As COVID-19 hit, Medical Director of Emergency Management Dr. Brent Kaziny and members of Texas Children’s Facilities team raced to invent a new device that would better protect doctor’s nurses and patients during intubation procedures. Kaziny then open-sourced the novel product design for others to use, and found a manufacturing partner called Sawbones that put the “Airway/Respiratory Containment System” up for sale. Read more
As the COVID-19 pandemic continues to dominate the news and impact our normal way of life, there is one thing that has not changed – our commitment to ensuring our patients and families have convenient access to the care they need, when they need it, while also continuing to protect their health and safety.
As we begin to adapt to this new normal, more in-person visits are being converted to video or phone appointments. Texas Children’s e-Health team, in collaboration with multiple departments across the system, has rapidly expanded and enhanced these e-Health services to make it easier and more convenient for patients to connect with a Texas Children’s provider without leaving their home.
In less than three months, the organization has seen a rapid growth in e-Health visits across the system. On March 2, Texas Children’s completed 39 video and telephone appointments. As of May 8, our providers had completed 72,285 telephone and video visits across Texas Children’s Hospital, Texas Children’s Pediatrics, Texas Children’s Urgent Care, Texas Children’s Health Plan and Texas Children’s® Anywhere Care. Along with this impressive milestone, over 1,000 providers have been trained to provide care through video visits to their patients across the system.
The Health Plan’s e-Health platform, Texas Children’s® Anywhere Care, which has been a major focus in the organization’s e-Health efforts, has seen an uptick in patient visits. Since launching the platform last summer, over 1,520 video appointments have been completed. A total of 750 e-Health visits were completed from March 1 to May 5 of this year.
“Our recent successes are attributed to the collaborative efforts that went into building the infrastructure that has enabled us to expand our e-Health capabilities more broadly across the system,” said Laura Laux Higgins, director of strategic projects in Information Services and member of the e-Health Executive Steering Team. “Not only did we investigate the technology solutions and invest in them, we had a team of e-Health experts in place across information security, EPIC, MyChart, billing, compliance, legal, credentialing, risk, and administrative and physician leadership who were able to help us move forward quickly because of the work they had done over the past year.”
With the demand for e-Health services on the rise due to COVID-19, Texas Children’s Heart Center, like many other subspecialties across the system, are leveraging the mutual benefits of e-Health services.
Shortly after the COVID-19 pandemic set in and local, state and federal governments asked non-essential businesses to close and residents to stay home, the Heart Center worked swiftly with physicians and staff to engage e-Health services for new and existing patients 6 months old and older who did not need to be seen in person.
Within about a week, the Heart Center was booking about half of its appointments at the Texas Children’s Medical Center Campus via video or phone. Although that number has decreased since Gov. Greg Abbott has started to reopen parts of the state, the Heart Center is still using e-Health services and is dedicated to the virtual patient care model for the foreseeable future.
“Our will to continue to work hard and keep our patients, families and staff safe has never been stronger,” said Chief of Pediatric Cardiology Dr. Daniel Penny. “e-Health is a way we can continue to serve our patients without putting them at unnecessary risk.”
All potential e-Health appointments at the Heart Center are reviewed by a pediatric cardiologist or advanced practice provider to determine whether it is clinically appropriate for a child’s appointment to be completed using one of these modes of virtual visit. If the cardiologist considers that a child’s appointment can be completed in this way, the clinic staff will contact the child’s family to provide more details and guide them through the new system.
Dr. Jeffrey Kim, director of the Arrhythmia and Pacing (Electrophysiology) Service at Texas Children’s Hospital, said his patients are good candidates for e-Health visits because they typically don’t need surgical intervention. For about a month during the pandemic, Kim said almost all arrhythmia and pacing patients were utilizing e-Health visits. Now, about half are using the service.
“Patients are very appreciative of the virtual visits,” Kim said, adding he conducted an appointment with a patient while they were standing in the middle of a field on their ranch. “They are thankful they don’t have to come in and expose themselves if they don’t have to.”
