November 13, 2018

Early on the morning of November 7, an excited group including Texas Children’s Hospital clinical leadership, executives and members of the Kangaroo Crew and Mission Control teams gathered on the roof of Lester and Sue Smith Legacy Tower for a special ribbon cutting ceremony marking the opening of our new helistop.

Watch the video or view the photo gallery below.

“The Lester and Sue Smith Legacy Tower has always been about improving care for the sickest children we see,” said Surgeon-in-Chief Dr. Larry Hollier. “The helistop is important because it improves access for those children. Whether they’re being transported as part of a scene response for an auto accident or transferred from another hospital, we can now get children and women here in very rapid fashion within a 150-mile radius.”

The helistop is the final element of Smith Legacy Tower to go live and represents the culmination of a major expansion at our Texas Medical Center campus. Months of planning and multidisciplinary cooperation between medical staff, Transport Services and engineering and facilities teams went into preparations for the helistop opening.

“A tremendous amount of work has gone into making sure that the helistop is very safe – safe for the helicopters coming in, safe for those crew that are delivering the patients to us, and safe for our own staff,” said Executive Vice President Mark Mullarkey. “Bert Gumeringer, Gail Parazynski and Deb D’Ambrosio and their teams have been instrumental both in making sure we’re prepared to open the helistop and really in bringing Smith Legacy Tower to full completion.”

Extensive simulation exercises were also held to prepare care and transport teams for potential eventualities they may face, as well as to analyze and improve processes. This included helicopter landings, transferring patients from the helicopter crew to Texas Children’s transport teams, and moving patients from the helistop at Smith Legacy Tower to Trauma and the Emergency Center.

“The helicopter simulation was fantastic,” said Dr. Jeanine Graf, chief medical officer at West Campus and pediatric medical director of the Kangaroo Crew. “We brought together members from our trauma, surgery, ICU and NICU teams, as well as our experts in maternal-fetal medicine, for training and simulations, which were coordinated by our Texas Children’s Simulations Center. Dr. Cara Doughty really did an excellent job demonstrating how more than a hundred folks would be involved in the communication and execution of a helicopter landing at Texas Children’s.”

The helistop at Smith Legacy Tower is the third helistop in the Texas Children’s system, with others in operation at West Campus and Texas Children’s Hospital The Woodlands. The addition of the new helistop will facilitate the rapid transport of patients across all populations, including neonatal and maternal patients. Before the helistop opening, Texas Children’s received roughly 150 helicopter transports a year, which landed at nearby partner institutions. Now with our own helistop, we’ll be able to offer our care to even more patients who need us.

“The helistop really changes things for us,” said Deb D’Ambrosio, RN, director of Transport Services and Mission Control. “We’re certainly expecting high volume, but with the processes we’ve developed with our helicopter vendors and the high level of coordination between Transport Services and Mission Control, this is going to be so much better for our patients.”

October 8, 2018

A world-class, multidisciplinary team at Texas Children’s is making huge strides in the care of children with extremely complex tumors.

The Head and Neck Tumor Program, begun in February 2016 as collaboration with partner institutions within the Texas Medical Center, has performed more than 20 major ablation free-flap multidisciplinary cases – a staggering number, considering the rarity and complexity of the tumors, which can be malignant or benign and can affect any combination of the sinuses, skull, jaw, mouth, neck and face. The ability to handle that volume of complex cases, combined with tremendous outcomes in the first two years, puts Texas Children’s Head and Neck Tumor Program among the best such programs in the country.

“Our institutional expertise is in taking care of these kinds of critically ill children, and Texas Children’s does it better than anyone,” said Dr. Daniel Chelius, attending surgeon in the Division of Otolaryngology and co-head of the program. “We’ve built a collaborative, coordinated program on that foundation of expertise in many different areas to provide the best care possible for the sickest children, while also reviewing and analyzing the care from every angle to see what went well and what processes could improve.”

Treatment of children with head and neck tumors around the country has historically been ad hoc, due to the varying functional issues or oncologic needs present from patient to patient and the extreme rarity of the tumors in any given city. Compound these complex physiological issues with the fact that most children these tumors have been treated in adult hospitals and the result has been a largely disjointed approach to care.

Texas Children’s Head and Neck Tumor Program, spearheaded by Chelius and Dr. Edward Buchanan, chief of Plastic Surgery, has developed a coordinated process around a multidisciplinary team approach that builds crucial experience in the treatment of these rare tumors and provides consistent, personalized care for patients – like 15-year-old Kami Wooten.

