December 5, 2017

A little over a year ago, Texas Children’s Hospital The Woodlands Outpatient Building opened its doors to the Greater Houston area and beyond. Since then, the ever-growing team of providers and support staff have seen 50,000 plus patients in the outpatient areas and received numerous compliments from the patients and family members they serve.

“Our first year has been packed with many new and exciting opportunities,” said Julie Barrett, director of outpatient and clinical support services for the Outpatient Building. “We have grown substantially, adding new service lines, providers and staff, and we have established a culture that exemplifies our mission to provide the best possible care for our patients and their families.”

Designed with a “spirit of the woods” theme to incorporate the lush, woodsy landscape that surrounds it, the six-floor, 209,973-square-foot Outpatient Building opened in October 2016 housing almost 20 areas of specialized care including cardiology, sports medicine, neurology and hematology/oncology. A dedicated medical staff at the facility works in conjunction with the Texas Children’s system to provide top-notch medical care.

Connected to the almost year-old Texas Children’s Hospital The Woodlands on floors one and two, the Outpatient Building offers a fresh, new kid-friendly environment to families seeking the best pediatric care for their children. A state-of-the art sports physical therapy gym is on the first floor, check-in and check-out stations resembling a child’s club house are at the entrance of each clinic, and spacious exam rooms and provider work stations line many of the building’s halls.

Susan Niles, a senior athletic trainer with Sports Medicine, said the Outpatient Building’s Sports Medicine staff has grown substantially since it starting seeing patients a year ago, adding nurses, physical therapists, athletic trainers and a sports dietitian. Such growth has allowed the staff to provide quicker access to therapy services, Niles said. It also has provided opportunities for research.

“Using technology from the motion analysis lab, we have launched a research project that we hope will provide breakthrough information on concussions,” Niles said. “We are the only campus with a motion analysis lab and we are excited to use the technology for our patients.”

Ambulatory Services Therapy Manager Jay Mennel said another unique service offered in The Woodlands comes by way of an Alter-G treadmill, an anti-gravity treadmill utilized by sports therapy patients, he said. Such a specialized service combined with other specialty clinics led to the therapy staff completing more than 18,000 outpatient visits during the Outpatient Building’s first year in operation.

“We have some fantastic physicians and great senior leadership at The Woodlands, which has helped our department grow at an exceptional rate,” Mennel said. “We hope to continue to grow this next fiscal year.”

Heather Jordan, a staff nurse in Outpatient Surgical Services, Melanie Garcia, a medical assistant with Plastic Surgery, and Yvonne Barham a staff nurse with Diabetes and Endocrine, all said they have seen tremendous growth in their areas and that they have seen patients from all over Texas and surrounding states.

“Our patients have come from Nacogdoches, Lufkin, Bryan/College Station, Corpus Christi, Port Arthur, and Louisiana,” Barham said. “Many of the local residents have stated how happy they are to not have to travel for their regular office visits.”

Garcia agreed and said patient experience is something that everyone at The Woodlands Outpatient Building takes to heart. “We go above and beyond on a daily basis to make sure every patient feels special,” she said. “We are always improving, always compassionately serving each other and our patients.”

When asked what’s next, leaders, providers and staff point to continued growth and involvement in The Woodlands community.

“Now that we are here and have established workflows, processes and procedures, we can begin to work on things such as more access to patients and families, and staff being more involved in the community,” said Shawnda Kelley, ambulatory manager of various service lines at the Outpatient Building. “I am happy and proud to be a part of this new beginning and can’t wait to see what’s next.”

The 14th Annual Texas Children’s Radiothon has begun and is packed with inspiring stories about many of our patients, the struggles they are facing and how we are helping them push through.

Historically, the Cox Media-hosted radiothon has been conducted over a couple of days and is broadcasted from Texas Children’s Hospital. This year, because of Hurricane Harvey, and the fact that many people have already been so generous to Houston already, the format of this year’s radiothon has changed.

Instead of a few days with a serious fundraising push, Cox Media will spread its fundraising efforts over several weeks from December 4 to Sunday, December 31, highlighting a story about a Texas Children’s patient each day during a segment called “Hero of the Day.” The stories will air on The Eagle (106.9 & 107.5), Country Legends (97.1) and The New 93Q (92.9).

Click here to view descriptions and a schedule of the stories that will be told by the radio personalities. Please note that the schedule is subject to change.

While listening, consider opening your heart and wallets and asking your family and friends to do the same. Every dollar donated to the radiothon will help Texas Children’s continue to fulfill its mission to create a healthier future for children and women throughout our global community by leading in patient care, education and research.

