October 21, 2019

Due to a high demand for our expert maternal fetal medicine services and our goal to keep access open to all patients who need our care, Texas Children’s Pavilion for Women has expanded its Maternal Fetal Center.

Located on the fourth floor of the Pavilion for Women, the center serves high-risk obstetrical patients and also bridges access to our pediatric subspecialists for our youngest patients through our Fetal Center program.

“The unit is designed so that the majority of services and partners needed to participate in a pregnancy come to us,” said Assistant Director of Ambulatory Clinical Practices for Women’s Services Aimee Jackson. “We pride ourselves on being a one-stop shop for our patients and families, providing timely, comprehensive, coordinated care in one place.”

Since opening its doors in 2012, the center has seen an 11 percent increase in patient visits. Last year, the center saw 36,000 patient visits and is expected to see 40,000 this year.

To continue to provide this growing patient population, construction on the Maternal Fetal Center began in September and was completed seven months ago at the end of April. The expansion added the following:

  • Three exam rooms bringing the total number of exam rooms in the center to nine. One of the exam rooms was built specifically for fetal intervention total care patients. These patients now can have their ultrasound, clinic visit and antenatal testing visit all in one location at the center. Historically, these patients had to schedule several different appointments in several different places to get these services.
  • Two ultrasound rooms, bringing the total number to 11. One of the new can be used for clinical imaging as well as imaging research and educational training.
  • A second conference room equipped with advanced imaging display capabilities. The room will be used for team and family meetings as well as patient classes.
  • A large multi-person office space to accommodate the center’s expanded nursing and business support teams.
  • In addition, the center’s two existing reading rooms for radiology and cardiology were renovated, expanded and optimized.

“We have needed this for a long time,” said Dr. Manisha Gandhi, the center’s medical director. “Most of our patients hoped they would never need our services, therefore we want to make their stay with us as comfortable as possible. This expansion will help us do that at an even higher level than we are now.”

Dr. Wesley Lee, chief of women and fetal imaging, agreed and said the center’s care team is committed to treating, respecting, and embracing patients with a spirit of hope and perseverance.

“Having the right space to carry out this type of care is key,” Lee said. “We are thrilled to have this extra space and to be able to use it to better serve our patients.”

Texas Children’s Pavilion for Women also is expanding its maternal fetal services at its community locations in the Greater Houston and beyond. Here are some of the latest developments:

Baytown: In April, the Baytown Maternal Fetal Medicine Clinic moved to a larger space at Houston Methodist Baytown Hospital. The clinic – which offers maternal fetal consulting and ultrasound, as well as nutrition, genetic and psychiatric counseling – opened in 2016 for just one day a week. The number of patients coming to the clinic steadily increased, prompting leadership in 2018 to keep the clinic’s doors open five days a week. Today, the clinic’s team sees 10 to 15 patients a day. The majority of those patients, 70 percent, are seen by clinicians via telemedicine. The remaining 30 percent are seen by in-house medical staff.

Medical Center: In June, the Maternal Fetal Medicine Clinic in Houston Methodist Hospital’s Smith Tower in the Medical Center expanded from two ultrasound rooms to three and one non-stress test chair to two. As a result, the clinic can see more patients for Maternal Fetal Medicine services as well as nutrition and genetic counseling.

Lufkin: In November, a maternal fetal medicine clinic is slated to open at CHI St. Luke’s Health Memorial-Lufkin. Ultrasound and maternal fetal consults will be offered.

“Our aim with these community clinics is to provide excellent patient care closer to where some of our patients live,” said Jennifer Dalton, patient care manager for the Pavilion for Women Community Clinics. “We don’t want them to have to drive to the Medical Center unless they absolutely have to.”

Akachi Phillips, manager for the Pavilion for Women Community Clinics, said she knows a patient from Louisiana who drove weekly to the Medical Center for her visits during one of her pregnancies. During a subsequent pregnancy, she was able to have her ultrasounds in Baytown, which cut down her travel time and enhanced her overall experience.

