November 19, 2019

At Texas Children’s, we care for some of the country’s most critically ill patients, and delivering safe, quality care for our patients is the most important responsibility of each staff member and employee.

In Fiscal Year 2019, Texas Children’s reached several remarkable patient safety milestones, which demonstrate our continued commitment to cultivating a harm-free environment for our patients.

“The key to creating an environment of safe patient care is ensuring that our staff is equipped with the knowledge and tools they need to take preventive action,” said Texas Children’s Chief Safety Officer Dr. Joan Shook. “When analyzing our patient safety statistics over the last several years, we have seen a significant decrease in both serious patient safety events and preventable deaths across the system.”

Texas Children’s reached several patient safety milestones in FY19 including:

  • Decreased serious safety events (SSE) – A serious safety event is a deviation from standard practice or process that reaches the patient and causes moderate to severe harm or death. In FY13, there were 20 SSE’s compared to 5 SSE’s in FY19, resulting in a 75 percent decrease.
  • Reached Zero SSE deaths in FY19 – Since January 20, 2018, Texas Children’s reached 655 days with zero preventable pediatric deaths and zero maternal deaths since 2013.
  • Reduced Hospital Acquired Conditions (HAC) – Pressure injuries have significantly improved over time and we have seen a considerable drop in adverse drug events, catheter associated urinary tract infections and surgical site infections.
  • Immunization compliance – Since implementing new immunization requirement in 2019, the organization has reached a 99.3 percent compliance rate, which is important to patient safety.

As part of Texas Children’s continuing efforts to improve patient safety across the system, employees and medical staff participated in the Agency for Healthcare Research and Quality’s 2019 Hospital Survey on Patient Safety Culture that is administered by Texas Children’s every 18 to 24 months. The survey evaluates 13 dimensions of patient safety and measures the organization’s overall patient safety performance.

When comparing survey results from 2016, Texas Children’s – for the first time ever – showed statistically significant improvement in five major areas including feedback and communication about error, teamwork across individual units, management support for patient safety, staffing, and hand-offs and transitions.

Through the hospital’s systemwide patient safety and quality improvement efforts, employees and staff continue to apply proven safety behaviors in their every day work and are more comfortable speaking up when there is a potential safety concern. Shook says this along with other contributing factors – like reviewing monthly unit-based safety scoop reports and reaccessing current practices to identify areas of improvement where change is needed – have helped us create and sustain a culture of patient safety.

“Our recent patient safety milestones reflect the tremendous work and collaboration from multiple teams across the organization that have led us on a positive trajectory,” Shook said. “Our goal is to build upon these successes and continue to take proactive steps to eliminate preventable harm to our patients.”

Norma Terrazas shares her excitement with colleagues as they prepare to move acute care services from the old Abercrombie Building into 15 West Tower – the former home of Texas Children’s Heart Center — on November 20. Read more

November 18, 2019

Maintaining the privacy and security of our patients’ and Health Plan members’ medical information is a key component of providing high quality care. Patients, Health Plan members, and their families must be able to trust that no one at Texas Children’s inappropriately accesses, discloses, or uses their protected health information (PHI). Having our patients’ and Health Plan members’ trust is an essential element of the care we provide and the relationship we develop with families.

As a Texas Children’s workforce member, you should only access medical records when it is part of your official, assigned work duties. Every “click” within our patient care systems is recorded. The Compliance and Privacy Office uses data analysis software to detect potential inappropriate access. When a workforce member appears to be “snooping,” the Compliance & Privacy Office coordinates with leadership and Human Resources to investigate and determine appropriate disciplinary action, up to and including termination. Three workforce members have been terminated this year for privacy violations.

Earlier this year, a child treated at Texas Children’s Hospital was the subject of multiple news stories. The Compliance and Privacy Office applied Epic’s Break-the-Glass tool to the patient’s record to deter inappropriate access. Despite these measures, two workforce members (who worked in areas in which the patient had no activity) “broke the glass” and accessed the patient’s record. Additionally, thirty-six workforce members searched the patient’s name in Epic but did not proceed past the Break-the Glass prompt into the medical record. This “snooping” was inappropriate and in violation of law and our policies. The two workforce members who accessed the patient’s record received disciplinary action, and the thirty-six individuals who searched the patient’s name received a warning from the Compliance and Privacy Office.

