June 17, 2019

Although great strides have been made in the battle against pediatric cancer, some children still do not survive. When this occurs, Texas Children’s does its best to envelop families with love, support and knowledge on how they can cope with such a profound loss.

One such program offered to bereaved families by Texas Children’s Cancer Center is the Retreat for Renewal. The weekend retreat is held at Camp for All in Burton, TX and features fun activities, as well as therapeutic breakout sessions for reflection and expression.

“Retreat for Renewal is a safe space where families can express their feelings and meet other people who are going through similar situations,” said Nicolle Bengtson, a Child Life Specialist involved in the program. “The experience really allows these families to bond and open up about their individual experiences.”

Funded by the Cancer Center and generous donors, Retreat for Renewal has been offered for almost a decade. However, the retreat primarily served English speaking families. This year Retiro de Renovación had its inaugural year. This retreat was created for Spanish speaking families.

Attended by eight families, Retiro de Renovación was held in March and included a combination of fun camp activities, and therapeutic breakout sessions. Bengtson and Child Life Specialist Alyssa DeMoss organized the retreat after experiencing the continued success of the Retreat of Renewal and identifying an unmet need for additional emotional support for the Cancer Center’s bereaved Spanish speaking families, in the language that felt the most comforting to them.

“We are excited to offer even more families this level of bereavement support,” DeMoss said. “It was really beautiful to see the parents and siblings at the retreat connect, and watch as the families created a new and meaningful support network.”

Many of the families expressed how much the retreat meant to them in written comments. One family wrote that it was nice to be able to share their stories with other families going through the same thing. Another family mentioned meeting others who were going through a similar situation made them feel less alone.

“It was nice to take time to remember our loved ones,” the family member said.

The Spanish-speaking retreat – Retiro de Renovaciόn – was funded by the Texas 4000 for Cancer cycling team, which rode 4,000-plus miles from Austin, TX to Anchorage, Alaska, in an effort to raise money for cancer-related programs and efforts.

The group donated $25,000 of their proceeds to Texas Children’s for the Retiro de Renovación. The Cancer Center is grateful for the donation and hopes to be able to hold future Spanish-speaking retreats.

June 11, 2019

Texas Children’s entered FY19 with a renewed focus on improving operational effectiveness and maintaining our financial excellence, goals that allow us to continue developing, expanding and reinvesting in our mission to provide the very best care for our patients and families.

Our recent credit ratings from the nation’s top three credit agencies are proof we’re accomplishing those goals.

The agencies – Moody’s, Standard & Poor’s and Fitch – have once again affirmed Texas Children’s high credit ratings (Aa2, AA and AA respectively), as well as a stable financial outlook. It is the 23rd straight year Texas Children’s has maintained outstanding credit ratings.

“This is fantastic news and it speaks volumes about Texas Children’s,” said President and CEO Mark Wallace. “The agencies’ ratings are certainly a reflection of our consistently strong financial performance, but their analysis goes beyond just the numbers. They also noted our world-class medical staff, our seasoned management team, and our successful expansion efforts, including the completion of the Lester and Sue Smith Legacy Tower and our growth in Austin. We should all be very proud of this achievement.”

Each year, the agencies analyze financial, operational and strategic data to determine our ratings, which can be compared to a company’s stock price or a person’s credit score. A great rating for Texas Children’s means that we are a financially sturdy organization that can easily meet our financial commitments, which leads to job security for each and every employee.

All three agencies cited Texas Children’s track record of clinical excellence, robust research programs, exceptional reputation, outstanding fundraising capabilities and strong financial position as key reasons for the ratings.

More Texas Children’s Pediatrics patients over the age of 18 will have the opportunity for a smooth shift to adult care as the Transition Medicine program expands to include seven locations: Corinthian Pointe, East, Gulfgate, Gulfton, Kingsland, Palm Center, and Ripley House.