“It means a lot to the patients to have a clinic nearby,” Phillips said.

For more information about the Maternal Fetal Center, click here.

September 23, 2019

Just a few months after being named the No. 1 destination in the country for pediatric cardiology and cardiac surgery for the third straight year, Texas Children’s Heart Center® is celebrating another milestone.

One year ago, on September 25, the Heart Center made the historic move into its new home in Lester and Sue Smith Legacy Tower.

Watch the video of move day.

The entire day was a carefully orchestrated ballet of coordination.

“The move to the Heart Center was the culmination of two years of preparation and was a momentous day for us all,” said Chief of Critical Care Dr. Lara Shekerdemian. “There were lots of moving parts all working together in concert, which was incredible. The entire day was a testament to collaboration and great planning.”

Six specially trained teams made up of more than 200 members transported 64 heart patients, some critically ill, safely to their new, state-of-the-art rooms. The patients ranged in age from 3 days to 22 years. As units in the new tower prepared for patients’ arrival, team members in a command center were monitoring patients’ conditions, making sure facilities were ready, and stationing support teams along the travel routes in case of emergency.

“Fortunately, we had experience since we had moved the pediatric and the transitional intensive care units over to the new building in the months prior to the Heart Center move,” said Maria Happe, Texas Children’s nurse practitioner and clinical project manager for Lester and Sue Smith Legacy Tower. “There was a lot of excitement and tons of activity in each unit as we were getting patients, parents and teams ready to move.”

Settling in

The new Heart Center was designed from top to bottom with families in mind. One of the most important difference-makers that Heart Center staff and employees are quick to point out is the ability for families to stay together while a child receives care.

“Being able to have parents in the rooms with their children, for them to be able to comfortably stay in the space, has been a huge improvement, said Carmen Watrin, director of nursing for inpatient units. “It’s also made families essentially a part of the care team, which has been phenomenal. The families are so grateful.”

The new space also increased desperately needed care capacity. During one especially difficult period in 2013, spatial constraints rendered Texas Children’s incapable of accepting additional transports of critically ill children. We were simply too full. This prompted the historical expansion of critical, surgical and emergency care capacity that included the construction of Lester and Sue Smith Legacy Tower.

“We never want to be in a position where we say no to a family or to a child,” said Chief of Cardiovascular Anesthesiology Dr. Emad Mossad. “This new setting has given us the privilege, and the space and resources, to be able to serve as many patients as come our way. It’s been a great thing to move to a new space, a new place, a fresh start, and to have the capacity to be able to say yes to families who are seeking our help.”

In addition to new space, the Heart Center has been on a mission to ensure that it has the staff needed to deliver the highest possible level of care. One example has been the onboarding of over one hundred new nurses to ensure that nurse-to-patient ratios are always at the optimum level. There’s also no substitution for experience, especially in health care, which is why in the months leading up to the Heart Center move, cardiac intensive care unit (CICU) leadership worked not only to recruit the best nurses, but also to retain them. As a result, the number of CICU nurses with greater than two years’ experience has increased over the past year, which helps improve the overall quality of the team.

Eyes on the future

With a year now in the books, the No. 1 heart center in the country is focused on continuing to deliver the best care, but also to improving wherever possible and to growing as a team.

“I’m looking forward to further consolidating the concept of a heart center as something that we all are part of,” said Chief of Congenital Heart Surgery Dr. Christopher Caldarone. “We all have allegiances to many things – to our community, to our families, to our homes, to the hospital, to our academic department. Over the next year, we want to continue creating a culture here in the Heart Center where people feel like they are truly a part of this big team.”

Additionally, the Heart Center is looking forward to growing care capabilities, including an expansion of the Adult Congenital Heart Disease (ACHD) program. Over the course of the next year, the Heart Center will develop a dedicated center for adults with congenital heart disease, where they will be treated by specialists who recognize and understand their unique needs.