Last year, Kami began to notice swelling in her gums. Just months later, a benign tumor had covered half her face and threatened her vision. The team at Texas Children’s developed a specialized care plan that included removing the mass and reconstructing a portion of her face including the roof of her mouth and her orbit (eye socket). Additional procedures will be necessary in the future, but Kami and her family are grateful for the care Texas Children’s gave them.

Learn the rest of Kami’s story here.

The collaborative program comprises more than 10 Texas Children’s specialties and subspecialties, including Otolaryngology, Plastic Surgery, Neurosurgery, Oncology, Interventional Radiology and Anesthesiology, as well as a dedicated operating room team – led by Audra Rushing and Kelly Exezidis – that has been instrumental in building robust perioperative protocols. The additions of pediatric head and neck surgeon Dr. Amy Dimachkieh and microvascular reconstructive surgeons Dr. W. Chris Pederson and Dr. Marco Maricevich have increased the program’s abilities and improved the quality of its recommendations.

“It takes a lot of thought and planning to remove these complex tumors completely, while sparing as many nerves and other important structures as possible, and then to reconstruct those structures to provide both a good functional and cosmetic outcome,” Chelius said. “We tell our patients that the process might not be fast because they need the right surgery the first time. That requires recommendations from a team of experts, not just one surgeon. And that means carefully coordinating to make sure everything is as perfect as possible.”

The care required to treat these tumors, particularly if the patient is also undergoing cancer treatment, can also take a massive emotional and psychological toll. The Head and Neck Tumor Program provides additional care support through the department of Clinical Psychology and Child Life Services.

The team also uses technology to enhance the patient experience, from diagnosis to recovery. The program uses 3-D modeling to reconstruct children’s anatomy to help predict the extent of resection and to develop the surgical plan. The team also developed a data-driven protocol for pediatric tracheostomy removal, in close collaboration with Speech and Language Pathology, which uses a pressure monitoring device to signal when the trach is loose enough in the airway to be removed without adverse effects.

As a result of this innovative approach to care, 100 percent of patients treated have left the hospital breathing, eating and swallowing on their own. And the average stay in the hospital: just 14 days.

The program has been steadily building a referral base, drawing patients from across the region and from as far away as Mexico and the Middle East. In the near term, the team will continue to solidify the program, publish data and findings, and work to increase Texas Children’s reputation as the leading referral center for these complex cases. Long-term goals include building a basic science research infrastructure around understanding the underlying causes of these tumors, as well as collaborating with Texas Children’s Cancer Center and other research partners.

“We know that families are coming to us shocked and scared,” Chelius said. “We want them to know that we’re building our experience, we’ve walked families through this before, and we’re going to get them through this with the absolute best care available.”

Learn more about Texas Children’s Head and Neck Tumor Program.


Dr. Jenny Despotovic, director of the Immune Hematology program at the Texas Children’s Hematology Center, served as editor of the recently published textbook Immune Hematology: Diagnosis and Management of Autoimmune Cytopenias. The textbook provides a concise yet comprehensive overview of the most common autoimmune cytopenias affecting adults and children.

This is the first textbook dedicated exclusively to immune cytopenias. Despotovic worked with several of her colleagues to develop, write and edit the content in the textbook, which had over 2,000 downloads in the first two months since publication.

The book is divided into four sections, each of which focuses on a major autoimmune cytopenia. The first section features background, pathophysiology, presentation, evaluation, and treatment strategies for immune thrombocytopenia (ITP), the most common cause of antibody-mediated platelet destruction. The second section reviews common forms and treatment strategies for autoimmune hemolytic anemia (AIHA), including a chapter dedicated specifically to Evans Syndrome. The third section comprehensively reviews the pathophysiology, diagnosis and current management approaches to thrombotic thrombocytopenic purpura (TTP), a potentially life-threatening autoimmune syndrome. The book concludes with a final section on autoimmune neutropenia. Each section includes a review of common underlying systemic autoimmune conditions and immune deficiency syndromes that can accompany or cause autoimmune cytopenias.

“It was a privilege to be part of the creation of this very important textbook,” Despotovic said. “It is an important addition to the body of literature available to guide providers in the diagnosis and management of these challenging disorders, and will hopefully positively impact the care of patients with these complex conditions.”

Those in the Hematology Center who contributed to the effort include:
Dr. Alicia Chang
Dr. Clay Cohen
Dr. Jenny Despotovic
Dr. Amanda Grimes
Dr. Taylor Olmsted Kim
Dr. Jacquelyn Powers
Dr. Shawki Qasim
Dr. Sarah Sartain

September 26, 2018

 

As the largest children’s hospital in one of the fastest growing cities in the country, Texas Children’s high-quality care is always in high demand. However, due to high volume, getting patients and referring providers the answers and access they need in a timely fashion can be a challenge, which is why improving access has been a key focus at Texas Children’s in recent months.