In addition to safety, Kim said e-Health services can be used to treat people in areas where there are limited pediatric cardiology services. Patients in these areas might not be able to drive into places like Houston for an appointment forgoing care altogether or seeking it in less-than-ideal places. e-Health would bring the visit to them, allowing our experts to reach more children and families.
“e-Health has a lot of benefits and possibilities,” Kim said. “I’m excited to see how it develops.”
Finding Hope
The following passage was written by Texas Children’s Chaplain Natalie Peters.
This week marks eight years since I’ve graduated from college and six since graduate school. I remember being so proud of all my hard work and having my family celebrate with me. I am the oldest of three children but both of my parents come from much larger families and we support each other through it all. As I reminisce on my celebrations those years ago, I can’t help but think of all of those who are missing out on these milestones this year.
And of course as my thoughts spiral, which they often tend to do, I realize this pandemic has changed much more than just graduations. Wedding plans have had to change or be postponed, vacations that we have been working hard to plan and save for have now been put on hold, and so much more. This week, I was supposed to be at my first conference as a board certified chaplain, but like so many other things, the conference was canceled. As I write this, I find myself daydreaming about what I would have learned if I had gone.
I imagine so many of us are feeling this way. I not only find myself with the fear of missing out but also hoping. Hoping for the best. Hoping for normalcy. Hoping for things to go back the way they were before. But yet I know they aren’t. This pandemic has forever changed the way we gather and social distancing will be a part of the “new normal.” There are also so many lessons that have been learned and much more to learn as well.
Fear often paralyzes us. But yet with the hope, we are able to carry on. We as a Texas Children’s team carry each other through this fear. Our celebrations have changed, but we find a new way to celebrate. Nurses Week last week looked drastically different, yet we still celebrated. In the middle of pandemic, we celebrated. As the world adapts, so do we.
May this new normal we face be filled with hope. Hope that we will get that celebration, hope that life will go on. Life has continued moving forward, just not in the way we expected. As we have learned, sometimes we can plan as best as possible then life gets in the way and steers us another direction. But yet, as we join with the rest of the world, we too will continue to hoe for whatever is next.
“It is because of hope that you suffer,” said Maxime Lagacé, a Canadian professional ice hockey goalkeeper. “It is through hope that you’ll change things.”
You can use Cigna Virtual Care by Amwell to talk with a doctor or nurse any time, day or night, via secure video on your computer, tablet or smartphone.
This service is available at no cost through Sunday, May 31, to Texas Children’s employees and their dependents enrolled in a Texas Children’s medical plan.
Visit the COVID-19 Resources site and follow the “Employee Health” link for the different ways to get connected and more information on telehealth options.
In this edition of the Voice of Nursing, we share a special video montage of heartfelt letters our patients created to show just how much they appreciate their nurses at Texas Children’s. Read more
So far, children have been relatively spared from the COVID-19 pandemic. Recently, however, the World Health Organization launched an investigation into a potential link between the disease and a severe inflammatory response that’s being seen in a small number of children across the world.
The symptoms have many of the characteristics of Kawasaki disease, an inflammatory condition experts at Texas Children’s have treated for decades. Our cardiologists, hospitalists and experts in inflammatory diseases, such as rheumatologists and immunologists, see about 100 children with Kawasaki disease each year.
“We believe our expertise in cardiology and rheumatology combined with our vast experience in critical care, patient isolation and infectious diseases will serve us well if we’re required to run toward this new COVID-associated problem,” said Chief of Pediatric Cardiology Dr. Daniel Penny. “We are ready for this.”
Penny, Chief of Critical Care Dr. Lara Shekerdemian, Chief of Rheumatology Dr. Eyal Muscal, and Special Isolation Unit Medical Director Dr. Amy Arrington answer some top-of-mind questions about this new condition, how it’s affecting children and how Texas Children’s can help.
What is Kawasaki disease?
Dr. Penny
Kawasaki disease is a condition that was first described in Japan by Tomisaku Kawasaki in 1967. The first cases outside of Japan were reported in the mid-1970s. About three-quarters of cases occur in children under the age of 5 years and it is more common in boys than girls. Although it may be more frequently found in Asian-American children, it does occur in children of all ethnicities.