Click here to make a donation to this year’s Texas Children’s Radiothon.

Watch a video from last year’s Radiothon, which raised more than $650,000.

In a little over a month, a Magnet appraiser team will visit Texas Children’s facilities for a site visit, which represents a huge milestone in the hospital’s journey towards achieving Magnet® re-designation.

Since 2003, Texas Children’s has been a Magnet-designated organization. Every four years, the hospital applies for Magnet® re-designation, which is the highest and most prestigious recognition provided by the American Nurses Credentialing Center (ANCC), and reflects Texas Children’s commitment to providing excellent patient care.

From January 22 to 24, 2018, Magnet® appraisers will conduct a site visit at Texas Children’s, which is one of the many required steps to obtain Magnet® re-designation. The site visit will provide an opportunity for nurses and the entire health care team to engage with the Magnet® appraisers, share their exceptional accomplishments, and highlight our great partnership, exceptional care delivery and collaboration to enhance patient outcomes. After the site visit, the Magnet® appraisers will submit a report to the Commission on Magnet®, which makes the final determination regarding Texas Children’s Magnet® re-designation.

From now until the Magnet® site visit in mid-January, a special series will be featured on Connect highlighting what Texas Children’s employees “need to know” regarding this important site visit.

To start the series off, we’ll answer the questions: “What is Magnet?”… and “Why is it so important?”

What is Magnet?

Magnet is a credential bestowed by the American Nurses Credentialing Center which formally recognizes an organization’s attainment of nursing excellence.

Why is it so important?

Obtaining and maintaining Magnet designation is important because it benefits patients, nurses and our organization. Examples of the benefits include:

  • Enhanced ability to attract and retain top talent
  • Improved patient outcomes, safety and satisfaction
  • Strengthened collaborative culture
  • Advanced nursing practice and shared governance structure
  • Heightened business and financial successes

Stay tuned to Connect for more of what you “need to know” regarding our upcoming Magnet® site visit. To learn more about the ANCC’s Magnet Recognition Program®, click here

On November 21, Texas Children’s earned The Joint Commission’s Gold Seal of Approval for Palliative Care Certification, making Texas Children’s Palliative Care Program the first of its kind in Houston and one of only 90 across the United States to receive such a distinction.

The certification demonstrates Texas Children’s focus on achieving optimum care for patients with serious illnesses and is a symbol of quality that reflects an organization’s commitment to providing safe and effective patient care.

The Palliative Care team recently underwent a rigorous onsite review during which Joint Commission experts evaluated compliance with national palliative care standards built on the National Consensus Project’s Clinical Practice Guidelines for Quality Palliative Care and the National Quality Forum’s National Framework and Preferred Practices for Palliative and Hospice Quality Care.

“Texas Children’s has demonstrated its commitment to serve patients diagnosed with a critical and debilitating illness in a safe, high quality and patient-focused environment,” said Patrick Phelan, executive director, Hospital Business Development, The Joint Commission. “We recognize and commend Texas Children’s for its efforts to provide palliative care services while emphasizing patients’ physical, emotional and spiritual needs as they make end-of-life decisions.”

Established in 2011, The Joint Commission’s Palliative Care Certification is awarded for a two-year period and recognizes organizations that demonstrate exceptional patient and family-centered care in order to optimize the quality of life for patients with serious illnesses.

“Texas Children’s is pleased to receive certification from The Joint Commission, the premier health care quality improvement and accrediting body in the nation,” said Dr. Tammy Kang, section chief of Palliative Care at Texas Children’s. “The certification recognizes hospital inpatient programs and helps to further promote and advance the field of palliative care, ultimately improving the care for persons living with serious illnesses.”

Helping parents verbalize their challenges and focus on what they want to accomplish with their seriously ill child are among the goals of the system-wide Palliative Care program at Texas Children’s Hospital.

“What we have tried to promote is the understanding that palliative care is about maximizing quality of life, and improving care and support for children and families with serious illness, regardless of prognosis,” said Kang, who holds a clinical epidemiology degree and was recruited from the prestigious Children’s Hospital of Philadelphia, where she started a palliative care team and managed it for the past 15 years. She launched the clinical service at Texas Children’s in October 2016.