Your responsibility as a Texas Children’s workforce member is to:

  • Only access PHI when it is part of your assigned work responsibilities.
  • Do not access the records of your friends, family members, children, or yourself.
  • Do not access records out of curiosity.
  • Do not disclose PHI to unauthorized persons.
  • Do not share PHI on social media sites (Facebook, Instagram, Twitter, etc.).

Key Takeaway! Do not access any medical record unless it is necessary to do your job. Inappropriately accessing, using or disclosing PHI is a violation of federal and state law and Texas Children’s policy, and may result in disciplinary action, up to and including termination.

Questions? Contact the Compliance and Privacy Office by calling 832-824-2085 or emailing compliance@texaschildrens.org.

On his blog, Mark Wallace continues his Leadership Maxim series with his fourth guest blogger, Kristi Lemmert, who writes about Maxim No. 4: We all should have our own definition of leadership.

By commenting on Lemmert’s blog – and the next blog in the Leadership Maxim series – you can secure a chance to score a spot at a Houston Texans event.

Throughout November, the Corporate Communications team will randomly select 100 people from the comments to attend a private event with the Houston Texans, including a behind-the-scenes tour of NRG Stadium, an autograph session with two Houston Texans football players and photos with Texans cheerleaders. The event will be held on Tuesday, December 3. Read more

During the final week of October, Texas Children’s Hospital hosted visitors from around the world for a very special Rett Syndrome Symposium and Workshop.

The two-day event was momentous for many reasons. It was the inaugural meeting held in the stunning new Auditorium and Conference Center at the Jan and Dan Duncan Neurological Research Institute (Duncan NRI) at Texas Children’s Hospital. It fortuitously coincided with Rett Syndrome Awareness Month. And the symposium also marked the 20th anniversary of the discovery of the underlying cause of Rett syndrome. In 2000, NRI director Dr. Huda Zoghbi’s research team made the pioneering discovery that loss-of-function mutations in methyl-CpG binding protein, MECP2, were the underlying cause of Rett syndrome.

Rett syndrome is a rare neurological disorder that primarily affects young girls between 6 months and 2 years of age. The children appear to hit normal developmental milestones until, inexplicably, their motor, cognitive and social skills start to rapidly deteriorate. Most patients develop autistic features, breathing difficulties, dementia, growth abnormalities, epilepsy and scoliosis.

The symposium opened with a warm welcome from co-organizers Dr. Adrian Bird – Buchanan Professor of Genetics and Welcome Trust Center for Cell biology at the University of Edinburgh, UK – and Zoghbi, who is also a professor at Baylor College of Medicine and Howard Hughes Medical Institute investigator.

“The purpose of this event was to bring together researchers who work on Rett syndrome and leaders from related areas of neuroscience working in academia, industry and government, to think deeply and spark new ideas,” said Zoghbi. “The hope is that out of the work and discussions that happened here, in five years, when we’re marking the 25th anniversary of the gene discovery of Rett syndrome, we’ll also be celebrating new treatments for people with Rett syndrome.”

The international symposium was sponsored by Rettsyndrome.org (formerly the International Rett Syndrome Foundation) and the Rett Syndrome Research Trust. The multidisciplinary group of attendees included scientists, physicians, members of the lay public, and representatives from the National Institutes of Health, the pharmaceutical industry, and several foundations, all brought together to look at Rett syndrome with a fresh, new perspective.

On the first day of the symposium, presentation topics ranged from clinical observations of MECP2 disorders like Rett and MECP2 duplication syndrome to pathogenesis (progression or development) of Rett syndrome, to discussions on neuronal circuit alterations and therapeutics. Texas Children’s pediatric neurologist Dr. Bernhard Suter spoke about MECP2 duplication syndrome, which typically affects male patients and causes symptoms such as hypotonia, motor delays, intellectual disabilities, gastrointestinal issues and epilepsy.

Following a day of stellar research presentations, the investigators split into three working groups that focused on Molecular Pathogenesis, Therapeutic Approaches and Young Investigators. The groups discussed the information presented over the course of the day and their vision for the future of Rett syndrome research. This included the systemic and technical challenges that currently exist, and the group brainstormed ways to overcome those. The next morning, key points from these discussions were shared with the audience.