What are the signs of Kawasaki disease?
Dr. Penny
The common features of Kawasaki disease are high fever, rash on the chest, back and abdomen, red eyes or conjunctivitis, swelling and inflammation of the mouth, lips and throat, enlarged lymph glands in the neck, and redness and swelling of the hands and feet. Abdominal pain can also occur and appears to be common in recent reports of this condition associated with COVID-19. One particularly important complication of Kawasaki disease is that it can result in damage to arteries, including the coronary arteries, which supply the heart muscle itself. This results in the weakening of the arterial wall causing it to balloon out in a so-called aneurysm. Sometimes clots can form in these aneurysms which can block the artery. While in most children the aneurysms resolve over time, in some, scarring and narrowing can remain. If the artery blocks, it can lead to a heart attack. Another important complication of Kawasaki disease is that it can result in inflammation in the heart muscle directly, which can also impair its function.
What is the relationship between COVID-19 and Kawasaki disease?
Dr. Penny
What is becoming apparent is that the onset of this Kawasaki-like syndrome in a community appears to lag behind the appearance of COVID-19, which supports the idea that it is not the infection itself, but rather the body’s response to it that’s important. This condition was recognized earlier in Europe than in the U.S., where the onset of the community infection was later. What is also intriguing is that the incidence of Kawasaki disease in Japan, where the incidence is usually highest, does not appear to have increased during the coronavirus pandemic. This could potentially mean the precise genetic mechanisms which predispose to usual Kawasaki disease may differ from those for COVID-associated Kawasaki disease. In some children, it appears that the abnormal immune response results in severe multiple organ failure with circulatory collapse, or shock, so what we are really seeing is a spectrum of related conditions, which are all likely to result from an abnormal immune response to a primary infection with COVID-19.
How big of an issue is this?
Dr. Shekerdemian
Right now we don’t have an accurate picture of quite how big a problem this is or how big it’s actually going to be. But obviously as we gain more information from overseas and now from the United States, we’re becoming hyper vigilant so that we don’t miss potential cases that are coming in our direction. Last week, the UK reported around a dozen cases, and every day we’re hearing of more reports from the European epicenters, typically the United Kingdom and Spain. And now over the past few days from the east coast of the US as well.
What types of symptoms do these children have?
Dr. Shekerdemian
Children with this new inflammatory syndrome can present with fever, inflammation, abdominal pain, diarrhea, but sometimes they’re very sick and they have what we call shock. And this means that the heart and circulation can be affected as well. It’s important to know that not all children are critically ill, but we do know that in the extreme, some have required intensive care and very intensive therapies, and even life support.
What types of treatments are there for these patients?
Dr. Muscal
We treat severe inflammation and Kawasaki disease with a few approaches. One is getting the right experts involved to ensure that we make the right diagnosis. And then there’s a variety of interventions and medications we use to dampen the immune response. One of them is called intravenous immunoglobulins from pooled donors. And then there’s a variety of other medications like steroids, like we use for asthma, or other medications we use in rheumatic diseases to turn off the inflammation and sustain the normal immune response.
How prepared is Texas Children’s to care for one of these patients?
Dr. Shekerdemian
At Texas Children’s, we have all of the right specialists ready to care for these patients. If a child like this came to our Intensive Care Unit, we would bring together intensive care specialists, cardiologists, surgeons, and specialists in rheumatology, infectious diseases and immunology. That really gives us a wonderful team to investigate and treat the children as aggressively as needed to ensure they have the best possible outcome.
How would Texas Children’s Special Isolation Unit be used?
Dr. Arrington
Five years ago during the unprecedented Ebola outbreak in the US, Texas Children had the foresight to create a very special, one-of-a-kind pediatric bio containment unit to care for any child with any highly infectious pathogens, such as SARS, Ebola or, now COVID-19. The unit has HEPA filtration, special visualization with large windows, cleanable surfaces and pass through boxes, its own laboratory and its own autoclaves for biohazardous trash. The unit is run by a team of nurses from all over the organization, as well as physicians and advanced practitioner providers. We also have laboratory personnel, respiratory therapists, and even security staff trained to take care of these patients and their families. Between the unit itself, the team that runs it and other expert resources throughout our system, Texas Children’s is incredibly prepared to give children with this condition or others caused by highly infectious pathogens the highest quality of care.
