August 3, 2020

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

July 27, 2020

If you ask Michael Pickett, a nurse practitioner in the Pediatric Cardiovascular Anesthesia Section at Texas Children’s, what he enjoys most about his job, he’ll be quick to say – his passion for innovation and the interdisciplinary collaboration with his colleagues. Pickett says no matter how big the challenge, staying focused on the end goal is what keeps him going.

“What I like about innovation is you have to expect the unexpected,” said Pickett, who also serves as an innovation mentor for the Texas Children’s Hospital Global Hematology-Oncology Pediatric Centers of Excellence and Nursing Innovative Solutions Council (ISC) at Texas Children’s. “There’s no guarantee that you’re going to be successful. But the hope is that you will be, and you just have to keep working at it.”

When Pickett was a graduate nurse 22 years ago, he says he faced many of the same challenges new nurses encounter when inserting a peripheral intravenous (PIV), performing central venous catheter (CVC) care and maintenance, and accessing a port on a patient for the first time. Back then, he wished there were more simulation training tools available when he was a new nurse.

As a natural innovator at heart, Pickett was determined to turn this vision into reality. Sharing his concepts with frontline innovators at Texas Children’s, Pickett gained the support from nursing colleagues and leaders across the organization who provided continual feedback throughout the innovation process. It quickly became the team’s goal to develop and implement novel skills technique videos partnered with the PIV, CVC and Port Task Trainers designed by frontline innovators that are wearable, cost-effective, durable, realistic and allow all procedural steps trainees would perform. A secondary goal was to document and open-source the innovation process utilized to develop these proof-of-concepts.

After nearly four years of development including more than 20 prototype iterations and pilot surveys, two international presentations and an international SimVentor award, the RediStik Wearable PIV, CVC and Port Trainers were finalized and produced in collaboration with Sawbones®, the leader in medical models for orthopedic and medical education, along with the support from ISC, Entrepreneurship and Innovation teams, Marketing and Legal departments, and hundreds of frontline innovators representing more than 20 different clinical areas at Texas Children’s Hospital.

The Redistik Wearable PIV, CVC and Port Trainers are portable, light weight, skin models that can be placed on a live person, table top or mannequin. The trainers help clinicians master various procedural skills like how to insert a PIV line, access and de-access a port, and how to perform sterile techniques for dressing application and cap changes to prevent pressure injuries and central line associated bloodstream infections.

“When we designed the task trainers, we wanted the experience to be realistic as possible,” said Pickett, lead inventor of the Redistik Wearable PIV, CVC and Port Trainers. “With many of the current simulation task trainers on the market, once they are used a few times, you can see where to stick and it’s just not as realistic. Our task trainers have a needle proof backing to prevent accidental needle sticks and resilient material that allow for over 1,000 punctures per task trainer that can’t easily be seen on the skin model.”

The RediStik PIV, CVC and Port Trainers were piloted in 2019 and are now being used throughout the Texas Children’s system. The nurse residency program has implemented PIV insertion skills training during new nurse orientation using the Redistik PIV trainers. Prior to training, 15 percent of nurses surveyed said they were “confident” on starting PIV lines. After completing training, their confidence level rose to 96 percent.

“We used the PIV and Port Trainers during our annual training and everyone appreciated the hands-on practice,” said Kate Jones, a decentralized education coordinator. “The ability to move the port placement around to increase the difficulty of access and the ability to get blood return made it much more realistic.”

The impact of Pickett’s innovation can also be felt around the globe. The RediStik PIV, CVC and Port Trainers have been piloted at Texas Children’s Global HOPE clinics in Sub-Saharan Africa where the PIV trainer has had a significant impact on improving their rates of PIV extravasations and reducing PIV attempts.

Far reaching impact

Global HOPE Director of Nursing Education Dr. Marilyn Hockenberry said when she learned about the RediStik PIV Trainer she was ecstatic because the rate of PIV attempts was high in her clinics as well as IV extravasation, which is when you are administering a drug, such as chemotherapy, and it seeps into the outer tissues surrounding the injection site causing painful inflammation.

“Children with cancer in Africa don’t have the benefit of a central line,” Hockenberry said. “All chemotherapy is done through a peripheral vein, creating challenges for both our patients and our providers.”

The use of the RediStik PIV Trainer has greatly reduced these challenges, lessening both the number of PIV attempts and IV extravasation incidents. Hockenberry introduced the innovation to her clinics in Botswana, Malawi and Uganda more than a year ago holding regular hands-on training workshops, many of which are still being held today.

During the workshops, clinical staff learn how to put in a peripheral intravenous line, care for the line and confidently administer chemotherapy. Prior to the trainer, staff learned as they cared for patients. There was no way to do hands-on training.