Transition Medicine is the process of educating, organizing and eventually transferring patient care from the pediatric to the adult health care system. During this time the patient and their parent are informed of various ways to optimize the patient’s health moving forward. Texas Children’s is dedicated to helping patients transfer care smoothly without a decline or break in their treatment.

In 2016 Dr. Cynthia Peacock, medical director of Texas Children’s Hospital and Baylor College of Medicine’s Transition Medicine Clinic, was awarded the “Healthy Tomorrows Partnership for Children Program” 5-year grant from the Health Services Research Administration to increase transition readiness at Texas Children’s Pediatrics.

“I wrote the grant to help the Texas Children’s practices because lots of the referrals within the Texas Children’s family were struggling in the community to find someone to take care of them,” Peacock said. “This was especially prevalent amongst children and youth with special health care needs.”

The grant provides funding that also serves as an incentive to encourage clinics to become involved in the program and begin developing their own transition medicine process by educating their staff and providers.

“As we are providing care for an increasing number of complex care patients, our need to have a well-defined system for transitioning care to adult providers who are capable of continuing to provide the care these patients and their families need has never been greater,” Vice President and Chief Medical Officer of Texas Children’s Pediatrics and Texas Children’s Urgent Care, Dr. Stan Spinner said. “Our partnership with Dr. Peacock is providing us with the education and the tools necessary to help ensure a successful transition for our patients and their families.”

Upon receiving the grant, Dr. Rebecca Laster was selected as the physician leader to work with the clinics and help them identify specific tools that they could use to promote transition readiness and transfer. Her experience as a physician in the community clinics sparked her desire to want to assist these patients during this transition.

“I always think back to a time when one of my patients had a really hard time transitioning to adult medicine. That made me want to learn more about the process so I could better assist them,” Laster said. “Although, we have a lot of patients who’d like to stay with us forever, sometimes that’s not appropriate because we’re not trained in adult care. Therefore, I have the transition conversation with every single one of my patients so they know how important it is to eventually find an adult physician, and if they can start the process of thinking about it early on then everybody’s prepared.”

Many young adults between the ages of 18 to 21 transition their care to adult providers when they leave for college or enter the workforce. But for those with complex chronic pediatric diseases, transitioning is a struggle filled with barriers and challenges that include patient maturity, psychosocial and family needs, coordination and reimbursement issues, and identification of adult providers able to care for unique patient populations.

“Coordination of care is essential to avoiding gaps in care and adverse health outcomes for our patients. This is especially true with our vulnerable populations who have multiple chronic illnesses and complex health and social needs,” Nurse Care Coordinator of Texas Children’s Pediatrics, Pam Brock said. “We help provide support and guidance to our patient/families in navigating this process and by making sure all needs are met prior to transition. This helps to ensure a smooth transfer and avoids disruptions in their care. This program has increased overall fund of knowledge surrounding transition and continues to help improve the transition process for our patient/families.”

Jimmy Garcia is a 20-year-old patient at the Texas Children’s Pediatrics Ripley House location and has recently transitioned to adult care at The Transition Medicine Clinic at Baylor College of Medicine (BMC). Garcia has a global developmental delay, cerebral palsy, scoliosis, an intellectual delay, and is also non-verbal and non-mobile. He has been a patient at Texas Children’s since he was only a few months old, and is one of the many patients who benefit from the Transition Medicine program as they get older. His mother, Cynthia Garcia says that she didn’t know what to expect during the transitioning process, and is thankful for the assistance that their physician provided.

“I still wanted him to continue to see Dr. Wright,” Garcia said. “She was such a great pediatrician to him and our family, and Jimmy just feels so comfortable with her. However, everyone in the office was very positive during the process and prepared and helped us to be comfortable with accepting that Jimmy was eventually going to leave them.”

Texas Children’s academic partnership with BCM allows for an effortless transition for our patients. The goal of the BMC clinic is to prevent urgent health care crisis and to minimize the impact of a shrinking social support network that these patients and families have come to rely on in the pediatric health care system. According to Garcia, transitioning into adult care was just as easy as transferring out of the pediatric system. Their pediatrician, along with the Garcia’s social worker were very instrumental in assisting with paperwork and other aspects of the process.

