May 18, 2020

As Texas Children’s begins its fifth official week of phased reopening and redesign, the organization continues to focus on a careful, strategic plan that supports family-centered care for our patients and meets our organizational expectations around quality and safety.

What this means for our patients and families is that services will open in phases, not all at once. For employees, a phased reopening means some of us will resume a full work schedule either at home or at one of our Texas Children’s facilities sooner than others.

“Patience and prudence are key,” said Chief Information and Innovation Officer Myra Davis. “We want to ensure everything we do operationally is safe and volume-driven. This means that just as we flexed down to demand, we will also flex back up to demand, where appropriate. The next few weeks and months ahead will be a thoughtful balance between the two and will help pave the way toward a successful future.”

Davis, along with Surgeon-in-Chief Dr. Larry Hollier and Executive Vice President Dan DiPrisco, are leading the Phased Reopen and Redesign Command for Texas Children’s.

Signs of success

Two areas of our system that have seen early success during the phased reopening and redesign are Surgery and Radiology. Since reopening in late April, the Department of Surgery, Anesthesiology and Perioperative Services have opened schedules in operating rooms across the system to nearly 50 percent capacity. To date, 700-plus cases have been completed at our community locations and more than 1,000 pediatric and women’s cases have been conducted at the Texas Medical Center Campus.

Two weeks ago, Radiology began its phased reopening and redesign, aiming for 50 percent of pre-COVID-19 imaging volume that week. The service line exceeded that goal, completing more than 640 studies per day. Pre-COVID-19, daily activity across the system was about 1,100 studies per day. During COVID-19, daily activity dropped to 350-400 studies per day. As a result of the steady uptick in patient volume, Radiology has completely reopened all of its appointments.

“We are encouraged by the quick response from the community to our thoughtful and agile reopening and redesign plans,” said Radiologist-in-Chief Dr. Thierry Huisman. “We are committed to continuing to serve our patients and families while keeping them and our staff safe and healthy during this pandemic.”

Hollier said his department plans to thoughtfully open additional ORs to match demand, all while maintaining social distancing protocols and other rigorous safety measures.

“Our primary goal has been and always will be to keep our patients and families safe and healthy,” he said.

Safety first

Safety measures and protocols have been put into place to protect our patients and families during their entire experience with Texas Children’s. This experience begins before they walk into one of our facilities and doesn’t end until long after they leave.

Before anybody comes into our facilities, they’re screened, to the best of our ability to make sure they are safe and healthy. This means all doctors, nurses, staff, patients and family members. Once they’re inside, everyone is required to wear a mask and adhere to social distancing.

“We want to respect these rules because we feel they protect patients from contracting the virus,” Hollier said. “We also feel it’s very important to test patients who are undergoing surgery and other procedures for COVID-19.”

No more than 48 hours before a surgical procedure, patients will receive a COVID-19 test, typically at one of our drive-through facilities for convenience. If the test is negative, the surgical procedure will proceed. If a patient tests positive for the coronavirus, the procedure will be delayed and retesting will occur to ensure the patient is negative before they undergo surgical or any other procedure that deems prior testing.

Radiology implemented a new process that allows patients to wait in their vehicle and call from the parking lot/garage upon arrival at our community locations, rather than entering the building and having to sit in the waiting area. Radiology services at Texas Children’s Hospital The Woodlands went live with pre check-in for patients who have a MyChart account. After a brief trial period, Radiology will implement this at West Campus and at our Medical Center Campus as well.

A mom who had rescheduled her daughter’s MRI due to safety concerns related to COVID-19, said she was relieved to learn about all of the safety measures and protocols Texas Children’s has in place to protect patients and families.

“Everything was easy and very smooth,” the mom said. “I appreciated calling from the garage, and I felt very safe.”

To learn more about additional precautions Texas Children’s is taking to protect our patients, families and staff click here.

Moving forward

This week, we launched plans for the reopening of our Ambulatory services and are working to ensure our facilities can accommodate increased activity while maintaining infection control guidelines.

Ramping our services back up at Texas Children’s is a welcoming indicator. It’s exciting, but this is merely the start for us. We are reopening thoughtfully and in phases, based on where we have the most demand for our services.