“This expansion will be a huge statement by Texas Children’s Hospital,” said Chief of Pediatric Cardiology Dr. Daniel Penny. “There should never be an expiry date on the care of children with congenital heart disease as they transition to adulthood. Our ACHD team already provides amazing care, but with this expansion, all aspects of care for adults with congenital heart disease will be available on one dedicated unit. It’s an exciting time at Texas Children’s Heart Center.”

Learn more about the world-class care and services provided at Texas Children’s Heart Center.

September 17, 2019

As one of the best pediatric cancer centers in the nation, experts at Texas Children’s Cancer Center are on the forefront of cutting-edge basic, translational and clinical research. The center’s world-renowned faculty have pioneered many of the now standard protocols for treating and curing children with cancer.

Scientists and clinical experts at the center are conducting more than 250 clinical trials – more than the majority of pediatric cancer centers in the nation. In addition, the center’s Developmental Therapeutics Program and its Cell and Gene Therapy Program have been leaders in the study of novel agents and immunotherapies, respectively, for the treatment of childhood cancer.

“Our physicians employ evidence-based guidelines and the most advanced clinical trials in the delivery of oncology care,” said Cancer Center Director Dr. Susan Blaney. “Our vast expertise in the development of new therapeutics means our patients have access to the most advanced and innovative therapies.”

Dr. Andras Heczey, one of the Cancer Center’s physician scientists and a member of the newly-formed Sky High Immunotherapy Center, is working with colleagues in his laboratory to develop novel treatments for children with solid tumors. His work is a prime example of what the Cancer Center is doing to advance treatments and ultimately find a cure for a disease that remains the leading cause of non-accidental death in children.

In honor of National Childhood Cancer Awareness Month, we interviewed Heczey about his research and why he thinks such work is so important to enhanced patient care.

What is the focus of your research?
My research focuses on redirecting the normal immune system to attack cancer cells. T cells are a type of white blood cell that participate in the immune response. I am using genetically engineered T cells to treat liver tumors in children and Natural Killer T (NK-T) cells to treat neuroblastoma, a childhood tumor that most commonly involves the adrenal gland.

How exactly does this work?
We take patients’ white blood cells from a simple blood draw, modify them in the test tube to recognize and kill tumor cells, and then re-infuse these genetically engineered (modified) cells into the patient’s blood stream. The idea is that we train the immune system to kill the cancer cells. In patients with neuroblastoma, we modify Natural Killer T cells to express a protein called chimeric antigen receptor (CAR for short) that targets GD2, a molecule on tumor cells but not on normal tissues. When the Natural Killer T cells arrive at the neuroblastoma tissue, they recognize the GD2 molecule and kill the cancer cells. In liver cancer patients, we are using a similar strategy using T cells that express CAR targeting a molecule called Glypican-3, which is primarily expresses on liver cancer cells.

Have you used these treatments in children at Texas Children’s?
Last summer, we started our first human clinical study in children who have relapsed or have refractory high-risk neuroblastoma. So far, three children have been treated. The results we have observed thus far are very promising. We also have started our first human clinical study in children with relapsed or refractory liver cancer. The first patient was recently treated and we are eagerly waiting for the results.

What else are you studying in your laboratory?
In addition to developing strategies to kill the tumor cell, we are also closely studying the tumor environment. We know that when genetically engineered cells enter the tumor, the cancer cells and other cells within the tumor will fight back. We don’t really know how this happens. We have some ideas, but we and others in the field are closely evaluating what happens in human tumors after the engineered cells are infused. This is really important because we want to make sure our cell therapies are effective and that the responses are sustained and the patients are cured. Ultimately, we’ll also need to develop techniques to engineer the cells inside the body. Right now, we have to grow and test the cells before infusing them into the patient. This typically takes four to six weeks, depending on the product and how many cells needed to be manufactured. A patient cannot always wait that long. In the future, we envision strategies where a patient’s immune cells are engineered inside their body to quickly redirect them against the growing tumor cells.

Are you encouraged by what you are finding?
Yes, I am very encouraged. We are getting closer each and every day to finding a cure for some forms of childhood cancer.