“When it came time to schedule Jimmy’s first appointment, it was so smooth and easy,” Garcia said. “Our first visit to the transition clinic was also amazing. It was a joy seeing everyone so accepting of Jimmy. When we go to the doctor now, he knows the clinic, and he recognizes the environment. Jimmy is non-verbal so he doesn’t exactly express his words or anything, but the smiles, his reactions, those are things that let us know he’s comfortable and he’s aware of his surroundings. He’s doing really well!”

The program began with two clinics during the pilot year and grew through the third year. While currently in its fourth year of the grant, the goal is to identify additional clinics that are willing to participate. At the beginning of the process, clinics sign a memorandum of understanding, then identify the activities they would like to implement and goals they want to achieve to help with addressing transition.

Patients like Garcia represent the hard work that the transition medicine team has put forth, and the success of the program as a whole allows for more practices to be added and even more patients to be helped. Identifying patients who will need help transitioning in the future is key.

“Transition is not an event, it’s a process,” Peacock said. “You can’t drop someone off at the curb. It’s really about making sure that they engage.”

Engaging with the teenager and parent to make sure they have a plan, looking into insurance options, knowing what the next steps will be in advance helps to facilitate the transfer more efficiently. All seven participating practices have done this and more as they recently met their goals for the 2018 grant cycle and are looking forward to celebrating their continued success.

“Texas Children’s Pediatrics is excited to have many locations become a part of the Transition Medicine Program,” President of Texas Children’s Pediatrics, Kay Tittle said. “The goal is that this success continues on past the length of the grant, more practices are added, and we to continue to address transition effectively.”

These clinics are provided with an array of resources in the form of trainings, Epic tools, and supports for developing their own transition initiatives. If you work with TCP and are interested in learning more about Transition Medicine and how you can help support these efforts, please reach out to Pam Brock, RN pmbrock@texaschildrens.org, or Dr. Rebecca Laster, rblaster@texaschildrens.org.

June 10, 2019

Texas Children’s Pavilion for Women has been designated a level IV maternal care facility, the highest level of care available. The designation was finalized late last week and followed a rigorous site visit conducted by the EMS/Trauma Systems Office of the Texas Department of State Health Services. A level IV maternal care facility provides comprehensive care for pregnant and postpartum patients, from those with low-risk conditions up to and including the most complex medical, surgical and/or obstetrical conditions that present a high-risk of maternal morbidity or mortality.

“This designation certifies that we offer the highest level of care for the most complex obstetric patients,” said Dr. Christina Davidson, a maternal-fetal medicine specialist and chief quality officer at Texas Children’s Pavilion for Women. “It speaks to the expertise of our clinical teams and the processes we have in place to ensure high-quality care and the positive outcomes we strive for.”

With the overall goal of reducing infant and maternal morbidity and mortality in the United States, the designation comes as the result of legislation passed in 2013 requiring Texas to establish and implement neonatal and maternal level of care designations by March 1, 2018. The intent of the legislation is to ensure both neonatal intensive care units (NICUs) and maternal care facilities have the resources and expertise to provide high-quality, specialized patient care that leads to the best outcomes for mothers and babies.

Texas is one of the first states requiring maternal care facilities undergo a site visit to verify the level of care provided to patients meets the Maternal Levels of Care classifications as defined in the Texas Administrative Code. Completing the designation process is a requirement to receive Medicaid reimbursement for obstetrical care by August 31, 2020.

“This designation is the fruit of the work we perform daily. It is recognition by the Department of State Health Services of Texas Children’s commitment and investment to maternal health,” said Dr. Nan Ybarra, director of nursing for inpatient services at Texas Children’s Pavilion for Women. “With over 6,200 deliveries annually, we are committed to serving women in our community and partnering with community hospitals to strengthen their maternal care processes and programs – our singular goal is to improve outcomes for pregnant women across Texas and beyond.”