It will take much more time and careful planning to reopen completely. But moving strategically is what will restore us for the long-term, and what will ultimately ensure our organization’s future success and sturdiness.

“Thank you for all you are doing,” DiPrisco said. “The care you are providing for our patients and their families through this evolving situation is outstanding and proves that our challenges of the past few months have made us even better equipped for what’s ahead.”

As COVID-19 hit, Medical Director of Emergency Management Dr. Brent Kaziny and members of Texas Children’s Facilities team raced to invent a new device that would better protect doctor’s nurses and patients during intubation procedures. Kaziny then open-sourced the novel product design for others to use, and found a manufacturing partner called Sawbones that put the “Airway/Respiratory Containment System” up for sale. Read more

As the COVID-19 pandemic continues to dominate the news and impact our normal way of life, there is one thing that has not changed – our commitment to ensuring our patients and families have convenient access to the care they need, when they need it, while also continuing to protect their health and safety.

As we begin to adapt to this new normal, more in-person visits are being converted to video or phone appointments. Texas Children’s e-Health team, in collaboration with multiple departments across the system, has rapidly expanded and enhanced these e-Health services to make it easier and more convenient for patients to connect with a Texas Children’s provider without leaving their home.

In less than three months, the organization has seen a rapid growth in e-Health visits across the system. On March 2, Texas Children’s completed 39 video and telephone appointments. As of May 8, our providers had completed 72,285 telephone and video visits across Texas Children’s Hospital, Texas Children’s Pediatrics, Texas Children’s Urgent Care, Texas Children’s Health Plan and Texas Children’s® Anywhere Care. Along with this impressive milestone, over 1,000 providers have been trained to provide care through video visits to their patients across the system.

The Health Plan’s e-Health platform, Texas Children’s® Anywhere Care, which has been a major focus in the organization’s e-Health efforts, has seen an uptick in patient visits. Since launching the platform last summer, over 1,520 video appointments have been completed. A total of 750 e-Health visits were completed from March 1 to May 5 of this year.

“Our recent successes are attributed to the collaborative efforts that went into building the infrastructure that has enabled us to expand our e-Health capabilities more broadly across the system,” said Laura Laux Higgins, director of strategic projects in Information Services and member of the e-Health Executive Steering Team. “Not only did we investigate the technology solutions and invest in them, we had a team of e-Health experts in place across information security, EPIC, MyChart, billing, compliance, legal, credentialing, risk, and administrative and physician leadership who were able to help us move forward quickly because of the work they had done over the past year.”

With the demand for e-Health services on the rise due to COVID-19, Texas Children’s Heart Center, like many other subspecialties across the system, are leveraging the mutual benefits of e-Health services.

Shortly after the COVID-19 pandemic set in and local, state and federal governments asked non-essential businesses to close and residents to stay home, the Heart Center worked swiftly with physicians and staff to engage e-Health services for new and existing patients 6 months old and older who did not need to be seen in person.

Within about a week, the Heart Center was booking about half of its appointments at the Texas Children’s Medical Center Campus via video or phone. Although that number has decreased since Gov. Greg Abbott has started to reopen parts of the state, the Heart Center is still using e-Health services and is dedicated to the virtual patient care model for the foreseeable future.

“Our will to continue to work hard and keep our patients, families and staff safe has never been stronger,” said Chief of Pediatric Cardiology Dr. Daniel Penny. “e-Health is a way we can continue to serve our patients without putting them at unnecessary risk.”

All potential e-Health appointments at the Heart Center are reviewed by a pediatric cardiologist or advanced practice provider to determine whether it is clinically appropriate for a child’s appointment to be completed using one of these modes of virtual visit. If the cardiologist considers that a child’s appointment can be completed in this way, the clinic staff will contact the child’s family to provide more details and guide them through the new system.

Dr. Jeffrey Kim, director of the Arrhythmia and Pacing (Electrophysiology) Service at Texas Children’s Hospital, said his patients are good candidates for e-Health visits because they typically don’t need surgical intervention. For about a month during the pandemic, Kim said almost all arrhythmia and pacing patients were utilizing e-Health visits. Now, about half are using the service.

