September 26, 2019

The Sickle Cell Program at Texas Children’s Hematology Center is the largest in Texas, serving more than 1,000 children a year. The clinic offers the latest treatments for the inherited red blood cell disorder and conducts some of the top research in the field.

The program’s multidisciplinary staff is made up of board-certified pediatric hematologists, hematology-trained nurse practitioners and physician assistants, research staff, as well as social worker and child life specialists. A couple of providers suffer from sickle cell themselves, giving them a unique perspective in caring for their patients.

Texas Children’s Sickle Cell Program Hematologist Dr. Titilope Fasipe and Nurse Practitioner Precious Uwaezuoke both have sickle cell disease. In honor of National Sickle Cell Disease Awareness Month, we talked to them about why they chose to dedicate their profession to caring for children with sickle cell disease and whether living with the disease has allowed them to better connect with patients and their family members.

How has sickle cell affected your life?

Uwaezuoke: My journey with sickle cell has been a tough one. I was in and out of the hospital multiple times when I was younger and there were occasions when I would get depressed. Thanks to family and staff here at Texas Children’s Sickle Cell Program, I was encouraged to stay the course. Sickle cell flares still occur, but I’m able to manage my disease by living a healthy lifestyle and hydroxyurea therapy.

Fasipe: I too suffered from bouts of depression during my early years of battling sickle cell disease. One of my lowest points was when my cousin died from the disease at just 17 years old. Childhood deaths related to sickle cell are not uncommon in Nigeria, which is where I’m from and where screenings and treatments are limited. Because of this, I try not to take life for granted and believe in treasuring all moments, big and small. Like Precious, hydroxyurea has also made a positive difference in my life.

Why did you decide to get into the medical field and help people like yourself?

Uwaezuoke: The treatment I received and the people I met at Texas Children’s inspired me to go into the medical field and help people like myself. I will never forget a nurse who told me to not let sickle cell take over my life; that I could and would be able to do more than just deal with my disease. The connection she made with me during that hard stay in the hospital is part of what made me pursue what is now my passion.

Fasipe: My cousin’s death and my parents’ encouragement motivated me to make a difference in the world and to do work that would help prevent any more deaths like hers. I chose pediatric hematology because I wanted to reach sickle cell patients and their families before they defined how their lives are going to be; and teach them that life can still be beautiful with this disease.

How has having sickle cell helped you connect with patients and families?

Uwaezuoke: A lot of people are devastated when they find out their child has sickle cell disease. Some think it’s a death sentence. The minute I tell them I have the disease and have managed to live a productive, well-balanced life, they break down in tears. They are overjoyed to meet someone older who is living with and managing their disease.

Fasipe: I think many of the families think I can read their minds! For the parents, I acknowledge the guilt and worry they have; and for the children, I acknowledge their pain and fears. After discussing the challenges, we then talk about how we can work together to best manage their disease. The bravery I have seen in our patients has inspired me to become a community sickle cell advocate. I have participated in several Houston sickle cell programs, and served on the first Sickle Cell Advisory Committee of the Texas Department of State Health Services. Precious and I also help coordinate the Texas Children’s Hematology Center’s annual Sickle Cell Education and Research Day, which was recently held at the Houston Museum of Natural Science.

How much progress is being made in finding better treatments cures, for sickle cell disease?

Uwaezuoke: I’m very optimistic. Funding for sickle cell research continues to grow as well as the number of people trying to find better ways to help people with the disease. People who have sickle cell are living longer, especially here in the United States where newborns are screened. All of these things are a step in the right direction.

Fasipe: We are learning more about this disease every day. There are currently several disease-modifying treatments in various stages of the research pipeline; some with successful clinical trials. Gene therapy trials have also shown promise to be a more universal cure than bone marrow transplant, which is only available to a few patients. I am encouraged by how far things have come since I was a child. And, I believe things will only get better.

To learn more about The Sickle Cell Program at Texas Children’s Hematology Center, click here.

September 25, 2019

Recently, several executives, physician leaders, and Revenue Cycle team members gathered at the John P. McGovern Campus to celebrate the 10th anniversary of the Texas Children’s Physician Service Organization (TCPSO). The TCPSO manages payor contracting and revenue cycle functions of our physician group.

