A group of extended family, friends and a Texas Children’s Hospital chaplain joined the Matas for an emotional prayer.

Lead surgeon Dr. Darrell Cass entered the room, gave the family a hug, and with the help of supporting operating room staff, escorted the girls to Texas Children’s Operating Room 12. Members of the girls’ NICU care team, who had been by their sides for almost a year, lined the hallways in an emotional show of support.

Just after 7 a.m., Hope and Faith were wheeled into the operating room where a team of 12 surgeons from seven specialties, six anesthesiologists, eight highly trained nurses and support staff spent nearly 24 hours performing an operation that would eventually separate the twins.

Surgery begins

During the first few hours of the procedure, Anesthesiologist Dr. Helana Karlberg and Surgical Nurse Audra Rushing prepped the girls for surgery. At 1:10 p.m., Chief of Plastic Surgery Dr. Larry Hollier made the first incision. For the next 18 hours, the surgical team worked in shifts to separate the twins, who shared a chest wall, pericardial sac (the lining of the heart), diaphragm, liver, intestines, bladder, uterus and pelvis.

As the surgeons continued the difficult task, family and friends gathered in a large, room praying and supporting the parents while they waited for updates from the surgical team.

“This is the (most difficult) feeling ever,” said John Eric Mata as he and Elysse waited for their first in-person update. “It’s giving me too much time to think. I’ll be a lot more comfortable when they say they are separated. I’m ready for that.”

At one point, the family was told there had been a rocky part in the procedure when the twin’s livers were being operated on. During that process, surgeons explained there was quite a bit of blood loss and that the anesthesiologists and cardiologist in the room had to keep up with that and maintain the girls’ blood pressure.

“At times it was difficult,” Hollier said. “But it was controlled very rapidly, allowing us to move on with the procedure.”

Hours later, Eric and Elysse heard the answer to months of prayers when Pediatric Surgeon Dr. Oluyinka Olutoye met them in a private consult room and delivered the good news – the twins had been successfully separated.

“This is the farthest they’ve been from each other,” Olutoye said when we greeted the family around 1 a.m. “They’re about 30 feet apart right now.”

They are two

Separate for the first time, the twins were taken to different operating rooms where surgeons continued to work on the girls’ critical organs. Just before 10 a.m., the surgery was complete, and the family visited their girls, apart for the first time in rooms next to each other in the PICU, where they are being cared for by a team of their NICU primary nurses and their new PICU nurses.

Elysse said she and her family are extremely grateful for the team that separated her babies, and the countless hours they put into understanding the girls’ condition, and how best to treat and care for them.

Cass and several of the other surgeons, including plastic surgeon Dr. Ed Buchanan, met the family in Adeline’s room to share in the family’s joy and relief. They gave the family a summary of the monumental procedure and explained what they should expect in the next few days.

“Thank you for your trust,” Cass said to the Mata family. “We are going to keep doing everything we can to get them through this. So far, so good.”

Hollier said that to the best we know this is the first time a case of this magnitude – conjoined twins connected at the chest, abdomen and pelvis – has ever been done.

“It could not have gone better,” he said. “It was phenomenal team work and great preparation on the part of the institution.”

Click on the photo to view a gallery showing the Mata’s journey to separation.
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A dream realized

By late morning Wednesday, February 19, Elysse and John Eric were again with their babies, watching over their girls, now in two beds, in adjoining PICU rooms. It was a moment they had been waiting for since more than a year ago when a routine ultrasound revealed that Elysse was carrying conjoined twins. They traveled from their hometown of Lubbock to Texas Children’s Fetal Center, where the next chapter of their journey began.

Today, their family has a promising new chapter, thanks to the compassionate expertise of our physicians, nurses and countless staff and employees.

“We love them,” Elysse said of the girls’ medical team. “They mean the world to us, and they will forever hold a special place in our hearts.”