Click here to view a preview of the next installment of “This is Cancer: Reflections from our patients.” This installment focuses on Tajah, who was diagnosed with osteosarcoma after visiting Texas Children’s Emergency Center with intense knee pain. The 13-year-old had to have her knee and femur removed. Surgeons replaced them with a metal extendable one, which will prevent her from undergoing several additional surgeries as she grows. The “This is Cancer” series documents the journeys of several families receiving care at Texas Children’s Cancer and Hematology Center. Their stories illustrate in intimate detail what they’re experiencing and how to better support them. Click here to learn more.

September 16, 2019

More than 1 million patients are harmed each year in the United States because of medical errors. The most common, yet preventable types of medical errors are those involving patient misidentification.

Collecting blood specimen and other lab results from patients is more than just placing a label on a tube. It’s a complex, multi-step process that involves meticulously checking and re-checking to ensure that the specimen being collected, labeled, processed and handled matches the right patient, every time.

“We know that safe, quality care for every patient at Texas Children’s is the most important responsibility of each staff member and employee here,” said Texas Children’s Vice President Trudy Leidich. “While no hospital is completely immune to medical errors, Texas Children’s continues to take proactive steps to improve the positive patient identification process in order to eliminate preventable harm to our patients.”

In conjunction with World Patient Safety Day on September 17, Texas Children’s has launched a new campaign – Don’t Skip the Check: ID every patient, every time – to engage our employees system wide around PPID efforts and to ensure error prevention alertness and accountability are always top of mind.

“We have several teams anchored around specific PPID goals,” said Denise Tanner-Brown, Director of Patient Care Services at Texas Children’s Hospital West Campus. “They’ve helped us assess and refine our PPID processes and develop learning principles that translate into safe practice at the point of care.”

Since one of the top safety risks nationwide is misidentification, Texas Children’s PPID leaders took an introspective look at our organization to re-assess and identify our potential safety risks. As part of our PPID improvement efforts, the Quality and Safety teams reviewed safety scoops from March 2018 to February 2019, and found that mislabeled specimens was by far the greatest risk of preventable harm.

“Our review of near miss safety events were invaluable lessons for us,” said Nicole Crews, a nurse practitioner in Pathology and Transfusion Safety Officer for the PPID Leadership Team. “By comparing these data trends, we saw what areas we’ve improved upon and what areas need more reinforcement, which subsequently has helped us proactively address these issues and remove barriers to success.”

PPID education roll-out plan – what to expect

The PPID education roll-out initiative will be conducted in several phases across the organization for clinical staff as well as nonclinical employees who have direct encounters with patients and their families.

The training modules accessible via Health Stream include an overview of Texas Children’s PPID policies and processes during blood specimen collection, processing and blood product handling. The modules also include patient families’ stories about misidentification to underscore the important role each of us play in helping to cultivate a harm-free environment for our patients and families at Texas Children’s.

To further drive home this message, the PPID Leadership team collaborated with Marketing to produce electronic slides and screen savers with our call-to-action messaging – Don’t skip the check: ID every patient, every time – that will be used across our three hospital campuses to keep positive patient identification top of mind. Posters will also be placed in our patient units to serve as a visible reminder.

In addition to this, Texas Children’s PPID campaign also includes efforts to educate our patients and families about the importance of wearing ID bands at all times while in our care to ensure their safety.

“September 17 marks a cultural revolution at Texas Children’s Hospital,” said Associate Chief Nursing Officer Jackie Ward, and executive co-sponsor of the PPID Initiative. “We want to ensure every patient has a positive PPID experience and that we’re providing the right care to the right patient every time.”

By just saying, “Alexa, open Texas Children’s Urgent Care,” you will now be able to access wait times and available hours immediately from your Amazon smart device. The feature was developed to make retrieving information about your local urgent care more convenient and hands-free.

Alexa is a widely popular digital assistant built into smart devices, answering questions and performing a multitude of tasks in millions of homes across the country.

Paola Alvarez-Malo, Vice President of Innovation, wanted to explore how to leverage the popularity of Alexa and connected with Information Services Applications Architect Brian Warwick.