“The TCPSO is the core body that represents our physicians, and having that within Texas Children’s allows us as hospital leaders to partner with our physician leaders,” said Executive Vice President Dan DiPrisco, who served as one of the first directors of the TCPSO until 2014.

For the past 60 years, Texas Children’s Hospital has had an affiliation with Baylor College of Medicine, serving as the primary pediatric training site for Baylor’s physicians. Prior to 2009, Texas Children’s funded the physician group, while Baylor provided the governance, including billing and contracting.

As Texas Children’s began to expand rapidly, developing strategies for sustainable long-term growth was critical. Subsequently, Texas Children’s and Baylor developed an operating agreement to create an employment structure for physicians and allow contracting and revenue cycle operations to function under the Texas Children’s umbrella.

“When it comes to learning all the ins and outs of how to sustain the TCPSO structurally as an organization, it was important to define roles and create a productive team of leaders, which we will continue to refine and expand over the years,” DiPrisco said.

On July 1, 2009, 145 Baylor employees in the revenue cycle and contracting area transitioned from Baylor to employment at Texas Children’s, forming the TCPSO. Ten years later, 54 were present for the festive anniversary celebration, which included cake and a commemorative pin for the “original” TCPSO staff.

“There was a strategic vision 10 years ago, and it’s hard to imagine the growth of Texas Children’s without the TCPSO,” said Pathologist-in-Chief Dr. Jim Versalovic. “As we look ahead to the next 10 years, we know that we have learned many lessons, and we have certainly demonstrated that the TCPSO can be a very effective platform for the growth, management, and connecting the clinical practice with the business.”

Versalovic was among the first physician leaders to transition to Texas Children’s when the TCPSO was formed, and he served as a TCPSO board member. He has been a part of the organization’s evolution over the past 10 years, and emphasized that the TCPSO has established itself as a core entity of Texas Children’s and, through strategic planning, has significantly advanced during that time.

In the TCPSO’s first decade, its growth has mirrored that of the hospital. Within the first year, professional billing was managed for 655 physicians, comprising 32 pediatric and adult specialties. Within 10 years, the number of physicians has grown to more than 1,800 billable providers and 45 specialties. Net patient revenue had grown 151 percent to $282 million annually in 2019. And August 2019 alone was the organization’s highest cash collections month ever, at just over $26 million.

As Texas Children’s expands into further markets and continues to provide high quality care to patients and their families around the globe, the TCPSO will be right there as well, providing the revenue cycle support and collections.

“The level of collaboration between the TCPSO and the Baylor physicians on payor contracting and revenue cycle functions has never been stronger,” said Richelle Fleischer, President of the TCPSO and Senior Vice President of Revenue Cycle. “Everyone is excited about what we will accomplish together over the next 10 years!”

September 24, 2019

There’s always a LOT going on at Texas Children’s Hospital.
And because life moves fast and schedules are full, it can be hard to keep track.
Plus, with a million different things competing for our attention, when we need or want information, a lot of the time we want it quickly.

That’s why Texas Children’s Corporate Communications team has put together “Got A Minute?” – a new video series that (quickly) highlights some of the important initiatives, programs and individuals that make Texas Children’s tick.

Each new episode will focus on one of three main topics:

  • Texas Children’s annual organizational goals
  • Our culture of leadership
  • Special recognitions for staff and employees.

Episode 1 spotlights a new special feature story from Corporate Communications called Unsung Heroes, which recognizes outstanding employees from across the Texas Children’s’ system whose important roles are not widely known throughout the organization.

You can learn more about these Unsung Heroes on Connect and on our employee Instagram, @oneamazingteam, throughout the week.

After undergoing a tracheostomy, Brenda Gregg shares how her journey strengthened her determination to reach her goals, and how this experience has impacted the way she cares for patients with similar health challenges. Read more

September 23, 2019

Premature infants and sick infants often need the kind of medical attention and care only found in a newborn intensive care unit like Texas Children’s Hospital Newborn Center.