Competencies learned on the PIV trainers have decreased extravasation rates from 42 percent to 5 percent in less than a year’s time. Prior to using the task trainer, only 19 percent of PIVs were obtained with three or fewer attempts compared to 99 percent after the post task trainer assessments.

“If you want to cure cancer in Africa you have to improve IV use, PIV use and the administration of medication,” Hockenberry said. “These devices are great for making that happen.”

Hockenberry added that without people like Pickett and the team of innovators, the progress made in Africa would not have been able to happen. She said Pickett and the innovation team are crucial to the clinical process and have made a significant difference in the lives of our patients around the globe.

“It’s just a great feeling to see how these innovative training tools have benefited our staff and our patients,” Pickett said. “It took a lot of hard work to finally get to this point, but it was all worth it.”

About Redistik

Visit www.texaschildrens.org/redistik to access product details, skills video tips/techniques and data outcomes. Click here to learn more about Sawbones®.

Contact Michael Pickett at mtpicket@texaschildrens.org if you would like to check out one of the RediStik products for staff training.

July 7, 2020

Calling all innovators! The Southwest National Pediatric Device Innovation Consortium (SWPDC) needs your help in identifying pediatric device projects that support COVID-19 related and other critical need projects.

SWPDC is a multi-institutional consortium supported by a U.S. Food and Drug Administration (FDA) P50 grant and anchored by Texas Children’s Hospital and Baylor College of Medicine that is dedicated to improving children’s health by supporting pediatric device innovators to create novel pediatric medical devices with local, regional, and national institutional and innovation partners.

The consortium is receiving supplemental funding to be able to award $100,000 in SWPDC 2020 Impact Grants for COVID-19 and other critical needs areas in the form of seed grants or in-kind support for related pediatric device projects. Applications are being accepted from July 8 through August 5. All pediatric device innovators can apply.

“Across the country, entrepreneurs are pivoting to address the health care challenges of the COVID-19 pandemic,” said Dr. Chester Koh, executive director and contact PI of SWPDC, Texas Children’s pediatric urologist, and Baylor Professor of Urology, OB/GYN, and Pediatrics. “This is a great opportunity to be part of this effort, especially as children are increasingly recognized as a vulnerable population for COVID-19.”

Interested applicants should complete the application here. The application consists of a short questionnaire, an itemized budget (up to $25,000 max) and an optional, but highly encouraged, one- to two-minute video pitch. Further information may be requested by the SWPDC staff, and funding will be made available September 1.

In this rapid cycle opportunity, these grants will be awarded to pediatric device companies as seed funding or in-kind services to support activities that improve the health care of the pediatric community during this pandemic. This opportunity is nonexclusive to COVID-19 and can also apply to other critical needs areas such as addressing the opioid epidemic. Medical devices with adult indications that are expanding their focus to the pediatric population are also welcome to apply.

Examples related to COVID-19:

  • Devices that address an underlying medical condition that puts pediatric patients at increased risk for developing complications related to COVID-19
  • PPE designed specifically to fit pediatric patients (to protect pediatric oncology and immune deficiency patients, to reduce community transmission)
  • Advances in life saving ICU equipment designed specifically for pediatric patients
  • Devices that permit pediatric patients to continue life-saving therapies at home (e.g. therapy for pediatric oncology patients)
  • Devices that facilitate effective remote pediatric care (e.g. devices that relay critical information back to physicians caring for pediatric patients with chronic diseases)
  • Devices that address pediatric device shortages (specifically related to COVID-19)
June 22, 2020

Like many projects across the organization, the implementation of Epic Tapestry has been on hold as we navigate our response to COVID-19.

But recently, project leaders were given the green light to return to this important work and the team is making great strides in getting the project back up and running.

Once implemented the system will allow Texas Children’s Health Plan to better integrate data for an improved member and provider experience. Tapestry, a module within Epic health care management, will help make this possible by first providing better information and improved work processes for employees who treat our more than 400,000 customers.

“The team has been incredibly patient and flexible as our pandemic response has taken priority,” said Justin Loudon, assistant vice president at Texas Children’s Health Plan. “However, COVID has resulted in an increase in health plan membership and served as a painful reminder of just how much efficiency and effectiveness must remain a focus for us. We are excited that the project is back on track.”

Benefits of Epic Tapestry

Epic Tapestry is an overarching application that will replace a variety of applications currently used. Its goal is to integrate the business of Texas Children’s Health Plan, and will:

  • Ensure a comprehensive, integrated enterprise solution with a common look and feel
  • Reduce manual work and provide a better data source for information
  • Incorporate evidence-based decision-support tools and better data entry at point of care
  • Optimize the patient/family experience across the enterprise
  • Challenge current practice – streamline and simplify
Employees will be trained for the change

All essential groups will be trained well before the Go Live date: Training will take place in a combination of ways, including:

  • E-Learning Courses
  • Quick Start Desk Reference Guides
  • Detailed Self-Guided Exercise Booklets
  • In-Person Classroom Training

Information Services educator, Elydia Villanueva, will lead training efforts for Texas Children’s Hospital employees, while Angie Ross, Epic Project Team Trainer, will lead training for Health Plan employees. Together they will ensure that impacted employees across the system will be prepared on Go Live day.