Conjoined Twins Separation Surgical Team

  • Plastic Surgeon Dr. Ed Buchanan
  • Lead Pediatric Surgeon and Co-Director of Texas Children’s Fetal Center Dr. Darrell Cass
  • Chief of Pediatric Gynecology Dr. Jennifer Dietrich
  • Pediatric Urologist Dr. Patricio Gargollo
  • Transplant Services Surgeon Dr. John Goss
  • Anesthesiologist Dr. Kalyani Govindan
  • Chief of Plastic Surgery Dr. Larry Hollier
  • Lead Anesthesiologist Dr. Helena Karlberg
  • Plastic Surgeon Dr. David Khechoyan
  • Pediatric Urologist Dr. Chester Koh
  • Cardiovascular Surgeon Dr. Dean McKenzie
  • Pediatric Surgeon and Co-Director of Texas Children’s Fetal Center Dr. Oluyinka Olutoye
  • Anesthesiologist Dr. Olutoyin Olutoye
  • Chief of Orthopedics Dr. William Phillips
  • Lead Surgical Nurse Audra Rushing
  • Anesthesiologist Dr. Steve Stayer

Learn more about the Mata twins and the preparation Texas Children’s team took on to care for the girls:
Mata conjoined twins born at Texas Children’s
Tissue expander surgery allows twins to prepare for separation surgery
Mata twins’ care team helps create swing for baby girls
Radiology team helps prepare surgeons for separation surgery with 3D model

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Many of you read the announcement about our CareFirst plans in November, and just a few weeks ago, you began seeing the CareFirst window clings and banners around the Main Campus. The CareFirst initiative will drive our reinvestment in the programs our most critically ill patients need – primarily in the Critical Care units, operating rooms, Heart Center, Emergency Center and many of our Diagnostic and Therapeutic Services.

We recently spoke with a mother whose child spent three months in our pediatric intensive care unit. The mother, along with President and CEO Mark A. Wallace and some of our leaders who are driving the capital project, explain what CareFirst will really mean to our patients, their families and our staff and employees.

Below are some key facts and figures about the CareFirst project.

19 floor expansion to create Pediatric Tower E, which will include:

  • 129 critical care beds
  • 7 additional high-technology ORs
  • 1 new radiology suite
  • Completed in 2018

West Tower renovation to include:

  • 57-bed emergency center with 12-bed short-stay unit
  • Completed in 2020

640,000 square feet of new space will be added overall.

$575M is the total cost of the project.

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Have you ever wondered why life leads us down certain career paths? For Dr. Ruth Ann Luna, the answer is obvious – her immense curiosity and passion for research to improve the quality of life for sick children.

As director of medical metagenomics at Texas Children’s Microbiome Center, Luna focuses much of her research on the link between disturbances in the gut microbiome – bacterial communities in the gastrointestinal (GI) tract – and GI symptoms in children.

Her quest for answers goes far beyond her role as an astute scientist. One of her biggest motivators is her 6-year-old son, Kellen, who has autism accompanied by significant GI problems – a common complaint among children with autism spectrum disorders.

22515autisminside495“When Autism Speaks announced its GI and Neurobehavioral Processes grant almost a year ago, I recognized it as the opportunity of a lifetime,” said Luna, an assistant professor of pathology at Baylor College of Medicine. “I was in awe when I found out we were awarded this funding to advance autism research.”

With the support of a $1.4 million, three-year grant, Luna and her colleagues at Texas Children’s and Baylor will embark on a comprehensive, multi-center study to determine if a biological connection exists between autism and GI disorders.

“Previous research has shown that gastrointestinal problems are more common among individuals with autism and may worsen behavioral problems,” said Texas Children’s Pathologist-in-Chief Dr. James Versalovic, the Milton J. Finegold professor of pathology at Baylor and director of Texas Children’s Microbiome Center.

Co-led by Luna and Versalovic, scientists in the Microbiome Center will evaluate behavior, GI symptoms, the microbiome and the metabolome, all in the hopes of identifying biomarkers of abdominal pain, understanding the impact of the gut-brain-microbiome axis and determining metabolic disturbances in autism.

