August 4, 2020

Five years ago, Texas Children’s Special Isolation Unit (SIU) opened at Texas Children’s Hospital West Campus to provide safe, effective care to patients with highly contagious infectious diseases. The decision to build the SIU came shortly after an unprecedented Ebola outbreak, resulting in the realization that Texas Children’s must always be prepared as an organization to handle any emerging infections that come our way.

Texas Children’s Special Isolation Unit at West Campus – the only one of its kind in Texas and among only a few in the United States – allows our teams to treat pediatric patients who are infected with highly contagious diseases in a state-of-the-art environment. The SIU is fully equipped with all of the latest scientific and technological approaches to biocontainment to assure the safety of the health care team, other patients and their families. The types of highly contagious pathogens that can be treated in the SIU include Ebola, influenza, measles and respiratory illnesses like MERS, SARS and RSV. Today, as many health care organizations face another global health pandemic, the SIU team at West Campus has been busy over the last several months providing care to COVID-19 adult and pediatric patients.

“As a virologist, I always thought in the back of my mind that we would possibly face a pandemic one day whether it be avian influenza or another coronavirus like SARS or MERS,” said Dr. Amy Arrington, medical director of the SIU at West Campus. “But I think until you’re really in that moment, it’s hard to imagine what responding to a pandemic like COVID-19 would be like for our team and the organization.”

Housed on the fifth floor of West Campus, the SIU has eight dedicated beds and up to 18 overflow beds on the fourth and fifth floors to care for COVID-19 patients, with the potential of expanding bed capacity as the need arises. The SIU is activated when patients meet a specific criteria, and in this case, are COVID-19 positive.

“We have nurses and doctors embedded in many clinical areas across our campuses who serve as clinician reservists on standby,” said Denise Tanner-Brown, Assistant Vice President of Nursing of Community and Ambulatory Nursing. “Once we activate them, they are pulled out of their home clinical areas to support the SIU.”

Since the pandemic began in early March, the West Campus SIU has been activated 12 times. The last time the SIU was activated was on May 30 and has remained open since then. As of July 31, 184 patients have been admitted to the SIU and 75 of those patients were admitted in June. West Campus has had 13 COVID-19 positive adult patients admitted to the SIU since it started taking care of adult COVID-19 patients on June 24. In May and June, the SIU saw a 48 percent increase in the average daily census.

Tanner-Brown says the SIU is on the downswing compared to previous months. Texas Children’s has seen a recent decline in COVID-19 admissions which demonstrate that masking protocols are working to curb the spread of the virus. However, the SIU team remains ready to care for increased patient volumes if warranted.

“When we began accepting adult patients in our SIU on June 24, we were a little worried about how they would perceive us as they came into a pediatric hospital setting for care,” Tanner-Brown said. “They have been more than grateful and extremely appreciative of our willingness to take good care of them.”

Since many of the adults who have COVID-19 or who required admission had some underlying disease presence, the SIU team collaborated with education coordinators from Houston Methodist West who provided guidance on general and COVID-19 specific care to ensure the best outcomes for these patients.

View a photo gallery of inside the SIU at West Campus below.

Preparing for a potential second wave

While some school districts are reopening campuses and others are sticking to virtual learning at least for the time being, Texas Children’s is ready and prepared to respond if the Houston area experiences another surge in COVID-19 cases after school starts and into the fall months during flu season.

“We are always in a constant state of readiness and we are not letting our guard down especially with the mounting uncertainty surrounding this unprecedented pandemic,” said Tanner-Brown. “As patient volumes decrease, we have a deactivation strategy where we can temporarily close down units. But we also have an activation strategy in place where we can turn it back on really quickly should the situation change. In general, many people are getting COVID fatigue, and may not feel the need to continue practicing social distancing or taking other safety precautions, so I anticipate that we may see more new cases emerge.”

For the 70 days and counting that the SIU at West Campus has been activated, the recent milestones achieved would not have been possible without the 100 percent collaboration from our team members across the system.

“I think as an organization, we have just really stepped up to the plate to provide good quality and safe care for these patients and our staff,” said Arrington. “It takes a huge village to put this together and to carry this out day after day. And it’s exhausting work, but it is work that is incredibly rewarding too.”

August 3, 2020

Aimee Martin’s two-year-old daughter Hope is extremely social. She chats up anyone she sees whether they are a stranger or a friend, and she does so at close range. Telling her to keep her distance to protect herself and others from COVID-19 is something she has a hard time comprehending to say the least.

So, when a routine trip to the ophthalmologist popped up on Amiee’s calendar, she cringed because she knew Hope’s eyes would need to be dilated and that they would have to spend at least 30 minutes in the waiting room of Texas Children’s Ophthalmology Clinic.