A new nine-bay labor and delivery ward at Area 25 Health Center in Lilongwe, Malawi, is providing women a private place to give birth, and clinical workers more space to deliver the same amount of babies per year born at the Pavilion for Women.

“This is a huge step forward for our patients and our clinicians,” said Dr. Jeffrey Wilkinson, vice chair of Global Health and professor, OB-GYN and director of the Global Women’s Health Program. “It falls right in line with our goal of providing the highest quality of care to the women and children we treat through our Global Women’s Health program.”

Formed in 2012, the program is a collaboration between Texas Children’s Hospital, Baylor College of Medicine Children’s Foundation – Malawi and the Ministry of Health of Malawi. This public-private partnership leads the way in the development of transformative programs that benefit thousands of women and babies as well as scores of learners in low resource settings.

Women and children are disproportionately affected by lack of access to health care services, particularly in resource limited settings. Malawian women have some of the worst odds with 675 deaths per 100,000 live births – among the highest maternal mortality ratios in the world. By contrast, the ratio for US women is 14 deaths per 100,000 live births.

To improve these odds, the Global Women’s Health program has invested a lot of time and effort into expanding the quality and quantity of services offered at Area 25 Health Center, significantly alleviating the burden of increasing demand for maternal and neonatal services at Kamuzu Central Hospital (Lilongwe’s referral hospital) and Bwaila Maternity Hospital, the largest maternity unit in the region with 17,500 plus deliveries per year.

With the help of generous donors, a maternal waiting home, a four-room operating theater and now a new labor and maternity ward have been built to help clinicians, midwives and non-medical staff better serve the women and children of Malawi.

Each room in the new labor and delivery ward is equipped with a swinging door that leads out to a nurses’ station. One of the nine rooms has a private bath and shower. The other eight rooms share four private baths and showers, each with a sliding door for easy access.

Prior to opening the new ward, women at Area 25 were delivering their babies in a six-bed labor and delivery ward on beds lined up in one room and separated by only a curtain. Because of the cramped quarters, family members were not able to accompany or help their loves ones during delivery.

The new ward has enough space for one family member to be in the room during delivery, an accommodation that is somewhat unique in health care facilities across Malawi and sub-Saharan Africa. The old labor and maternity ward will be used for anti-labor, triage, admissions and evaluation of patients coming in for labor.

“This has been a transformational gift for the women and babies in this region,” said Dr. Ibe Iwuh, one of the OB-GYNs at Area 25. “It’s helped us not only provide high quality care to women but also to demonstrate the potential between a public-private partnership between a US academic institution, a US health care organization, and the Malawi Ministry of health.”

Dr. Chikondi Chiweza, one of the OB-GYNs at Area 25, said it’s very satisfying to see Area 25 become one of the busiest maternity wards in the area.

“Because of the waiting home, women who might have gone into labor far from a medical institution now have a safe place to wait during their last few weeks and days of pregnancy,” Chiweza said. “The operating theater has enabled us to take care of more complex patients, and the new maternity and labor ward will allow us to better meet the ever-growing demand of births and well-woman services.”

For more information about the Global Women’s Health program and Area 25, click here.

June 18, 2020

On June 12, Juliana Graves met her donor heart family with her mom, dad and brother by her side. Juliana, now 6, had a life-saving heart transplant at Texas Children’s in 2014 at just 17 days old.

The Graves family knew they would one day want to meet the family who gave their daughter the gift of life. That meeting happened last week when the Graves family met the Aguiars at LifeGift where they shared stories and memories about Juliana and the Aguiars’ son, Christopher.

Christopher’s mom, Jennifer Aguiar, also listened to her son’s heart beating inside Juliana’s chest.

“Meeting the Graves family was both beautiful and comforting,” Jennifer Aguiar said. “It’s helping me process the loss of my son.”

Riki Graves, Juliana’s mother, said her family thinks and prays about Christopher every day and that being able to meet his family was “wonderful.”

During the meeting, Juliana handed Jennifer a teddy bear and gave her a big, long hug.

“The most important thing this family has given me is Christopher’s heart,” the little girl said.

Living without a new heart was not an option for Juliana. Doctors with Texas Children’s Fetal and Heart Centers diagnosed her with a complex heart condition before she was born and initially thought she would need several heart surgeries shortly after being delivered.

Riki was already fighting a battle when she found out, at 20-weeks pregnant, that her unborn daughter might not survive. Earlier in her pregnancy, Riki was diagnosed with breast cancer and decided to pause treatment while still pregnant.