“It gets information that’s already out there, and it’s quick, easy and very helpful,” Alvarez-Malo said. “Innovative ideas often come from two people with a common interest connecting and helping each other think through the possibilities. The partnership with IS and Texas Children’s Urgent Care is a great example of how we can work together to bring new ideas to life.”

Warwick had previously built the online Texas Children’s Urgent Care wait times and had already begun to explore how to extend that build to Alexa as a means to demonstrate the use of new technologies.

“I think it’s something that definitely sets us apart from other children’s hospitals and what’s being offered right now,” Warwick said. “I believe we are the only one that is actually pulling real time Epic data, so I’m pretty proud of it.”

By just saying, “Alexa, open Texas Children’s Urgent Care,” you will be able to access wait times and available hours.

“This skill is another way that Texas Children’s is enhancing patient experience through innovative tactics,” President of Texas Children’s Pediatrics and Urgent Care Kay Tittle said. “We look forward to its expansion and how this skill will allow our urgent cares to provide even more efficient services.”

As the first phase of this process rolls out, the information services team plans to include more features and add more locations to the skill. We would love your feedback to determine how we can make Alexa more effective for all patients.

Click here to take our survey and let us know your thoughts.

The Jan and Dan Duncan Neurological Research Institute (NRI) at Texas Children’s Hospital recently hosted the first-ever family conference for EBF3-HADD (Hypotonia, ataxia and delayed development) syndrome (HADDS). Medical residents, genetics counseling students and research scientists joined more than 20 families from across North America that attended in person and 13 families that participated via live-streaming services from countries around the world – including Ireland and Australia – making it a truly international event.

The conference was organized by the EBF3-HADDS Foundation, a nonprofit organization created in 2018 by families to promote awareness, research and support for this genetic syndrome. The foundation was co-founded by Ashley LeMaire and her husband, Mark. After one of their children was diagnosed with HADDS in 2016, the LeMaires started a Facebook group for HADDS families. In just two years, that group has grown into an international community and was the impetus behind the foundation’s creation.

“Our HADDS community is a motivated and talented group of families dedicated to supporting research, education and advocacy efforts for HADDS patients, and we support each other on this journey,” said LeMaire, who is a clinical neuropsychologist at the Menninger Clinic, assistant professor of Psychiatry & Behavioral Sciences at Baylor College of Medicine, and also board member of the EBF3-HADDS Foundation. “There is still much to learn about HADDS, but when you have such a dedicated team of physicians and researchers collaborating with families to learn about the condition and provide needed support, it fosters so much hope for our families.”

During the conference, guests attended presentations on a variety of HADDS-related topics given by NRI researchers Drs. Hsiao-Tuan Chao and Michael Wangler; pediatric urologist Dr. Irina Stanasel, a former Texas Children’s fellow; Texas Children’s genetic counselor Pilar Magoulas; and Geraldine Bliss, research director of the Phelan-McDermid Foundation. Additionally, Chao and Wangler offered clinical evaluations for patients, and attendees were also able to tour research labs and facilities at the NRI, where one of the first genetic discoveries for HADDS was made in 2016, and the first lab (Chao’s) devoted to understanding the biology of this disorder.

A search for answers

If you’ve never heard of HADDS, there’s a good reason. The rare genetic disorder, caused by a mutation in the EBF3 gene, was only discovered in 2016 by Chao and Wangler when they were training in NRI investigator Dr. Hugo Bellen’s lab, in collaboration with colleagues at the Undiagnosed Diseases Network (UDN) and New York University Langone Health.

The UDN had been stumped by a case in which a child exhibited symptoms including impaired speech and cognition, low muscle tone, balance and gait issues, reduced ability to feel physical pain, and an inability to show facial emotional expressions. Though earlier DNA sequencing had yielded a few candidate genes, there wasn’t a significant patient cohort or research to help determine which gene was responsible for the symptoms.

Researchers selected EBF3 as the most likely candidate gene. Chao then used fruit flies to mimic mutations to better understand EBF3’s role, and within a few months three patients were found who presented with similar symptoms and similar mutations in the EBF3 gene.