“There are inherent differences in the guts of children with autism,” Luna said. “By analyzing all of these factors, we hope to develop better ways to diagnose and treat gastrointestinal issues in children with autism.”

The autism study will enroll 375 children ages 4 through 12 at Texas Children’s, the University of Texas Southwestern Medical Center in Dallas and Nationwide Children’s Hospital in Columbus, Ohio.

Children with autism – with and without GI symptoms – and their unaffected siblings, and children without autism, with and without GI symptoms, are currently being recruited for the study.

“The data gleaned from our research will benefit my son and other families who have children with autism, especially those children with limited verbal abilities” Luna said. “This amazing opportunity to positively impact lives is what makes my job extremely fulfilling.”

For more information or to enroll in the Microbiome Center’s autism and GI study, contact Luna at Ext. 4-1894 or raluna@texaschildrens.org.

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Klaus Loewy from Information Services is the latest Texas Children’s Super Star employee. “The thought that my efforts result in value to my customers and ultimately in better care for our patients is what motivates me every day,” Loewy said.

Read more of Loewy’s interview:

Q&A: Klaus Loewy, November 2014 Employee

Your name, title and department. How long have you worked here?
Klaus Loewy, Business Intelligence Architect. It is going to be two years in March since I started working at Texas Children’s Hospital.

What month are you Super Star for?
November.

Tell us how you found out you won a super star award.
Information Services had an impromptu huddle. My boss announced the award. This caught me by surprise.

What does it mean to be recognized for the hard work you do?
It is humbling. I work every day with many people that deserve this kind of recognition, people from my department and from the departments I collaborate with.

What do you think makes someone at Texas Children’s a super star?
People who are mission driven and results oriented. People who work hard to add value to the organization and the teams he or she belongs to.

What is your motivation for going above and beyond every day at work?
I really enjoy the work I do and the collaborative environment that it requires. The thought that my efforts result in value to my customers and ultimately in better care for our patients is what motivates me every day.

What is the best thing about working at Texas Children’s?
The people and the culture of the organization.

Anything else you want to share?
I am really happy to be part of the Texas Children’s Hospital family. I look forward to continue growing professionally here and continue building friendships and good memories with my coworkers and customers.

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Texas Children’s Mobile Clinics are now equipped with EPIC, allowing medical staff to offer a more thorough continuum of care.

“We aim to find medical homes for all our families,” said Dr. Sanghamitra Misra, medical director of the Texas Children’s Mobile Clinic Program. “Now that we are entering our clinic notes into EPIC, any practitioner within the Texas Children’s system can read our notes to understand a patient’s history and diagnoses. This provides continuity of care that we have never had before.”

As a result, follow-up care, even if it takes place in the emergency room, can be more coordinated. With a simple keyboard stroke, medical staff organization-wide can access information about patients treated at the mobile clinics. In turn, staff at the mobile clinics can track their patients’ follow-up care.

“We often care for children on the mobile clinics who suffer from chronic illnesses and need follow-up care,” Misra said. “With Epic, we can more easily get them into a medical home and, if needed, a referral to a Texas Children’s specialist.

Texas Children’s Pediatric President Kay Tittle said the move to putting the mobile clinics on EPIC is a positive one that will provide better documentation of the patients seen through the Mobile Clinic Program.

“Our patients will benefit from it and so will our medical staff,” Tittle said. “It’s a win-win for everyone involved.”

The Texas Children’s Mobile Clinic Program is composed of two clinics: The Superkids Mobile Clinic and the Ronald McDonald Care Mobile. The mission of the program is to provide underserved children in the Houston area with comprehensive health care and preventive education.

During the school year, the Super Kids Mobile Clinic travels primarily to Houston Independent School District schools, community centers and churches in the Southwest Gulfton area. The Ronald McDonald Care Mobile travels primarily to HISD schools, community centers and churches in the Southeast Hobby area.