Her team of doctors at the Fetal Center monitored her pregnancy very closely. Juliana was born on April 9, 2014 and it was determined that her heart was too structurally abnormal and weak to undergo surgery. Juliana was placed on the transplant list on April 21. On April 26, at 17 days old, she received her new heart.

Dr. Jeffrey Heinle, associate chief of congenital heart surgery, led the transplant surgery, which was a success. He and Dr. Jeff Dreyer, pediatric cardiologist and medical director of heart failure, cardiomyopathy and cardiac transplantation, have been following Juliana and working with the Graves family to provide them with continuous, ongoing care.

“The Graves’ story is a remarkable one and much of it is owed to the generosity of the Aguiar family,” Heinle said. “Organ donation truly saves lives. This is a perfect example of that.”

Dreyer agreed and said it’s always nice to be part of such a happy ending.

“This mother and child have overcome so many obstacles,” he said. “Continuous monitoring for Juliana will be needed, but she is on a positive path forward thanks to her donor family and others.”

Diana Harter, assistant clinical director of nursing for transplant, was Juliana’s transplant coordinator. She said she knows the Graves family has been waiting a long time to meet their donor family and that such meetings are meaningful and healing for everyone involved.

“Donor meetings are so special to witness,” said Harter, who attended the meeting with the Graves and Aguiars last week via video conference. “They bring everything full circle.”

June 8, 2020

As the world continues to fight COVID-19, Texas Children’s has implemented a number of changes to create an overall health care experience that promotes social distancing — tagged a touchless experience.

This experience strives to strike a balance between enforcing an important life-saving practice, while also maintaining the high quality care that our patients and families expect. Employees’ health and well-being is also a priority as changes around the organization are made. These are many of the new procedures in place:

MyChart Pre Check-In

For many years now, patients and families have been able to access MyChart to schedule appointments, access medical records, refill prescriptions and contact providers. But amid our current pandemic, there is an even greater emphasis on the PreCheck-In feature.

Launched last summer, this feature allows the patient to complete the check-in process online, which includes updating demographics and insurance information, signing documents, making payments, verifying meds and allergies, and answering patient questionnaires. PreCheck-In saves patients time, limits interaction with our staff, and reduces the amount of time spent at registration desks when they arrive for an appointment.

Video visits

MyChart also allows patients to complete video visits depending on the specific health care need. Each patient is evaluated individually to determine qualification, but the level of convenience and effectiveness is nothing short of remarkable.

In an article previously reported in Connect news Dr. Jeffrey Kim, director of the Arrhythmia and Pacing (Electrophysiology) Service at Texas Children’s Hospital, said his patients are good candidates for video 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 video visits.

During that interview Kim mentioned that he’d conducted an appointment with a patient while they were standing in the middle of a field on their ranch.

Texas Children’s Pediatrics and Urgent Care Centers are also using video visits. For more information about MyChart video visits, go to texaschildrens.org/mychartvideo

Drive-Through visits

When video and other e-health options are not available, drive-through care is a growing option at some Texas Children’s clinics.

OB Drive-Through Clinic: The drive-through prenatal care clinic at Texas Children’s allows pregnant women who do not need to be seen in the clinic to remain in their vehicles while being assessed by a health care professional. This reduces potential patient, health care professional, and staff exposure to COVID-19.

Drive-Through Pharmacy: Texas Children’s Pharmacy Services is now offering curbside pick-up. All Texas Children’s patients are eligible for this prescription service and can pick up refills and new prescriptions at select locations.

Drive-Through Patient Express: The Dermatology Clinic at Texas Children’s also offers drive-through services in the innovate “Patient Express” line located in a section of the Wallace Tower valet line. Additional service lines and procedures from around the organization are likely to be available in the Patient Express soon.

Physical distancing at Texas Children’s facilities
  • Pre-check in ambassadors are now in place in elevator lobbies, eliminating the need for patients and families to press elevator buttons.
  • Employees are encouraged to use service elevators or take the stairs so that main elevators can be reserved for patients and families.
  • Floor stickers and signage as a reminder of a 6-foot distance requirement have been placed throughout our organization.
  • Furniture in dining and waiting areas have been spread apart at least six-feet.
  • Any patients who are diagnosed with COVID-19 are immediately isolated and not cared for within proximity of non-COVID patients.
  • Providers and staff are continuously being trained to provide optimum treatment while not physically touching patients and families.

“I am so proud of the way our organization has adapted to this demand for new health care options,” said Paige Schulz, assistant vice president for Clinical Support and Research Administration.

Schulz says Texas Children’s success during this time can largely be attributed to our spirit of innovation and willingness to embrace change. “As technology evolves and we continue to listen to the needs of our families, additional procedures may be implemented to keep our employees, patients and families safe.”

For a glimpse of what a visit to the hospital might look like, view our latest video.