Named No. 7 in the nation by U.S. News & World Report 2019-2020 Best Children’s Hospitals rankings, The Neonatal Intensive Care Unit (NICU) at Texas Children’s Hospital is designated by the Texas Department of State Health Services as a level IV NICU, the highest level of care available for premature and critically-ill newborns.

More than 1,800 infants are cared for each year in the Texas Children’s Neonatal Intensive Care Unit (NICU), making us one of the largest, most experienced NICUs in the country. We provide all services that critically ill or premature babies might need, including on-site neonatologists available 24/7, the highest level of respiratory support, advanced imaging, pediatric surgery, pediatric anesthesiology and more.

Texas Children’s NICU is led by a multidisciplinary team of neonatal experts – physicians and nurses who are internationally known for their level of experience and knowledge in the care of premature and critically ill infants. They serve on committees and consortiums that set the standard of care for newborn care nationally and conduct research on a range of topics in perinatal and newborn medicine.

“I am extremely excited that our neonatal team has been named again as one of the best in the nation,” said Chief of Neonatology Dr. Gautham Suresh. “As a Level IV NICU, our neonatal team has the resources and expertise to deliver the highest level of care available for premature and critically ill newborns.”

Texas Children’s Newborn Center is continuously ranked by U.S. News as one of the best places in the nation to receive pediatric care. The rankings use a well-accepted framework for evaluating quality of health care, which factors in patient outcomes, such as mortality and infection rates; available clinical resources; and compliance with best practices. Improved rankings demonstrate a health care organization’s commitment to not only providing high-quality care, but also to identifying gaps where improvements are needed.

Big wins for patients and families

This past year, the Newborn Center built on its legacy of success and implemented new initiatives to increase transparency, reduce risk of infection and improve the quality of care. Here are some of the center’s big wins for patients and families:

Increased the number of infants discharged drinking their mother’s milk.
Studies have found that when infants receive their mother’s milk at discharge they are more likely to breastfeed and/or breast milk feed for longer. To encourage this behavior, the Keeping Abreast Quality Improvement work group was formed to identify areas for improvement involving human milk feeding and direct breastfeeding in the Newborn Center. From this group, two sub-groups were formed to optimize colostrum for oral care and infant-driven feeding. Colostrum is the first fluid produced by the breast after birth and is rich in nutrients, immune and growth factors. The work of these groups helped increase by 15 percent the number of infants discharged drinking their mother’s milk. This year, 1,024 infants were discharged drinking their mother’s milk compared with 894 last year. A bar coding system for correct breast milk identification also was implemented. The system decreases the likelihood of milk misappropriation.

Achieved a less-than-24-hour turnaround time for urine organic acid and amino acid on-site analysis. The 24-hour turnaround time on urine organic acid and amino acid tests has important implications for newborns. These tests help clinicians diagnose newborns with inborn errors of metabolism, a group of disorders caused by defects in pathways that are crucial for metabolizing food and turning it into a source of energy. Prompt diagnosis of these conditions is important as it allows us to start targeted treatments and initiate dietary changes without significant delay. Rather than presuming the diagnosis and implementing generalized treatment plans, we are able to customize specific treatment plans based on the diagnosis and counsel families accordingly.

Emergent neonatal transports were dispatched within 30 minutes of being requested.
This improvement was made by strengthening partnerships between neonatal nurse practitioners and members of the Neonatology and Transport service team. To ensure the neonatal nurse practitioners were able to respond to the transport team when a transport request was made, a float neonatal nurse practitioner was scheduled and dedicated to such requests. When a float neonatal nurse practitioner was not available, the neonatal nurse practitioners on the floor were empowered to provide a short, succinct checkout to the neonatologist or fellow neonatal nurse practitioner to ensure a timely dispatch time.

Increased the number of registered nurses with neonatal intensive care certification.
The number of registered nurses with neonatal intensive care certification increased 14 percent in 2019 compared with 2018. Our rate of 55 percent is higher than the required certification rate of 51 percent prescribed by Magnet. As noted by the American Nurses Credentialing Center (ANCC), certification affirms advanced knowledge, skill, and practice to meet the challenges of modern nursing. Increasing/maintaining our certification rate is important because research findings have demonstrated a relationship between higher rates of nursing specialty certification and lower rates of negative patient outcomes, such as falls, hospital acquired pressure injuries, select hospital acquired infection rates and failure to rescue and death.