It’s hard to contain the celebration of nursing to just one week at Texas Children’s. Every day there are inspirational stories that demonstrate how our nurses go above and beyond for our patients and their families to ensure they have the best experience and the best possible outcomes while in our care.
To celebrate National Nurses Week from May 6 to 12, Texas Children’s Nursing Retention Council planned a series of celebrations at the unit level and partnered with our chaplains and our Employee Well-Being Team to offer virtual activities – blessing of the hands and self-care sessions – to honor our more than 3,700 nurses across the system and to show how deeply valued they are and how much we appreciate them for their hard work, dedication and sacrifice especially during these challenging times.
While Nurses Week activities were planned differently this year to maintain social distancing, nurses organized their own celebrations on their units. Some of these activities included a sombrero ball toss, scavenger hunts, bingo, and several units celebrated “show your pride” day where nurses wore their favorite T-shirt representing a different theme for each day – College Pride Day, Disney Magic Day, Sports Team Day, Super Hero Day and Texas Children’s/Unit Pride Day.
Throughout the week, nurses received a generous outpouring of support from the community. Three local grocery store chains – H-E-B, Randall’s and Kroger – delivered hundreds of colorful, Texas grown-flowers and snacks for our nurses at Texas Children’s Hospital Medical Center Campus, Texas Children’s Hospital West Campus and Texas Children’s Hospital The Woodlands to show their appreciation and support for all that they do for our patients and their families.
“As nurses we strive to make everyone who walks onto our campus feel listened to, loved and taken care of,” said Sarah Pierce, an acute care staff nurse at Texas Children’s Hospital The Woodlands. “This is exactly what our community has shown us through the outpouring of gifts, food, and heart filled thank you notes. The appreciation and compassion our community has shown not only to nurses but our support staff (because it takes a village) is incredible and humbling.”
Coinciding with Nurses Week, the U.S. Navy Blue Angels conducted a spectacular 30-minute flyover across the greater Houston area including the Texas Medical Center on May 6 to salute our health care workers, first responders and other essential employees on the front lines of the COVID-19 pandemic. To celebrate our nurses and our One Amazing Team heroes at Texas Children’s, President and CEO Mark Wallace shared this special tribute video which is inspiring and uplifting.
Additionally, as a tribute to our doctors, nurses and health care workers on the frontlines, Purple Songs Can Fly, in collaboration with patients from Texas Children’s Cancer and Hematology Centers’ Long Term Survivor Program and staff from The Periwinkle Foundation, shared this inspirational music tribute video.
During Nurses Week, Texas Children’s recognized our Nursing Excellence Award recipients and our 15 Houston Chronicle Salute to Nurses honorees, two of whom were honored as Greater Houston’s Top 15 Nurses of the Year. Click here to read the Connect article and a list of our 2020 award recipients.
Texas Children’s also recognized the 2020 recipients of the Molly Mae LeBlanc Nursing Scholarship, named in memory of Molly Mae, a beloved and former patient at Texas Children’s. The program provides tuition assistance to patient care assistants (PCAs) and RNs who are pursuing BSN or MSN nursing degrees. The first scholarship was awarded in 2018. Since then, several 2018 and 2019 scholarship recipients have graduated from their degree programs and are now working as nurse practitioners.
Texas Children’s also honored our 2020 recipients of the David and Polly Roth Nursing Education Scholarship that provides tuition assistance to Texas Children’s employees in certain roles (like PCA, MA) that are pursuing professional nursing/BSN degrees. Established by Dr. David Roth and his wife, Polly, the first scholarship was awarded in 2017. The 2017, 2018 and 2019 scholarship recipients are now working as RNs at Texas Children’s today.