The clinic provides free vaccinations to those who qualify for the Texas Vaccines for Children program and also provides free well child visits, sick visits and hearing or vision screenings for uninsured children in the Houston area. In addition, both mobile clinics have pharmacies that are stocked with common medications. The providers can perform common laboratory tests. Lastly, providers and staff members educate all patients coming through the clinic about the different insurance options available to them.

In the summer, the clinics travel throughout the Houston area and sometimes even further to provide free vaccines to children before the school year starts.

February 17, 2015

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Quality is key, but convenience also plays a big part in the decision-making process when parents are looking for subspecialty and therapy services. That’s why Texas Children’s works hard to make such services convenient to families throughout the greater Houston area.

The organization’s most recent efforts focus on Kingwood, where Texas Children’s Specialty Care at Kingwood Glen opened January 5, and Texas Children’s Hospital Outpatient Therapy at Kingwood Glen and Texas Children’s Hospital Sports Medicine Therapy at Kingwood Glen opened in October.

Texas Children’s Specialty Care at Kingwood Glen offers medical services in cardiology, pediatric surgery, plastic surgery and pulmonary medicine. The specialty center also offers diagnostic services in cardiac echosonography, EKG/Holter/Event Monitors, pulmonary function testing, X-ray and ultrasound. Orthopedics, urology and point-of-care testing will be offered in the late spring or early summer.

Staffed by pediatric specialists from Texas Children’s Hospital and Baylor College of Medicine, the 4,874-square-foot facility at the corner of Farm to Market Road 1960 and West Lake Houston Parkway in Humble has six exam rooms, an X-ray room, a casting room and a lab. The Specialty Care Center at Kingwood Glen joins four existing Health Centers in the greater Houston area. Those centers are strategically located in Clear Lake, Cy-Fair, Sugar Land and The Woodlands. Texas Children’s Hospital West Campus Outpatient Services also offers outpatient specialty services.

“The hospital is excited to have dedicated, physical space for pediatric specialty services in the northeast area of greater Houston,” said Diane Scardino, vice president of medical subspecialty practices and the Health Centers at Texas Children’s. “By providing a community-based location, it is our hope that children and families will have better access to the nationally recognized Texas Children’s Hospital subspecialty network.”

Texas Children’s Hospital Outpatient Therapy at Kingwood Glen and the Texas Children’s Hospital Sports Medicine Therapy at Kingwood Glen occupy a 12,666- square-foot space in the same strip mall as the specialty care center. Therapy services offered at the locations include physical, occupational and speech therapy as well as orthopedic and sports medicine therapy. Women’s health therapy services will soon be offered at the sports medicine location.

Staff at the therapy and specialty care locations work together to provide the most comprehensive care to Texas Children’s patients and join a network of community-based initiatives that serve the greater Houston area.

“We are thrilled to also bring dedicated therapy services to the community,” said Tabitha Rice, senior vice president for clinical support services. “Many of our patients require therapy multiple times per week, so having access to these services so close to home makes a significant difference for the families we serve.”

Jamie and Jeremy Platt use Texas Children’s network of subspecialty and therapy services often and are grateful they exist.

The couple takes their 2-year-old son, Logan, to Texas Children’s Health Center in Cy-Fair twice a week for physical therapy and once a week for speech, language, feeding and occupational therapy. They also visit the health center regularly for either an X-ray, a consult or a follow-up. Most recently, they came for an ultrasound.

“It is such a relief to be so close and have a health center right around the corner from our house,” Jamie Platt said. “There have been times where I’ve forgotten either medical equipment or a device or something that I need to bring in for Logan and I’ve been halfway there. I have time to turn around, go back home and get it, and come and still make our appointment right on time.”

In addition to convenience, Jeremy Platt said the health center offers superb care and that the staff at the center has helped Logan do things he and his wife never thought he could do, such as walk, talk and eat on his own.