“Sitting in the waiting room with Hope during a pandemic or not is a train wreck,” Amiee said. “She wants to hug and talk to everyone she sees.”

To help prevent situations such as these and ease people’s anxiety about coming to the hospital during a challenging time, a handful of departments, including Ophthalmology, are offering some of their services via Patient Express, a drive-thru service at Texas Children’s Hospital’s Medical Center Campus.

Set up near the ambulance bay at Wallace Tower, patients call about five minutes before arriving for their appointment, pull up and are seen by a clinician. To ensure everyone’s safety, all patients and family members are asked a series of COVID-19 screening questions, their temperatures are taken and they are required to wear a Texas Children’s-issued mask. Texas Children’s employees participating in Patient Express are required to wear personal protective equipment including a mask, gown, gloves and facial shield.

“It’s great to be part of a project that is good for everyone,” said Ophthalmology Clinic Supervisor Veronica Gonzalez. “I feel like we are taking an extra step to make everyone feel safe – staff, patients and family members.”

Gonzalez’s team is using Patient Express to treat otherwise healthy patients who need to come in for a routine eye exam that requires dilation. Before going into the clinic for their exam, patients get their eyes dilated car side at Patient Express. By the time they park and make their way up to the clinic, it’s about time for their appointment.

Most patients are in and out of the clinic in 30 minutes. Prior to using Patient Express, they would spend an hour to an hour and a half in the facility, half of which was spent in the waiting room during the dilation process.

“Patient Express is a much better alternative,” Martin said. “I appreciate Texas Children’s coming up with the idea and for making our safety and health a priority during such challenging times.”

The drive-through or car side concept began in May when Texas Children’s Pavilion for Women opened a drive-through prenatal clinic at our Medical Center Campus to reduce the anxiety of expectant moms and to lower their risk of COVID-19 exposure and infection.

The clinic, which was recently phased out due to an increase in telemedicine and in-person visits, allowed pregnant women who do not need to be seen in the clinic to remain in their vehicles while being assessed by a health care professional. The drive-through visits included key elements of a prenatal exam such as blood pressure measurements for evaluation for hypertensive disorders of pregnancy, fetal heart rate assessment, and selected ultrasound-based measurements or observations, as well as face-to-face patient-health care professional interaction.

In June, Texas Children’s Dermatology started offering drive-through service via Patient Express to patients who need basic dermatological treatments for conditions such as warts and/or molluscum. The service is being offered every two weeks and has been very successful with both patients and clinicians.

Ophthalmology offers dilating services via Patient Express daily. Pulmonology offers services every other week through Patient Express to cystic fibrosis patients who are undergoing eradication treatment for two types of bacteria they are susceptible to getting and possibly having complications from.

“There is no need to bring them on site and expose them if we don’t have to,” said Caroline Hanson, who manages the outpatient nursing team for Pulmonology. “Our parents have been very appreciative of our efforts to best care for them and their children.”

To help create a fun environment at Patient Express, Hanson said she plays kid-friendly music when appropriate and hands out stickers any time she can. She said her staff forms a special bond with their patients since they tend to come in frequently and that being able to serve them in this way has been very fulfilling.

Valdemar Garza, practice administrator for Ophthalmology, said he has been impressed with the success of the drive-through service and with the collaboration between several teams to make it happen.

“We received a lot of help from Pulmonology, Dermatology and Women’s Services to come up with our Patient Express plan,” Garza said. “I’m grateful to work for an organization that values such creativity and innovation. It goes a long way in forwarding patient care.”

Click here to watch a video of Patient Express when it began with Dermatology.

This week on Mark Wallace’s blog, he reflects on the many accomplishments of Texas Children’s Pediatrics in celebration of the group’s 25th anniversary. Read more

Twenty-five years ago, Texas Children’s launched what is now the largest pediatric network in the nation with more than 250 board-certified pediatricians and more than 60 practices throughout the greater Houston area, College Station and in Austin. The group cares for over 400,000 patients and completes more than a million visits each year.

The physician network was formed in 1995 under the guidance of Dr. Ralph Feigin with the acquisition of the Ashford practice in west Houston owned and operated by four brothers – Drs. Paul, Morris, Ben and Harry Rosenthal. Because of its success, more and more pediatricians joined the group, making it what it is today.

In addition to its ever-growing primary care network, Texas Children’s Pediatrics operates 11 urgent care centers in the greater Houston area and one in Austin. The group also includes the Community Cares Program that provides trusted, high-quality pediatric medical services at designated locations to children who otherwise would seek care from emergency rooms or possibly go without care or treatment due to low family incomes and/or lack of health insurance.

Texas Children’s Pediatrics has consistently adapted to the needs of patients and their families while continuing to provide high-quality care. In celebration of the group’s 25 years of service, Texas Children’s Pediatrics President Kay Tittle answered a few questions about the group’s beginnings, present challenges amid the pandemic and future success.