“Patients are very appreciative of the virtual visits,” Kim said, adding he conducted an appointment with a patient while they were standing in the middle of a field on their ranch. “They are thankful they don’t have to come in and expose themselves if they don’t have to.”

In addition to safety, Kim said e-Health services can be used to treat people in areas where there are limited pediatric cardiology services. Patients in these areas might not be able to drive into places like Houston for an appointment forgoing care altogether or seeking it in less-than-ideal places. e-Health would bring the visit to them, allowing our experts to reach more children and families.

“e-Health has a lot of benefits and possibilities,” Kim said. “I’m excited to see how it develops.”

May 4, 2020

When Kirsti Clifford found out she was pregnant with her second child, she was excited beyond belief. She was grateful to be giving her daughter a sibling and she was looking forward to pregnancy and delivery more so than with her first child because she knew what to expect. Then the pandemic happened and Clifford’s anxiety rose right along with it.

“There is so much unknown.” Clifford said. “I have felt much more uneasy this time and am trying to be really careful. I am limiting my exposure, social distancing and not going out unless I have to.”

To reduce the anxiety of expectant moms like Clifford, and to lower their risk of COVID-19 exposure and infection, Texas Children’s Pavilion for Women has opened a drive-through prenatal clinic at our Medical Center Campus.

A group of Texas Children’s obstetrics and gynecology physicians in consultation with the American College of Obstetrician Gynecologists (ACOG) came up with the idea while discussing how to adequately care for pregnant mothers while reducing their risk of contracting COVID-19 while traveling to hospitals or clinics for a prenatal exam.

“Providing access to prenatal health care while limiting exposure of both obstetric health care professionals and patients to COVID-19 is challenging,” said Dr. Mark Turrentine, a Texas Children’s obstetrician and gynecologist. “Although reductions in the frequency of prenatal visits and implementation of telehealth interventions provide some options, there still remains a need for patient–health care professional visits.”

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, thus reducing potential patient, health care professional, and staff exposure to COVID-19.

View photos of the drive-through clinic below.

The drive-through visits include 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.

“Patients using the drive-through clinic feel reassured that they can actually see a health care provider and hear their baby’s heartbeat without having to come into our facility and risk being exposed to the virus,” Turrentine said. “Our providers like it as well. They enjoy being able to provide patients with an option that might better suit their needs during these unprecedented times.”

Clifford said she used the drive-through clinic at the Medical Center Campus for her 30-week appointment because she didn’t want to take any unnecessary risks, and that it turned out to be a great decision. She said she got her blood pressure taken and that, more importantly, she got to hear her baby’s heartbeat.

“I appreciated the setup because we can still get some of the important monitoring that we need to feel reassured,” Clifford said. “It’s a creative solution that I would opt to use again.”

In conjunction with Turrentine and other Texas Children’s obstetrics and gynecology physician, Obstetrician and Gynecologist-in-Chief Dr. Michael A. Belfort recently published a paper about the drive-through prenatal clinic in Obstetrics & Gynecology, the official publication of ACOG. In that paper, Belfort said the drive-through model is projected to reduce the number of in-person clinic visits by 33 percent per patient compared with the traditional prenatal care paradigm, using equipment and supplies that most obstetric clinics in the United States can access.

“What we have seen so far at Texas Children’s is that the concept of a drive-through prenatal clinic works,” Belfort said. “They are reducing patient anxiety without compromising quality of care. It’s a win-win for everyone involved.”

Texas Children’s is also using drive-through capabilities for a variety of services including per-operative COVID-19 testing at all three of our hospital campuses and will expand these options as we continue to refine how we care for our patients.

April 28, 2020

Throughout the COVID-19 pandemic Texas Children’s has remained focused on caring for our patients and their families while preserving their safety and the safety of our workforce. One area where this is especially important is in the operating room where the risks of contagion could be higher than the average hospital setting.

“The operating room is a high-risk environment because of the potential to need to intubate and extubate patients,” said Children’s Surgery Program Manager Joyce Enochs. “Both of these procedures generate aerosolized particles, which can put medical workers at a greater risk of contracting COVID-19 from an infected patient.”