Clearing up misunderstanding

“Many people have the misunderstanding that palliative care is hospice care or end-of-life care,” Kang said. “We certainly partner with hospice agencies in the community to provide those kinds of services, if that’s what the patient is facing and that’s the family’s choice. But the vast majority of children served by pediatric palliative care providers are not in hospice care and are not terminal. Instead, these are children with complex, serious illness who require additional support and services for managing distressing symptoms. It’s for helping families understand the medical processes and interventions, for providing psychosocial, spiritual and emotional support for patients, their families and their siblings. And it’s just helping families navigate this very complicated health care system.”

To provide that support takes an interdisciplinary team of physicians, nurses, social workers, child life specialists, chaplains and other support specialists.

“Many of the kids have issues with multiple organ systems, where they have 20 or 30 medical problems” said Dr. Daniel Mahoney, a palliative care physician. Sometimes the course of treatment, such as chemotherapy or bone marrow transplants, may cause problems in the heart or kidneys. A problem in the genetic code can affect every organ system in the body – the brain, heart, lungs, kidneys and liver.

“Often kids have multiple specialists who try to coordinate care,” Mahoney said.

Long-term attitude

Although the formal, system-wide Palliative Care program is somewhat new at Texas Children’s, individual palliative care programs existed in several service lines. And, of course, working as a team to provide the best care for very sick children is not a new concept at Texas Children’s.

A landmark report published in 2000 by the Institute of Medicine, When Children Die: Improving Palliative and End of Life Care for Children and Their Families, stimulated work across the country to improve palliative care programs for children.

In the years since then, Texas Children’s has:

  • Taught twice a year the End-of-Life Nursing Curriculum, developed from a national Robert Wood Johnson Foundation project;
  • Started a perinatal palliative care service for pregnant women facing difficult fetal diagnoses;
  • Supported clinicians to attend the Palliative Care and Practice Educational course at Harvard and a retreat presented by the Initiative for Pediatric Palliative Care;
  • Started a palliative care service for Texas Children’s Cancer and Hematology Center patients.

Under the leadership of Physician-In-Chief Dr. Mark W. Kline, and with the efforts of Dr. Susan Blaney, deputy director of the Texas Children’s Cancer and Hematology Centers, and representatives with Ethics and Palliative Care at Texas Children’s, the organizational umbrella opened in 2016 with support from Texas Children’s Hospital and Baylor Department of Pediatrics.

Texas Children’s Information Services team also was instrumental, partnering with Epic Production Support to create the necessary tools to improve the care of their patients. This collaboration included the development of a customized navigator, note templates, and letters. These improvements also provided the “Pink Sheet” in an electronic format. The pink sheet, which was previously only available in a paper format, ensures that this patient population is cared for in accordance to county and state regulations. As an added benefit, the new electronic form will streamline workflow by making it easier to identify required documentation. Automation of documentation lets our Palliative Care Team have more time to provide more family centered care.

“One of the things that already existed here is this commitment from the leadership on down to the clinical providers to really provide the best possible care for every patient, for every family, regardless of where they came from, what their diagnosis was, or their prognosis,” Kang said. “What also exists here is this great collaborative energy between the medical teams, the department, the hospital and the hospital administration that’s needed for our integrated way of caring for children.”

The Palliative Care team sees patients across the hospital and its many clinics. In its first year of clinical operation, the team provided more than 435 consults and 1,800 follow-up visits.

“We’ve heard from families that they really appreciate this consultant team helping them identify the goals of care,” said Joy Hesselgrave, a longtime nursing staff member in Hematology-Oncology, who is now assistant clinical director of Palliative Care. “The team listens to what the family thinks they want for their child, listens to the clinical medical team who manages the medical care and who says what’s possible, and then communicates that to the family in a way that helps with their decision-making process.

“I think a lot of families have ideas about what they think, but they haven’t articulated them. They haven’t made any plans or contingencies. Just offering them a space in which to communicate and to clarify is very helpful. It’s not high tech, but high touch is really important.”

Available 24 hours a day

It may not be clear in the first visit how the team can be helpful, but it becomes clear as they get to know the family and build a long-term relationship. The team provides a cell phone number to parents, staff and referring physicians for a phone that is answered 24 hours a day, seven days a week by a physician from the team.

One of the team’s goals is a home visit program, in which psychosocial providers can go to the homes to check on patients, as well as provide support for caregivers and siblings.

“We know that siblings of children with serious illness are at risk for increased health issues, increased learning issues, and increased behavioral and psychological issues,” Kang said. “These children are often going through a lot of difficulties because their parents are at the hospital, and there is a lot of emotional and financial stress in the household. Being able to provide some support for these children in the home is a future goal.”

While physician visits are billed as medical visits, families are not billed for any of the other services.