“He loves doing what he’s doing here,” Jeremy said. “It’s like a kid getting to go to school.”

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Around 100 BC acupuncture simulation was used and recorded in China. The long history of simulation has helped health care workers learn difficult procedures and manage high risk or complex patient care situations before they’re done on actual patients. It’s a sort of “practice” for real life situations in the clinical world. In 1910 life-like simulators were created. While Texas Children’s has been practicing simulations for many years, five years ago, under the leadership of Dr. Jennifer Arnold, neonatologist and medical director of Texas Children’s Simulation Center, the simulation center was created. It is a dedicated space in the Feigin Center which gives caregivers a safe space to practice life-like situations with simulators which react just as humans would.

In November, simulation experts from the Center for Medical Simulation (CMS) at Massachusetts General Hospital and Harvard Medical School held a four-day course, the Institute for Medical Simulation (IMS) course, for health care providers interested in or already leading simulation efforts across Texas Children’s. The course is one of the most comprehensive and immersive simulation training programs available and focuses on how to implement best practice simulation for improving quality, patient safety, and education. Four days of theory, practice, and reflective feedback create a truly experiential education where our simulationists develop a strong and comprehensive understanding of how to most effectively use simulation within their departments and educational programs.

“The goal of bringing the IMS course to Texas Children’s is to transform our simulationists to be outstanding simulation educators,” Arnold said.

“This course is a chance to have top experts in the field teach us about debriefing after a simulation exercise,” said Cara Doughty, Emergency Center physician.

Debriefing during or after simulation is singularly the most critical aspect to a successful simulation activity. It is where the learning occurs. Debriefing involves a discussion led by a trained expert reviewing what went right, how each person performed, what should have been done differently and how this situation could be improved in the case of a real-life scenario. It also is the most challenging aspect of implementing simulation, typically debriefing techniques are not instinctive to most healthcare providers and require rigorous practice.

Simulations can take place both at the Simulation Center and in real patient care settings like the operating rooms. Bonnie Eaton, a nurse in the operating rooms, has seen a great benefit with being involved in these courses as well as encouraging more simulations for operating room staff.

“It’s reassuring to the staff to have the ability to practice these scenarios before they are experiencing them with real patients,” said Eaton. “In the ORs, we are trying to develop a program to get all of the staff involved in simulations.”

Arnold has been a major advocate of bringing more simulation training activities to all areas of the hospital. Currently, simulations are done with clinicians from almost every area of the hospital and simulation scenarios have helped the staff prepare for major surgeries like the Mata conjoined twins separation surgery, and even for the possibility of a patient with Ebola visiting the hospital. Simulations play a key role in preparing the staff for these rare cases and helping determine the best course of action.

The simulation experts from CMS come from diverse backgrounds, but all have simulation educational expertise in common. Dan Raemer, PhD, has a background in bioengineering and is an expert in teamwork and crisis resource management. Walter Eppich, MD, Med, is a pediatric emergency medicine physician and is an expert in debriefing and faculty development. Kate Morse, PhD, MSN, RN, is a critical care advanced practice nurse and an expert in interprofessional education.

“Having Drs. Raemer, Eppich, and Morse here really re-energized the overall simulation program at Texas Children’s Hospital,” said Kelly Wallin, assistant director of Texas Children’s Simulation Center. “It is vital that we continue to develop and support a strong expert team of simulationists across the institution so we can implement simulation activities in all patient care areas.”

Not only did the visiting faculty lead a 4 day course for 20 simulationists here at Texas Children’s Hospital, but Dr. Raemer gave two innovative grand round presentations, one to pediatric surgery and the other to pediatrics. Simulation is becoming a more recognized and even standardized quality and safety tool across the nation and even internationally.

“We need to support and develop simulation activities not only to be a leader in quality, safety and education, but also to better serve our patients,” Arnold said. “The simulation center resides within the Quality and Safety Department at Texas Children’s Hospital because we recognize the value of it to patient care outcomes and safety.”