Since the March 2018 launch of the Patient Access Initiative, several key improvements have been made to streamline processes for patients, including standardized clinic sessions and enhanced implementation of MyChart. On September 5, the Department of Surgery took a major step in improving access for referring providers with the launch of 1-855-TCH-KIDS, Texas Children’s new Provider Priority Line, available 24/7 exclusively for referring physicians and advanced practice providers.

“The Provider Priority Line creates a pathway for referring providers to have easier access to Texas Children’s surgeons for questions about patients,” said Dr. Sohail Shah, surgical director of Perioperative Services at Texas Children’s. “We want to make ourselves available to referring providers to assist them in the care of children across the state of Texas, and ultimately the region.”

Previously, if a referring provider had a question for a Texas Children’s surgeon, the communication pathway might route them across numerous Texas Children’s campuses, offices, clinics, and health and specialty care centers. This fragmented approach had the potential to result in multiple call transfers, which could contribute to delayed response times. Now providers can simply call the Provider Priority Line and reach on-call attending surgeons for specialties including Neurosurgery, Ophthalmology, Orthopedics, Otolaryngology, Pediatric Surgery, Plastic Surgery and Urology.

Department of Surgery leadership partnered with Texas Children’s Mission Control and Telecommunications Services to develop the line’s efficient communication flow.

  • When a referring physician calls the line, the call is triaged through Mission Control.
  • Mission Control gathers patient information, and determines the specialty area needed and whether the call is urgent or non-urgent.
  • The call is routed to the on-call attending surgeon at the Texas Children’s campus nearest to the referring provider’s location.
  • The attending surgeon calls Mission Control and is connected to the referring provider on a recorded line, which closes the communication loop.

Early metrics have shown rapid connection times between providers and on-call specialty surgeons, with responses for urgent calls occurring in 15 minutes or less. Initial referring provider reactions have been overwhelmingly positive.

“An early call we received was from a physician at a regional emergency center who had a question about a 14-year-old patient,” Shah said. “He was pleased to be able to speak directly with a pediatric surgeon and relay a care plan to the family immediately afterward. He said the usual course of action would have required an opinion from a local adult surgeon, which often led to a delay in definitive care.”

The Provider Priority Line will not only create easier access to Texas Children’s pediatric surgical expertise, it will also make interactions with providers more customer focused.

“Dr. Shah and his team, in collaboration with Mission Control, have developed a system that delivers an enhanced level of service for our referring providers, who very much appreciate help and advice when seeing pediatric patients who are dealing with complex problems,” said Texas Children’s Surgeon-in-Chief Dr. Larry Hollier. “As the largest children’s hospital in the country with the largest number of surgeons and operations, we should be able to provide them with the help they expect from us. With the Provider Priority Line, we can show them we’re committed to meeting and exceeding their expectations.”

In the near term, the service will be promoted to referring providers across the region with the ultimate goal of routing all such referring provider calls through the Provider Priority Line for a more streamlined experience. The long-term goal will be to extend the service to emergency centers and urgent care facilities as well. And in addition to 1-855-TCH-KIDS, there is also a local number available: 832-TCH-KIDS.

Learn more about how Texas Children’s is improving access.

September 19, 2018

The new outpatient clinic at Texas Children’s Heart Center® is now open! As patients and families came through the doors of the new clinic for the first time on September 18, they entered a space designed from top to bottom with them in mind.

“From the very beginning of the design process, the opening discussion for every space has been about making sure the focus is on the patient and that they have everything they need,” said Texas Children’s Chief of Pediatric Cardiology Dr. Daniel Penny.

The outpatient clinic is situated across the 21st and 22nd floors of Legacy Tower and has been specially configured to offer families a more personal approach to care, and to handle high clinical volume. Last year, there were nearly 29,000 outpatient clinic visits, 2,300 of which were part of the Adult Congenital Heart Defect program, and more than 27,000 echocardiograms were performed.

On a recent walkthrough in advance of the opening of the new outpatient clinic, Penny showed off a few of its special features and described the care and painstaking attention to detail that has gone into every aspect of the facility.

Pod-based model
One of the key differences in the model of care in the new outpatient clinic compared to our previous facilities is the integration of echocardiography and exam rooms. To incorporate the two, a pod-based model that will enhance the patient experience and streamline the care we provide has been implemented.