“We really rely upon philanthropy to allow us to think about how to grow and to provide the best care and the best support both in the hospital and in the community,” Kang said. “I perceive our outcomes as being successful if we are doing our very best for every patient and every family that walks through the door.”

Significant support for staff

In addition to caring for patients and families, the team helps support staff.

“We didn’t really anticipate support for staff as being so significant,” Hesselgrave said. “To take care of and be the witness and the caregiver for children who are very sick or dying is very emotionally, physically and mentally exhausting. It’s very helpful to have members of our team there walking the journey with them.”

Besides emotionally supporting the staff, the team provides education about palliative care to staff at Main Campus, The Woodlands and West Campus. The program received Accreditation Council for Graduate Medical Education accreditation for a fellowship program in pediatric hospice and palliative medicine in 2016 and is training its first fellow. Beginning next year, the team will be able to train two fellows per year. They anticipate broadening their reach within the hospital and to community physicians and home care providers, educating them on the benefits of palliative care.

“We are committed to developing a research and outcomes platform as well,” Kang said. “We are well poised at Texas Children’s, because it is the largest academic pediatric program in the country, to help move the palliative care field forward through actively engaging in educational and research opportunities. A number of researchers across this institution right now have research interests relevant to palliative care, where I think important questions could be answered here relatively quickly.”

Putting its large, diverse patient population to good use for research, Texas Children’s is a member of the Pediatric Palliative Care Research Network, a research group of children’s hospitals in the U.S. and Canada.

In the complex world of medicine, the Palliative Care team leads families and staff through the thicket today and uses research to clear the way for tomorrow.

November 29, 2017

Information Services, the Cancer and Hematology Centers and Pharmacy recently partnered to successfully launch Epic Beacon, a new medical oncology module that gives physicians and other providers a better tool with which they can create personalized treatment plans and support care regimens based on standardized protocols. The outcome of such treatment plans and support care is a more efficient and effective way to follow each patient through outpatient doctor’s visits and inpatient hospital stays, easing the patient’s transition to lifetime, post-cancer care.

“This initiative has changed how we deliver care to some of our sickest patients,” said Cancer Center Director Dr. David Poplack. “With Beacon, we are able to provide more tailored treatment, more efficiently and at a decreased risk to our patients who receive some of the strongest medications.”

During the 18-month implementation process, about 600 treatment protocols were made electronic via Epic Beacon, which is fully integrated with Epic’s pharmacy and electronic Medication Administration Records (MAR) products, allowing oncologists to better track medications that have been dispensed and administered, including medications ordered outside of an oncology treatment plan.

In addition, Beacon, which is being used system wide where oncology patients receive chemotherapy, features decision support that can suggest protocols as well as dose-specific medication modifications based on chart data. It also tailors plans at the patient level, so medication orders can be created and queued up in advance of patient visits for cancer treatment.

“Using Beacon has been a culture change for the Cancer Center but well worth it,” said Julie McGuire, director of Enterprise Systems for Information Services. “It has taken real dedication from all teams involved as well as a tremendous amount of physician and nurse engagement.”

Dr. ZoAnn Dreyer, an oncologist with the Cancer Center, said Epic Beacon’s buildout and go-live process was smooth and seamless.

“Even Epic’s own representative was impressed, saying it was the best he has ever seen,” Dryer said. “And it’s worked well in clinic so far for sure!”

Other first impressions of Epic Beacon have been positive as well:

“I’ve never seen a project with as much dedicated physician support and I think that was a HUGE part of this project’s success!”
– Drew Willert, Information Services

“The success of the go-live and Beacon’s functionality is a direct result of a multidisciplinary team that demonstrated resilience, excellence and commitment to the overall success of the project.”
– Denise Tanner-Brown, Cancer and Hematology Centers

“I am so proud of what WE have done. I am so humbled by all of the outpouring of support from operational, Epic and IS leaders, as well as end users on the front lines.”
– Dr. Marla Daves, Cancer and Hematology Centers

When Peggy Kellum called the Texas Children’s Office Move and Relocations Team (OMART), all she wanted was three filing cabinets moved from one side of a room to another.

“I thought they were going to tell me no, but they did it,” said Kellum, an administrative assistant with the Department of Pathology. “I was so impressed by their willingness to go above and beyond.”

OMART was created less than a year ago to handle small jobs like the one Kellum requested as well as larger office moves and relocations. In the past, Texas Children’s has outsourced such jobs, but as the organization has grown, so have the requests and in turn the cost of such services. In addition, efficiencies initially seen by outsourcing have been replaced with extended turnaround periods for surveying, quoting, scheduling and completing the requested task.