As result of those efforts, more than 200 patients with HADDS have been identified to date.

“The gene discovery of EBF3 illustrates the ‘Power of One’ in medicine and biomedical research, how a single patient with an undiagnosed disorder – a ‘medical mystery’ – can lead to the discovery of a gene responsible for a previously unknown disorder,” Chao said. “This becomes the starting point to develop the diagnostic tests and therapies that can transform the lives of many patients and their families.”

Since 2017 Chao and Wangler have offered monthly clinical evaluations for HADDS patients at Texas Children’s and have now seen the largest number of such patients at any single institution worldwide. They are also enrolling patients in a study to better understand the condition and to help translate research into potential clinical interventions in the future.

The conference was a testament to the power of teamwork and collaboration in research, and also shows how dedicated parents and volunteers from across the globe can work together to build a community of support.

September 10, 2019

As part of Texas Children’s Patient Access Initiative, the organization has made major progress to ensure our patients easily and conveniently get in the door to receive the care they need, when they need it.

“Our objective has been to lay a solid foundation and layer on additional patient access solutions now that we have a sturdy infrastructure to build from,” said Texas Children’s Surgeon-in-Chief Dr. Larry Hollier and co-chair of the Access Executive Steering Committee. “Because we really care about our families, we have to pay attention to their needs and do more to help them out. We have to keep the doors open to our patients and their families.”

Last year, Texas Children’s Patient Access Committee evaluated 944 provider templates and found additional slots where physicians could see patients for a duration of four hours, which resulted in the organization adding 53,000 new appointments to the system that had not existed before. In addition to this, the 72-hour flip helped the organization maintain flexibility and open schedules. If an appointment slot for a specific patient type was not filled 72 hours out, the slot automatically opened to a broader group of patients.

7-3-1 strategy: Building on our previous successes

After expanding appointment availability with four-hour clinic sessions and 72-hour flips, the Capacity Management Team this year was tasked with deploying a strategy to ensure these slots were filled.

Led by leaders in Ambulatory Operations and Central Scheduling, the team identified the largest area of opportunity was to work to decrease no shows – particularly for appointments scheduled more than 30 days in advance – and to implement a standardized way to recapture patients following a no show.

Focusing efforts on automated solutions, the team partnered with Information Services (IS) to optimize the hospital’s text message reminder system for appointments. Previously, patients only received a three-day reminder message for their appointment, which particularly for appointments scheduled three months – or even a year – in advance, is not enough of a reminder notice to arrange for time off, childcare or transportation. Now, patients receive their first request to confirm or cancel their appointment via text message at seven days, with additional 3-day and 1-day reminders prior to the appointment date.

The impact has been immediate after going live with the “7-3-1 strategy” at the end of May. In July, the hospital hit the system goal of a 10 percent no show rate for the first time ever, down from a three year average of 11.5 percent. While this change may seem small, a 1.5 percent decrease in no shows represents about 1,000 completed appointments a month.

Because we will never be able to completely eliminate patient no shows, the team also implemented an automated text message that will go out to patients the day after their missed appointments, offering the opportunity to be connected with a live scheduler to get another appointment scheduled. Historically, only 20 percent of patients that miss an appointment get rescheduled. Since launching recapture messaging in July, that number has already started to increase steadily.

“Overwhelmingly, our patients and families tell us that they prefer to engage with us via text message and on their phones,” said Grace Karon, Assistant Director of Business Operations and Strategic Planning for the Department of Pediatrics. “By focusing on technology rich solutions, we are giving families the customer-obsessed experience that they have come to expect from other services they receive, while working to ensure that patients who miss appointments do not fall through the cracks.”

Other patient access improvements

Texas Children’s patients and their families continue to benefit from the hospital’s patient access improvements that were implemented over the past year and a half.

Click here to watch this recent video on other patient access solutions we’ve implemented across the system to improve access, care coordination and patient experience at Texas Children’s Hospital.