To protect the perioperative staff from any undo exposure or risk, the Departments of Surgery and Anesthesiology, Perioperative and Pain Medicine have taken a two-phased approach in protecting families and staff alike. The first phase entailed creating a training program for a new care paradigm for potential COVID patients. Dr. Chris Glover, medical director of Perioperative Services, in conjunction with Department of Anesthesiology and Perioperative and Pain Medicine Simulation Committee Members – Dr. David Young, Dr. Lisa Caplan, and Dr. Kathleen Chen – created the program from the ground up to reinforce this new workflow.

The program includes an information session where team members learned about COVID-19 and how Texas Children’s employees are protecting themselves from the disease; a simulation where team members learn how to don and doff PPE appropriately and confidently; and a simulation where team members transport a mock patient from an intensive care setting into the operating room, intubate them, return to the intensive care unit.

In addition, the training covers additional precautions to limit transmission risk in the operating room. These precautions include modifications during intubation and extubation, such as the use of N95 masks and goggles, as well as the incorporation of High Efficiency Particle Air or HEPA filters on the anesthesia circuits to filter out particles and ensure that none are emitted into the air. Another effort to mitigate aerosolization in the operating room is modifying induction techniques by using plastic barriers for patients.

The second phase of this new care approach is the incorporation of expanded testing so that every patient presenting for surgery receives COVID-19 testing prior to arrival. This further answers concerns on potential exposures of our perioperative staff as well as taking a judicious approach to appropriately utilize PPE.

“This is an overarching effort to ensure our health care workers, our folks who are on the frontlines, are protected as we’re dealing with this unprecedented event,” Gover said “For us to proceed along this pathway, we’ve had a lot of support and guidance throughout the organization.”

Anesthesiologist-in-Chief Dr. Dean Andropoulos agreed and said the efforts and countless hours from the anesthesiologists who led this simulation training should be commended. “Not only are they leading at Texas Children’s Hospital, but they are setting standards for potential future outbreaks at all Children’s hospitals,” Andropoulos said.

The training positions the team well as it continues to prepare to care for those diagnosed with COVID-19 and as the team begins to take on elective surgeries again. In light of Gov. Abbott’s decision to loosen restrictions put in place for elective surgeries, the Department of Surgery is prioritizing cases that initially may not have been urgent, but are now more important due to the several week delay.

“Through a phased approach, our surgical team is working through the large number of cases that are pressing, primarily outpatient cases, and prioritizing them appropriately based on a variety of factors,” said Surgeon-in-Chief Dr. Larry Hollier. “During the previous order, Texas Children’s continued to serve patients who needed us while remaining mindful of the impact elective surgeries may have had on critical supplies and resources. We remain prepared to care for those diagnosed with COVID-19 and cognizant of our supply levels while providing the best care possible to all patients, as we are here for them during this time and beyond.”

April 27, 2020

Our employees and staff are always collaborating on innovative ways to improve efficiency while keeping the safety of others in mind. Recently, Texas Children’s implemented new technology for temperature screening that has improved the organization’s COVID-19 employee/patient screening processes.

“We are now implementing the use of thermal imaging cameras for temperature screening,” said Bert Gumeringer, senior vice president for Facilities Operations. “We deployed 10 thermal cameras at our employee screening, and patient and visitor screening locations, at the Medical Center Campus. We plan to install these thermal cameras at West Campus and The Woodlands once they become available.”

Currently, a total of 10 thermal cameras have been installed at these Medical Center campus locations:

  • Garage 19 – three cameras
  • Pavilion for Women – two cameras
  • Legacy Tower – two cameras
  • Wallace Tower, West Tower, and Feigin – one camera each

The thermal imaging cameras measure temperature on the skin’s surface using infrared light to generate a thermal image and temperature reading in a fast, non-invasive and precise method. By leveraging this new technology, screeners can simply and accurately detect elevated skin temperatures. If an elevated temperature is identified, the employee is promptly directed to receive appropriate follow up guidance and care.

Since implementing screening protocols on March 23 as part of our COVID-19 response, the employee screening process has undergone several evolutions to adapt to the changing environment, all while maintaining a continual focus on ensuring safety and providing a positive employee experience.

“The introduction of the thermal cameras was a giant leap in advancing the efficacy and efficiency of the screening process,” said Julie Griffith, director of Patient Support Services. “Integrating thermal cameras within the screening process has been seamless. We adjusted the screening workflows and staff training relatively quickly and employees, patients, and families have become accustomed to the new process.”