  • Rett syndrome is a particularly challenging disorder to correct. The levels of MECP2 protein in the neurons need to be precisely regulated because too much MECP2 protein causes a different neurological condition, the MECP2 duplication syndrome. Despite these challenges, research in Rett syndrome is advancing at a rapid pace, having moved from gene discovery to promising clinical trials in under 20 years.
  • Gene therapy offers exciting opportunities to develop treatment for Rett syndrome and is an area of active research. However, there are challenges to overcome including controlling the level and distribution of the delivered gene.
  • While the ultimate long-term goal of researchers is to find a lasting cure using gene therapy, clinicians in the audience weighed in on the benefits of also developing short-term strategies to treat specific behavioral or motor issues and/or how to delay the age of symptom onset. This would be a huge step forward for patients, their families and caregivers who cope with this debilitating condition on a daily basis. Participants in the discussion also drew parallels to the field of breast cancer, where non-targeted treatment modalities serve as the workhorses to treat the majority of patients.
  • There is a dire need to develop early screening/diagnostic methods for Rett syndrome among newborns. Early diagnosis, in combination with specialized therapies – such as neuromodulation physical therapy, speech therapy or psychotherapy may provide maximal improvements in the quality of life of the patients.
  • Building collaborations between academia and industry, with a focus on multidisciplinary team science and data-sharing, is critical to facilitate the development of superior reagents (i.e., better viral vectors for gene therapy), biomarkers (i.e., meaningful measures of clinical outcomes) and therapies. Moreover, there was a general agreement that close partnerships between various key stakeholders, such as scientists, physicians, pharma/biotech industry, families, caregivers and advocacy groups, are crucial for developing effective therapies.

Learn more about Texas Children’s research efforts at the Jan and Dan Duncan Neurological Research Institute and world-class clinical expertise provided at the Rett Center.

As a Texas Children’s employee, it is important to make informed, thoughtful decisions about what you choose to post online. Learn more about how to be social media savvy. Read more

Texas Children’s Hospital and Baylor College of Medicine recently hosted the Pediatric Critical Care Summit of the Americas, a first of its kind bilingual assembly that provided a forum for building bridges among health care providers in the Americas.

More than 500 people from 15 countries attended the summit, which was held from November 7-10 and included seven pre-conference workshops, a tour of Texas Children’s Hospital, three full days of symposia, a bachata dance workshop and a fiesta.

Some of the goals of the summit, which blended two pediatric critical care organizations – the US-based 26th Pediatric Critical Care Colloquium and the Latin American-based 15th Latin American Congress of Pediatric Intensive Care – were:

  • Support, encourage and promote excellence in clinical care and research in the field of pediatric critical care across the Americas.
  • Encourage collegial relationships between US, Central American and Latin American pediatric intensivists and the greater inter-professional team.
  • Promote basic, translational, and clinical research related to critically ill children both while acutely ill and after discharge from the ICU.
  • Promote and disseminate related quality improvement and patient safety materials through established and developing communication technologies.

Plenary speakers and their topics of discussion included:

  • Drs. Jesus Lopez-Herce (Spain) and Jefferson Piva (Brazil) – Intensive Care in the Americas in 2019: Forging a New Doctor
  • Texas Children’s Physician-in-Chief Dr. Mark W. Kline – Global / International Outreach in Pediatric Medicine
  • Texas Children’s associate chief of Critical Care Medicine Dr. Paul Checchia – Pediatric Cardiac Care in 2019
  • Dr. Bettina Von Dessauer (Chile) and Texas Children’s Critical Care physician Dr. Fernando Stein – The Human Cost of ICU Survival
  • Dr. Joseph Carcillo (University of Pittsburgh) – Inflammation, Sepsis, and Organ Failure: Where are We Going?

The modernization of pediatric critical care medicine has improved the quality of health care delivered to children with life-threatening conditions and has drastically reduced their mortality. As a consequence, a growing cohort of children and adolescents who survive a stay in a Pediatric Intensive Care Unit (PICU) do so with varying degrees of special healthcare needs and technology dependence.

They need a medical home and require complex medical care often coupled with frequent ICU readmissions and pose new challenges to caregivers, providers, health care systems and society. Pediatric intensive care providers are tasked with providing skilled quality care to critically ill children with empathy, compassion, professionalism and resilience but are also obliged to transition them from hospital to nurturing home care.

Global collaboration and information sharing has improved greatly but accessibility still is not uniform across the Americas and profound disparities still exist with regard to resources, organization, and continuing education. The Pediatric Critical Care Summit of the Americas represented international cooperation targeted toward these challenges in global Pediatric Critical Care.