“We were given the opportunity to improve the cost and delivery of this service and I believe we have found a solution that works for everyone involved,” said Dan Samora, director of Facilities, Planning & Development. “We’ve received positive feedback from many of our clients and we are providing a cost savings to the organization.”

Since launching the three-person OMART team in April, OMART has fulfilled more than 200 requests, with an average turnaround time of five and a half days from when the initial request was made. The team’s work has saved Texas Children’s an estimated $100,000 and has the potential of saving more if the team grows and expands to areas of the system outside of the Medical Center.

Currently, OMART has the capacity to fill requests from the Abercrombie Building, Feigin Tower, the NRI, Pavilion for Women, Meyer Building, Wallace Tower and West Tower. The team will cover Legacy Tower when it opens and will look at the possibility of expanding to West Campus, The Woodlands and beyond in the future.

OMART also would like to take on larger jobs when capable. Such jobs, as well as capital projects, are still supported by outside vendors.

“We have hit the ground running and are off to a really good start,” said Patrick Hatcher, manager of the Facilities Logistics Program. “We are getting things done more efficiently and effectively, and are looking forward to growing and serving even more of the Texas Children’s system.”

To request move and relocation services submit a Request for Service via the Connect site.

November 21, 2017

Because of the complexity of conditions seen at Texas Children’s, many patients and families view the health system and its staff as a family that supports them both inside and outside the hospital. That relationship was on full display November 15 when several patients of the Texas Children’s Craniofacial Clinic were given the opportunity to attend a free, early screening of the movie, Wonder.

Wonder tells the incredibly inspiring and heartwarming story of August Pullman, a boy with facial differences who enters fifth grade, attending a mainstream elementary school for the first time. Based on the New York Times bestseller, the film stars Julia Roberts, Owen Wilson and Jacob Tremblay.

“We feel that this screening was a wonderful opportunity to highlight the courage displayed by so many of the children that we help treat every day,” said Dr. Larry Hollier, chief of plastic surgery and associate surgeon-in-chief for clinical affairs at Texas Children’s. “And it reinforces the importance of seeing things through others’ point of view. Finally, we thought it was a great opportunity for everyone to attend a real movie premiere.”

The premiere was sponsored by members of the Children’s Craniofacial Association and Texas Children’s Craniofacial Clinic team, which treats and researches complex craniofacial differences such as Treacher Collins Syndrome, the one highlighted in Wonder.

Held at AMC Studio 30 on Dunvale Road in Houston, the screening of the movie began with patients and families walking down a red carpet and posing for photographs before making their way to the theater. The event ended with comments from two Craniofacial Clinic patients and their family members.

Grace Anto, a 10-year-old Craniofacial Clinic patient, said she could relate to much of what August, the lead character in the movie, went through.

“I have felt like Auggie,” she said. “Every time I make a new friend, it’s like a new beginning.”

Twelve-year-old Lance Dromgoole, another Craniofacial Clinic patient, agreed and said his favorite part of the movie was when August and Jack became friends.

“That was definitely the best,” he said.

Like the lead character in Wonder, Lance and Grace have had multiple surgeries to correct their craniofacial differences. Grace has had 10 surgeries and Lance has undergone 38. Some of those procedures helped Lance breathe better and others gave him actual ears, something he was born without.

Lance’s grandmother, Kathy Dromgoole, said she will never forget the first time Lance was able to put on sunglasses and that she will forever be grateful for the care her grandson has received at Texas Children’s. Regarding the movie, she said she hopes Wonder shows people that children with craniofacial differences are normal kids and that they deserve to be treated as such.

Grace’s mother, Lynn Anto, said the movie beautifully illustrates the power of kindness and how greatly it is needed people’s lives.

“Everyone is going through something,” she said. “And everyone could use a little kindness.”

Athena Krasnosky, a nurse practitioner with the Craniofacial Clinic and one of the organizers of the screening, told last week’s audience that Texas Children’s sees itself and its patients and families as one big happy family, and that everyone within the Craniofacial Clinic was thrilled to have been able to watch such a meaningful film together.

“We are so glad to have been able see this movie together tonight as a family,” she said. “We hope you enjoyed it.”

Haley Streff, a genetic counselor with Texas Children’s and another organizer of the movie screening, echoed Krasnosky’s comments and said the moving screening was a powerful experience.

“All of us here have a connection to someone with a craniofacial difference,” she said. “We all can relate in one way or another to what just happened on that movie screen.”