Texas Children’s announced in January it opened one of the nation’s few intensive care units dedicated solely to obstetrical critical care. It is the only four-bed maternal ICU in the country staffed 24/7 by both pulmonary critical care and maternal-fetal care teams embedded in a hospital’s labor and delivery unit. This maternal ICU offers a specialized, private space for high-risk expectant and postpartum mothers with conditions such as sepsis, peripartum bleeding, placenta accreta, maternal heart disease and other serious conditions.

The hospital also has a nationally known placenta accreta spectrum program, where a team of experts provide comprehensive, multidisciplinary care for women with this potentially life-threatening pregnancy complication that occurs in approximately 1 in 1,000 to 2,000 pregnancies.

Additionally, in 2017, Texas Children’s obstetrics service partnered with the hospital’s Kangaroo Crew to create the Maternal Transport Service, further bolstering its reputation as a primary referral site for patients with high-risk pregnancies. The team, consisting of a Kangaroo Crew nurse, labor and delivery nurse, respiratory therapist, and EMT, can provide specialty care to mothers while enroute to the Pavilion for Women, helping the hospital’s community partners transport their sickest patients for the most optimal outcomes for mothers and babies.

“It’s crucial for women, especially those experiencing a high-risk pregnancy, to be educated about the level of obstetrical care available in the facility in which they plan to deliver,” said Dr. Michael Belfort, obstetrician/gynecologist-in-chief at Texas Children’s Pavilion for Women.

The Department of Critical Care celebrated the remarkable legacy of Dr. Thomas Vargo during Pediatric Ground Rounds on May 24.

Texas Children’s founded the Thomas A. Vargo Visiting Professorship in honor of Vargo’s service as the first chief of Pediatric Critical Care Medicine and the first full-time medical director of Texas Children’s pediatric intensive care unit (PICU), a position he accepted in 1979 at the personal request of legendary Physician-in-Chief, Dr. Ralph D. Feigin.

“The Visiting Professorship is a wonderful opportunity for us to honor Dr. Vargo and his great contributions to Critical Care and Cardiology at Texas Children’s and at the same time learn from and interact with the top experts in the field of pediatric critical care,” said Texas Children’s Chief of Critical Care Dr. Lara Shekerdemian. “I can only imagine what an undertaking it was to build a program at a time when pediatric intensive care was in its infancy and none of the resources we have today – human, technology or equipment – were available. Despite these challenges, Dr. Vargo persevered and laid the foundation for the wonderful service we are part of today.”

This year’s Visiting Professor was Dr. Peter Laussen, Chief of the Department of Critical Care Medicine at the Hospital for Sick Children (SickKids) in Toronto, Professor of Anaesthesia at the University of Toronto, the David and Stacey Cynamon Chair in Critical Medicine, and a globally recognized authority on cardiac critical care.

Over the past decade, Laussen has focused on systems and human engineering applied to critical care, and is the lead developer of a web-based data visualization platform that stores ICU data collected in real time from multiple sources, such as patient monitors, ventilators and lab systems. That data is then seamlessly synthesized in a manner that reduces the impact of human error in ICU decision-making processes.

In his presentation, “Boosting Signals and Seeing Patterns: Artificial Intelligence and Critical Care,” Laussen described the changing landscape of critical care medicine over the past 40 years. He also discussed the increasingly important relationship between critical care and technology, and specifically addressed the potential advantages of artificial intelligence and data science in critical care.

Technology and data utilization are already crucial aspects of care at Texas Children’s. Ultimately, we hope to have the ability to use sophisticated data platforms as decision support tools to enhance patient care and even to predict imminent deterioration.

Another example of how we’re using data is in Texas Children’s Mission Control, where we have real-time tracking of our transport ambulances and plane. That simple ability lets us better estimate ETAs and redirect teams for emergencies. Our teams also have access to real-time census data that allows them to know our bed capacity and how best to direct patients to the closest ICU.