All attending physician extenders participated in a competency simulation for an infrequently performed procedure (chest tube placement) in the past 24 months.
It’s important that all health care providers in the Neonatal Intensive Care Unit are competent in performing key life-saving procedures. Some of these procedures are used rarely, therefore we provide refresher courses and measure each provider’s competency in performing these procedures using hi-fidelity simulation. This allows our providers to feel confident in their skills and be ready to perform them when necessary.

Texas Children’s has received the 2019 “Most Wired” designation for outstanding healthcare-based technology from the College of Healthcare Information Management Executives (CHIME).

The annual Most Wired survey recognizes hospitals and health systems nationwide for information technology (IT) initiatives in the areas of infrastructure, business and administrative management, clinical quality and safety, and clinical integration. For the first time, CHIME introduced separate surveys for domestic, ambulatory and international healthcare. Texas Children’s earned Most Wired in the domestic and ambulatory surveys. We did not participate in the international survey.

“Earning Most Wired designation reflects the partnership of the Information Services team and our many clinical and operational partners at Texas Children’s,” said Myra Davis, senior vice president of Information Services. “One of our strategic goals is to leverage technology and digital platforms to revolutionize the way we provide care to our patients and manage our business enterprises.”

Texas Children’s has earned Most Wired recognition in 2013, 2014, 2016, 2017, 2018 and now in 2019. This year’s survey incorporated an improved certification system that allows participating organizations to better benchmark their level of adoption and outcomes achieved. This year, participants were certified at a level between one and 10 that represents their respective achievements, allowing organizations to clearly benchmark against a defined worldwide industry standard.

Texas Children’s achieved Most Wired Certified Level 8. Organizations certified as levels seven and eight met the criteria for being designated as Most Wired. These organizations have deployed technologies and strategies to help them analyze their data and are starting to achieve meaningful clinical and efficiency outcomes. Some of these organizations, such as Texas Children’s, are experimenting with more advanced technologies, like telehealth, that expand access to care.

Some of Texas Children’s notable IS achievements include:

Successful Epic system upgrade – IS successfully upgraded Texas Children’s Epic electronic health record. The upgrade is important because it touches users and patients throughout the organization. It provides a robust platform to support patient engagement and care team enablement to influence positive patient outcomes through quality, safety and operational efficiencies. Some highlights include:

  • Renal – EpicCare Dialysis (Nephrology) integrates outpatient dialysis treatment and therapy plan data; extracting clinical information and demographic data and submits directly to CrownWeb/CMS, provides new specialty plans of care activity for required monthly, annual and unstable reviews, and creates a ‘snappy’ new dialysis snapshot report available by default to clinicians.
  • MyChart – Texas Children’s newly redesigned patient portal has expanded functionality to include subspecialty self-scheduling, quick and easy account (instant) activation, guest bill pay, pre-appointment check-in, waitlist for sooner appointments, and the ability for patients to share the information in their MyChart accounts with other medical providers via Share Everywhere.
  • Beacon – Epic’s module to manage oncology care allows providers to create a patient’s treatment plan that carries over to every oncology appointment. Treatment plans are created from standardized protocols, which are templates that promote standardized documentation and treatment for similar diagnoses.

More Epic benefits to come – In addition to improvements and new features, the recent Epic upgrade set the stage to launch additional application features:

  • Beaker – Epic’s new pathology information module manages lab orders and results, specimen collection, workflows, testing and reporting.
  • Cupid – Epic’s new cardiovascular information module provides order entry, scheduling, procedure documentation and structured reporting for diagnostic cardiology procedures.
  • Alaris Smart Pump – A communication interface between patient IV pumps and Epic that allows staff to focus on patient care rather than manual data entry. The system also promotes patient safety by decreasing the risk of IV medication errors.
  • Tapestry Program – Implementation of Epic Tapestry, CRM and Healthy Planet modules to replace several disparate systems at Texas Children’s Health Plan in order to improve Health Plan operational efficiency and improve care of its members.