The clinic houses five pods, each with its own separate waiting area. Two of the pods comprise six exam rooms and four echo rooms apiece. Close proximity between rooms will enable greater coordination of care between care teams. A third pod has been designed specifically for patients in the Adult Congenital Heart Disease Program. It has three exam rooms, two echo rooms and a private waiting area. Two more pods are dedicated for cardiac surgery and arrhythmia specialists and house an additional six exam rooms apiece. Additionally, each pod is equipped with a large, centrally located high-definition care board to help teams monitor patients along the examination and treatment pathway.

“Now, rather than traveling from one side of a building to the other, families will have access to all the care they need in one convenient location,” Penny said. “This system will also encourage closer interaction between care givers. And even with the greatly expanded footprint, we have additional shell space that will allow for additional consult and echo rooms when the demand arises.”

Sedation Area
The Heart Center receives many echo patients, as well as patients transferred from inpatient units, who require sedation. The new outpatient clinic features an expansive six-bed sedation area, with an additional five echo rooms. The sedation area’s layout, similar to an anesthesia area or recovery room, has improved visibility and access, which will allow caregivers to monitor patients more closely. And its location will afford patients and families more privacy.

Exercise labs
One of the most important aspects of a patient’s ongoing assessment is exercise function. For that reason, the new outpatient clinic has two exercise labs. The labs are linked by a central control room, similar to a catheterization lab, from which physicians can supervise tests and monitor real-time patient data displayed on banks of high-resolution monitors. The exercise lab also features a dedicated space for pacemaker care.

Simulation
Simulation and process mapping have been crucial in the clinic’s development. Because the layout of the new clinic’s pod-based space is significantly different than the previous outpatient clinic, simulations were necessary even as part of the initial design process.

High-fidelity simulations used mannequins to test clinical systems, documentation systems, patient safety processes and more for single-patient interactions. Comprehensive workload and patient flow simulations were conducted to test patient movement through the clinic at various volume levels, which is important for a clinic that often sees more than 80 patients in a day. This unique, hands-on process involved clinical staff and simulated patients and families entering the clinic, tracked the flow of multiple patients moving through the clinic simultaneously, and also monitored the utilization of space. Additionally, computer-based simulation models were used to monitor check-in processes, wait times and potential bottlenecks to help make necessary changes to the process flow.

Part of a united heart center
At Texas Children’s, cooperation and teamwork are pervasive across the hospital system, within specialty and subspecialty areas and across service lines. The same is true of the Heart Center, which combines cutting-edge technology and surgical expertise with research and compassionate, family-centered cardiac care – all located in the same, state-of-the-art complex.

“We’re not a cardiology section and a cardiac surgical section siloed from one another,” Penny said. “In everything we do, we want to emphasize that we are, both culturally and, indeed, physically, a unified heart center. That has been one of the fundamental philosophies of this whole endeavor: we can do more for our patients working together as a comprehensive team.”

Texas Children’s Heart Center is a global leader in pediatric cardia care, treating some of the rarest and most complex heart cases. With several multidisciplinary teams working in conjunction with pediatric subspecialties throughout the hospital, the Heart Center strives to provide unparalleled care at every point from diagnosis through treatment and follow-up to achieve the best outcome for every patient. For the past two years, Texas Children’s Heart Center has led the nation as the No. 1 place for children to receive cardiology and surgery care according to U.S. News and World Report.

Learn more about the Heart Center.

September 18, 2018

As part of National Childhood Cancer Awareness Month, Texas Children’s Bone Marrow Transplant Unit (BMT) was transformed for a few hours last week into a full-fledged parade route – music, costumes and all.

The Lace Up 4 Life event – hosted in part by Be The Match, which manages the largest and most diverse marrow registry in the world – began in the inpatient portion of the unit with patients dressed in super hero capes and costumes parading downs the halls with staff members by their side and cheering them on.

“We enjoy this event every year,” said Dr. Robert Krance, director of the Pediatric Bone Marrow Transplant (BMT)/Stem Cell Transplant Program at Texas Children’s Hospital. “It’s a time for us to celebrate the lives of those who have been saved by a bone marrow transplant, and to remember those who are still racing to find a match.”

After several laps around the inpatient unit, patients retired to their rooms while the parade continued to the outpatient portion of the unit, pausing for a special announcement from Hope Guidry-Groves with Be The Match.

“Today, 16-year-old Jacob Bustamente is going to meet his donor, Heather Wallace, for the very first time,” Guidry-Groves said. “We are so fortunate to be a part of an organization that makes moments like these possible.”