Why, 25 years ago, did Texas Children’s start offering primary care services to patients and families across the greater Houston area and beyond?

Texas Children’s Pediatrics was part of Texas Children’s President and CEO Mark Wallace’s vision of what Texas Children’s needed to thrive in the changing environment in the 1990s. Many community pediatricians had reached out to Texas Children’s to ask for help as they were struggling to manage the increased complexities of running a practice. Managed care in particular was a large challenge for the practices as they worked to understand the changes in insurance coverage.

How did the group grow and become such a success?

Our focus has always been to provide the support needed to help physicians, advanced practice providers and staff provide the highest quality of care possible. We do this by providing physicians with administrative, financial and management expertise. Our reputation for providing such support helped us grow 25 years ago and continues to help us flourish today.

What are some of the things Texas Children’s Pediatrics has had to do over the years to maintain quality of care while also meeting the ever-growing and changing demands of patients and families?

In 2011, we made the decision to pursue National Committee for Quality Assurance (NCQA) recognition as a patient-centered medical home. This program focuses on how practices use data to improve the care they provide. The program provided the structure to help us maintain our focus on quality care and patient needs. We have been recognized every three years since as a Level III patient-centered medical home by NCQA, which is the highest recognition the organization gives out.

How has the COVID-19 pandemic changed the way Texas Children’s Pediatrics and Texas Children’s Urgent Care delivers care?

The pandemic has changed many things in our organization. Our focus has been to provide safe care and a safe environment for our patients as well as our staff while meeting the changing needs of our patients and families. We have received a positive response to changes such as Precheck-in using MyChart, waiting in one’s vehicle instead of our waiting rooms, being taken to an exam room as quickly as possible after arriving, scheduling well visits in the morning and sick visits in the afternoon, and car side immunizations. We were also able to quickly incorporate a telemedicine program with support from across the system. More than 20 percent of our encounters are now completed via telemedicine, which has helped meet the needs of patients and families in so many ways. The comments on our Press Ganey surveys are good reminders of the challenges our families are facing, and what we as an organization need to focus on to help them receive the right care, at the right time and at the right place.

What are some of the things the group will need to do in the future to remain successful?

We will need to continue to adapt to the needs of our patients and families as well as to the health care industry as a whole. We want to continue to lead the change and innovation necessary to grow and provide the highest quality of care no matter the circumstances.

In looking back and ahead, what are some of your most memorable moments as president?

Our team has created many great memories over the past 25 years. I think the move to an electronic medical record was notable and most exciting when paper charts were no longer needed. It has also been great fun to grow in Austin and College Station over the past few years. They are both exciting areas. As we look ahead, I look forward to making more great memories with the team.

Members of the Child Life team have decorated sidewalks at the Medical Center Campus with inspiring chalk art. The art is meant to send positive vibes to anyone and everyone visiting or working in our facilities. Go check it out, and thanks Child Life!

Dare to be 

The following passage was written by Texas Children’s Chaplain James Denham.

We are in the middle of a pandemic that feels like it will never end.  At times, it can feel like we are frayed or tired.  You need not feel alone in that.  Welcome, and I will give you an air hug in solidarity.

One of the many answers in the face of this is to confront our own exhaustion, our own worry.  Confront it with compassion and the understanding that you long for. Confront your exhaustion by daring to live genuinely in the face of a scary and lengthy challenge.  Confront it by daring to be what you are: a human being whose heart is strong even in vulnerability, whose hope is enduring when it is hard, and whose compassion draws from a deeper well than the pandemic could ever find.  In the face of hard times, confront them with the power of ordinary things that you can do to share solidarity with others.  Compassion with others is nourishing when we need it.  And just as importantly, it is not our exhaustion that defines us, but our dare to be compassionate that does.

This week, let these words from a poet inspire you to dare to be compassionate, even in times like this:

Dare To Be
By Steve Maraboli

When a new day begins,
Dare to smile gratefully.
When there is darkness,
Dare to be the first to shine a light.

When there is injustice,
Dare to be the first to condemn it.
When something seems difficult,
Dare to do it anyway.

When life seems to beat you down,
Dare to fight back.
When there seems to be no hope,
Dare to find some.

When you’re feeling tired,
Dare to keep going.
When times are tough,
Dare to be tougher.

When love hurts you,
Dare to love again.
When someone is hurting,
Dare to help them heal.

When another is lost,
Dare to help them find the way.
When a friend falls,
Dare to be the first to extend a hand.

When you cross paths with another,
Dare to make them smile.
When you feel great,
Dare to help someone else feel great too.

When the day has ended,
Dare to feel as you’ve done your best.
Dare to be the best you can –
At all times, dare to be!