Disney Team of Heroes – IS worked with the Walt Disney Co. to ensure the installation of equipment related to the Disney Team of Heroes Program. Texas Children’s is the first hospital to work with Disney on this comprehensive new initiative that will enhance the patient and family experience at children’s hospitals across the globe through a unique combination of reimagined spaces, personalized moments and engaging content, all featuring Disney’s beloved characters and themes.

Improved access to care – IS improved the patient experience by enhancing access to care by:

  • Patient scheduling – IS partnered with clinicians, schedulers and the Epic & Revenue Cycle team to generate a questionnaire template to guide scheduling staff when making appointments. The result is a consistent process that improves the patient experience and promotes access to care.
  • Wait times – IS updated the Texas Children’s Urgent Care website to display location wait times, which allows patients to make an informed decision and potentially save time, improving patient satisfaction.

Spanish language version of MyChart – The Epic Patient Engagement team introduced a Spanish language version of the MyChart patient portal for Texas Children’s multilingual patients, families and staff.

Texas Children’s Hospital was recently honored with the 2019 Sepsis Heroes Award presented by the Sepsis Alliance at the organization’s eighth annual Sepsis Heroes gala on September 12.

Sepsis Alliance, the nation’s leading sepsis organization, recognized Texas Children’s for its continued support and instrumental efforts in raising sepsis awareness and improving treatment for sepsis – the body’s life-threatening response to infection that affects 1.7 million children and adults each year.

‘We are incredibly honored to receive this prestigious award in recognition of our efforts on sepsis quality improvement initiatives at Texas Children’s,” said Dr. Lauren Hess, director of Simulation for Pediatric Hospital Medicine. “Our continued investment in innovative processes, decision support and analytics has helped our care teams across the organization significantly improve pediatric sepsis care and outcomes.”

During the awards gala, Sepsis Alliance recognized Texas Children’s for several notable achievements, including the successful development and implementation of a pediatric sepsis algorithm to improve the timely diagnosis of sepsis. The computerized algorithm records data such as a patient’s heart rate, blood pressure, skin appearance, temperature, respiratory rate, and other risk factors like diagnosis and/or high-risk medical treatment like chemotherapy, to calculate a risk score and generate a sepsis alert.

“The algorithm automatically calculates the sepsis score each time a patient’s chart is opened or a pertinent data element is filed,” said Texas Children’s Quality Safety Specialist Terri Brown. “If the sepsis score reaches eight or higher, the score is pushed to clinicians in the form of an alert, leading to the early detection and timely care of sepsis, which significantly improves a patient’s chance of recovery.”

Click here to read an article about Texas Children’s sepsis algorithm and the collaboration that went into creating and implementing this electronic screening tool which was featured in the journal Health Affairs.

Other notable recognitions

Texas Children’s was also the recipient of a Health Catalyst award for data utilization at the 2019 HAS conference and a finalist for the clinical achievement award in recognition of our sepsis quality improvement efforts.

Since improving access to meaningful data and analytics among clinicians and staff is key to improving patient care and outcomes, Texas Children’s established the structural foundation to make this possible, and to ensure timely, accurate data drives new care interventions for the treatment of pediatric sepsis.

To obtain information necessary to drive sepsis improvements, Texas Children’s improved data collection and sharing throughout the organization. Several sepsis quality improvement milestones included:

  • Developing a pediatric sepsis analytics accelerator to monitor, improve sepsis performance. Leveraging the use of Texas Children’s Health Catalyst Analytics Platform, clinicians can use the analytics accelerator to evaluate outcome measures including the number of children with sepsis, the number of sepsis encounters, and sepsis mortality. Clinicians also use this tool to evaluate the impact of their interventions on patient outcomes and gain insight into actionable improvement opportunities.
  • Improving team structures that oversee quality improvement and analytics work related to sepsis. Enhanced workflows were implemented to facilitate escalation of concern about sepsis. Sepsis huddles became more routine following a sepsis alert to ensure staff had the latest information on the patient’s condition, and to determine if additional interventions or monitoring were required for the patient.

Click here to read a Health Catalyst article highlighting Texas Children’s data analytics efforts to reduce sepsis mortality.