Jacob is a patient at Texas Children’s and so is Wallace’s son. When they first laid eyes on one another they quickly embraced in a long, emotional hug.

“Thank you so much,” Bustamente said. “You are such a blessing.”

Wallace told the audience that everyone should join the marrow registry. “There’s no reason not to,” she said.

Texas Children’s Cancer Center has a premier bone marrow and stem cell transplantation program. Our state-of-the-art, 15-bed inpatient transplant unit is among the largest of its kind in the Southwestern United States and focuses exclusively on transplantation. The Bone Marrow Transplant Clinic performs over 100 transplants per year.

Texas Children’s works closely with Be The Match to find donors for our patients. Learn how marrow donation works, the steps of a patient transplant, steps of donation, and factors that can impact the likelihood of finding a match here. A marrow transplant may be someone’s only hope for a cure.

Imagine you’re the parent of a newborn with an arm injury. During your admission you’re told not to move the arm and to protect it all times. Now imagine coming back for your clinic appointment and hearing that it’s time to start moving the arm at home – unsupervised. For parents of children with brachial plexus birth palsy, this moment can be daunting.

Brachial plexus birth palsy occurs when there’s a stretch or tear in the bundle of nerves known as the brachial plexus, located near the neck and upper arm area. These injuries may cause weakness, pain, sensory loss and functional impairment. Sometimes the nerves need time to recover, anywhere from a few days to a year. Other times surgery might be required. Regardless, a focus on treatment during the waiting period can help prevent the shoulder joint from becoming stiff. The only way to keep the joint loose is through passive exercises, which must be performed early and often by the patient’s family.

“If we can find a way to keep these shoulders loose, we can eliminate many of the problems we see down the road,” said Dr. Chris Pederson, head of Texas Children’s Pediatric Hand and Microvascular Surgery programs. “Unfortunately, for a lot of parents performing the exercises can be an intimidating task.”

To help empower parents, Texas Children’s brachial plexus clinic recently teamed up with engineering students at the Oshman Engineering Design Kitchen at Rice University to develop a model that allows parents to practice movement exercises in clinic before performing them on their children at home. The project was part of an ongoing collaboration with Rice begun in 2014 by Texas Children’s Brachial Plexus Clinic Coordinator James Northcutt.

“I originally pitched the idea for the brachial plexus model to the freshman design class at Rice in the fall of 2017,” Northcutt said. “Using the model, I wanted parents to be able to identify the different parts of the shoulder and shoulder blade and feel the difference between a stiff shoulder and a healthy shoulder. And ultimately, I wanted to help alleviate the anxiety parents feel about moving their child’s arm by giving them the opportunity to practice the exercises on the model first.”

Northcutt met with the students monthly to serve as clinical lead on the project, providing information about anatomy, biomechanics, caregiver needs, therapy concerns and overall device application. Less than a year later, design team “Can’t Brachius,” produced a professional and well-functioning prototype. But it needed to be tested by parents. Mayra Oliver was the first.

When she was first told she’d need to perform exercises on her infant son, Raphael, Oliver was nervous and worried. But a demonstration of the model and the opportunity to use it herself had her feeling much more confident.

“When I first knew that Raphael was hurt, I was scared I’d do the exercises wrong and hurt him or somehow make his injury worse,” Oliver said. “Being able to feel the different parts of the shoulder on the model and then on Raphael, and then feeling the way the healthy shoulder should move freely, as opposed to the stiffness of an injured shoulder, was very helpful. I think this model will be very useful in helping families feel less nervous about doing the exercises.”

Using a survey developed in conjunction with the Rice design team, Northcutt will begin conducting a randomized control study over the coming months to determine the device’s efficacy both in educating families and in preparing them for the performing the exercises at home.

“I look forward to finding out more about our parents’ needs in helping these infants grow up to function at the highest level,” Northcutt said. “This project represents an attempt to improve patients’ futures by equipping parents to be informed, active care team members.”

The Brachial Plexus Clinic is part of Texas Children’s Brachial Plexus Program, which comprises plastic surgery, orthopedic surgery, physical medicine and rehabilitation, and occupational therapy. The clinic provides comprehensive care for brachial plexus injuries including specialized assessment, developmental and functional screening, primary nerve surgery when indicated, secondary orthopedic surgery for the shoulder and lower arm when indicated, and preoperative and postoperative care in the therapy setting. The brachial plexus team provides high-level, evidenced-based care, utilizing ultrasound to monitor shoulder integrity in infants recovering from brachial plexus injury, providing specialized splinting for prevention of joint contractures in the arm, and implementing best surgical practices for primary nerve and secondary orthopedic procedures.