A recent scenario when this technology made a lifesaving difference happened in August 2018. Mission Control received a call from a surgery center north of Houston, where a child suffered a lacerated carotid artery during a routine outpatient procedure. The Kangaroo Crew team at Texas Children’s Hospital The Woodlands was dispatched to the patient, while a second team was sent from the Texas Medical Center with emergency blood. Mission Control coordinated a precise meeting between the two teams to hand off the blood and was in constant communication with our emergency center, ENT surgeons and others to meet the child on arrival. Prior to launching Mission Control, with its sophisticated technology and communication tools, this would not have been possible.

About Dr. Thomas A. Vargo

Dr. Tom Vargo was born and grew up in Los Angeles, California. He received his bachelor’s degree from George Pepperdine College and his medical degree from UCLA. He trained in pediatrics in Madison, Wisconsin, where he met his wife, Connie. The two have been married since 1964 and have three children.

After spending two years in the United States Air Force in Florida, Vargo joined Baylor College of Medicine and Texas Children’s in 1968 to train in Cardiology with Drs. Dan McNamara and Denton Cooley. Vargo has remained in Houston since, serving as a professor of Pediatrics at Baylor. In that time, he laid the foundation for Texas Children’s world-class Critical Care service, which now has 80 attending physicians, 40 advanced practice providers, 10 physician instructors and 20 fellows, admitting more than 7,000 patients annually to the critical care units at our Texas Medical Center campus, West Campus and Texas Children’s Hospital The Woodlands.

The highlight of Vargo’s career has been the education and training of students and residents. He has been a long-time member and chair of various medical school student and resident physician advisory committees. His lectures were always popular with the medical students and he has mentored numerous fellows and faculty. For more than 40 years, he has been the training program director of four different residency programs at Baylor – in pediatrics, pediatric cardiology, critical care medicine and the post-graduate year 1 residency. Vargo was a founding member and president of the Society of Pediatric Cardiology Training Program Directors. He has received multiple teaching awards from medical students and residents at Baylor, including the Pediatrics Department’s lifetime teaching award.

Camp Periwinkle Days came to the Cancer and Hematology Centers last week creating a fun surprise for patients and families arriving for their appointments.

“This could not have happened at a more perfect time,” said Sarah Payne as she watched her two daughters stuff with cotton a plush pig and monkey wearing astronaut outfits. “She was not excited about coming today.”

Organized by The Periwinkle Foundation and sponsored by Northwestern Mutual, the two-day affair included NASA-themed decorations and displays, various arts and crafts, face painting, games, music and more. The camp was held in the Cancer and Hematology Centers’ infusion and waiting room areas for easy access to all.

“Our goal is to bring the magic of summer camp to those who might not have otherwise have the opportunity to go,” said Doug Suggitt, executive director of The Periwinkle Foundation. “We are always so pleased to see the smiles on the faces of those who get to experience the camp and are thankful to our partners for making it such an impactful event for everyone involved.”

This is the ninth year Camp Periwinkle Days has been held at the Cancer and Hematology Centers and the third year for Northwestern Mutual to sponsor the event.

Northwestern Mutual Managing Partner Jeff Reeter volunteered at the camp and said it was a joy to participate in such a wonderful occasion.

“It’s a very heartwarming experience that probably impacts us more than the patients and families we encounter,” Reeter said. “We are so grateful to be a part of it.”

Director of Texas Children’s Cancer and Hematology Centers Dr. Susan Blaney said she is thankful for everyone who continues year after year to make the event such a success.

“Fighting cancer is hard,” Blaney said. “A little extra fun goes a long way for these patients, families and staff.”

To learn more about Camp Periwinkle click here. To learn more about Texas Children’s Cancer and Hematology Centers click here.

The Texas Children’s Pavilion for Women garnered several top distinctions in medical care for women and babies by excelling in maternity quality measures like breastfeeding practices, minimally invasive gynecology and exceeding patient satisfaction. Learn more by visiting our 2018 virtual Annual Report.