While it’s been over a week since the thermal cameras were integrated into the system, employees have expressed intrigue and gratitude towards this new technology. They understand that it is a necessary advancement to support the number one goal of protecting the health and safety of our patients, families and workforce.

“There is a higher level of confidence among staff now that we are screening more effectively,” said Aimee Jackson, director of Ambulatory Clinical Practice. “The new cameras allow us to process more people in a shorter amount of time while maintaining social distancing throughout the screening process.”

April 20, 2020

As Texas Children’s continues to navigate through these unprecedented times, our focus has been, and will continue to be, the health and safety of our patients and staff. Extra precautions have been taken and additional processes have been put in place to ensure we keep moving forward as a strong unit. But we know our responsibility reaches far beyond Houston and its surrounding areas. As a recognized leader in global health, Texas Children’s has worked diligently to create adaptive solutions for our clinics in sub-Saharan Africa, South America and Eastern Europe.

One of those solutions was rolled out this week in Malawi, Africa, at the Baylor College of Medicine Children’s Clinical Centre of Excellence-Malawi (COE) where children and young adults with HIV/AIDS are tested, diagnosed and treated. The InTouch Lite V2 (often referred to as ‘Lite’) device was deployed to the COE as part of our efforts to provide patient care during the COVID-19 crisis in sub-Saharan Africa by utilizing available resources.

This remote presence robot, which was donated to Texas Children’s Global Women’s Health program in Malawi by the World Telehealth Initiative in 2018, allows for remote monitoring of patients and can be maneuvered electronically at the bedside to assist in care delivery. The device will be used during in the upcoming months at the Baylor-Malawi COE to assist in patient care.

“The technology is amazing even with Malawi’s bandwidth challenges,” said Dr. Jeff Wilkinson, an accomplished female pelvic and reconstructive surgeon with Texas Children’s Global Women’s Health Program. “It removes the location barrier and allows us to provide expertise from afar when we can’t be on location.”

Wilkinson said he’s used the robot many times in the past at the Fistula Care Center and thinks it will be a great resource at the COE, especially during this unique time of need.

By deploying this resource for use at the COE, health care workers have the ability to interact with patients remotely to reduce transmission of the infection among their immunocompromised patient population. This quick adaption and working partnership between Texas Children’s and World Telehealth will allow the teams to continue safely providing the same high-quality care and treatment for HIV, tuberculosis, malaria and malnutrition while limiting the spread of COVID-19.

Sharon Allen, executive director of World Telehealth Initiative, said the robot is connected to a proprietary worldwide network built and operated by InTouch Health and is ready to be used once she finishes training the physicians who will be accessing the machine to see patients. The training takes about 20 minutes and is indicative of just how easy the device is to operate, Allen said.

“After hitting just a few buttons – boom – you are right there,” she said. “And if there are any problems, we are here to help.

The mission of the World Telehealth Initiative is to provide medical expertise to the world’s most vulnerable communities to build local capacity and deliver core health services, through a network of volunteer health care professionals supported with state-of-the-art technology. Part of that mission is to ensure health care workers know how to use and deploy the technology.

“We are available to help in any way possible,” Allen said. “Our main goal is to connect medical experts with people who might not receive health care otherwise.”

Phoebe Nyasulu, Executive Director of BIPAI’s operations in Malawi, said she is looking forward to seeing the robot in action at the COE and believes the machine will help her staff protect themselves and their patients and families, many of whom are immunocompromised and possibly susceptible to COVID-19.

Malawi has seen an uptick in the number of COVID-19 cases over the past week, leading to a 21-day national lockdown. Texas Children’s and Baylor College of Medicine are participating at national levels with local and regional leaders to shape policies aimed at curbing the impact of COVID-19 and protecting the work that’s already been done to strengthen their nations’ health care systems.

“The use of the robot Lite is one of many ways health care workers can continue to care for our patients in the safest way possible,” Nyasulu said. “We have to continue to be innovative and open to ideas like this as we continue to navigate the COVID-19 public health crisis. We are thankful we have partners like Texas Children’s, Baylor and the World Telehealth Initiative to help us along the way.”