July 19, 2016

72016jrreporters640A team of nurses, surgeons, and anesthesiologists from Texas Children’s Hospital’s Main Operating Room recently participated in a medical mission in Antigua, Guatemala.

The mission was coordinated by Faith in Practice, a Houston-based organization dedicated to the medical care of indigent people in Guatemala. The 44-member team that went consisted of medical and surgical staff from hospitals in the Medical Center and out of state. Among the volunteers from Texas Children’s were Drs. Olutoyin Olutoye, Oluyinka Olutoye, Robert Power, David Mann and Stephanie Cruz; certified registered nurse anesthetists Nate Jones and Megan Koudelka; and registered nurses Karen Bustos, Debra Batiste and Juan Sale.

Focusing primarily on pediatric patients, the team performed nearly 140 surgeries in just four days, including inguinal and umbilical hernias, orthopedic surgeries, podiatric cases, and dental extractions conducted in support of the people of Antigua.

“It is always a humbling experience to go on this mission trip,” said Bustos, who has been on the mission five times now. “These people come from villages eight to 10 hours away and come to us full of trust that we will make their children well.”

Sale, a first-time volunteer, said the trip was “an amazing experience, especially when you get to help the children.”

Glass, the group coordinator for Texas Children’s, said she has been participating in similar mission trips since 2002 and has gone to Guatemala 15 times.

“This activity is open to all surgeons, operating room nurses, anesthesia staff, recovery room nurses, and especially bilingual people,” Glass said, adding that financial donations will help support the mission as well as donation of unused OR supplies.

According to the organization’s website, Guatemala is considered extremely impoverished in comparison to other South American countries. Half of Guatemala’s 14 million people live in poverty, which is defined as living on less than $2 per day. In addition, the vast majority of Guatemalans have virtually no access to public health care.

In spite of these deficiencies, The Faith in Practice organization has made a significant impact on the people of Guatemala. In 2015 alone, 1,200 US volunteers travelled to Guatemala to participate in the mission activities coordinated by Faith in Practice. As a result, a total of 2,400 surgical procedures were performed and 25,000 Guatemalan patients were seen by the medical mission teams. Texas Children’s Hospital is extremely proud of this team and their selfless dedication to service.

72016fetalconference640The International Fetal Medicine and Surgery Society (IFMSS) led by co-presidents Doctors Oluyinka and Olutoyin Olutoye, will convene for its annual meeting in Kasane, Botswana from August 2 to 7, 2016. This is the second time the meeting has been held on the African continent in the society’s 35-year history.

The IFMSS is an international gathering of fetal medicine practitioners from all over the world,” said Dr. Oluyinka Olutoye, co-director of Texas Children’s Fetal Center. “The annual meeting is the forum where innovations in fetal therapy are discussed even prior to general dissemination.”

Topics that will be discussed at the meeting include updates on the management of fetuses with spina bifida, innovative therapies for congenital diaphragmatic hernia (CDH), advances in the management of complex twin problems, as well as topics on ethics, anesthesia, genetics, cardiology, diagnostics, neonatal care and long-term outcomes amongst others.

Anesthesiologist-in-Chief Dr. Dean Andropoulos is one of the invited keynote speakers. The other keynote speaker is the Executive Director of the BIPAI Center of Excellence in Botswana, Prof. Gabriel Anabwani. Other Texas Children’s physician attendees include Dr. Darrell Cass, co-director of the Fetal Center, who will present the hospital’s experience with the management of CDH, Texas Children’s neurosurgeon Dr. William Whitehead who will deliver a presentation on the fetal management of spina bifida and Texas Children’s maternal-fetal medicine specialist Dr. Alireza Shamshirsaz who will present on fetal intervention for non-immune hydrops.

Other meeting attendees include Drs. Karolina Adam and Joanie Hare of Houston Perinatal Associates, and research fellows Drs. Stephanie Cruz and Patricio Lau who will also present at the meeting and are two of the seven recipients of the young investigator travel award. Kristen Kaiser, PhD, of Texas Children’s Pediatric Surgery Division together with Adam Gibson and Taylor Napier Earle of Texas Children’s Global Health have graciously provided administrative and logistical support for this international meeting.

In addition to the IFMSS meeting in Kasane, Botswana, a pre-meeting symposium will be held in conjunction with the Botswana Pediatric Association and the University of Botswana in the capital city, Gaborone, Botswana from July 31 to August 1. This symposium, also involving international speakers, will address issues in prenatal diagnosis, pediatric anesthesiology, obstetrics, pediatric surgery, cardiology and critical care, and is targeted at Botswana physicians not involved in fetal therapy.

“Serving as co-presidents of an international society is an honor and privilege,” said Dr. Olutoyin Olutoye, director of the Fetal Anesthesia Service at Texas Children’s. “It acknowledges our participation in the society’s activities over the years, reflects our contributions to the field, and places Texas Children’s and Baylor College of Medicine amongst elite institutions whose faculty have led such a prestigious organization.”

The logo for the 35th IFMSS meeting was designed by Beth Sumner of Texas Children’s Department of Surgery, with inspiration from the co-presidents. The elephant acknowledges the region of Botswana where the meeting will be held, which is home to the largest concentration of elephants in the world. The fetus encased in the elephant trunk acknowledges the care of the fetus that is the focus of the meeting.

July 12, 2016

71316MostWired640Texas Children’s has received the 2016 “Most Wired” designation for outstanding health care-based technology from Hospitals Health Network Magazine – the flagship publication of the American Hospital Association. This is the third time Texas Children’s has won this award.

Health Care’s Most Wired Survey, conducted between January 15 and March 15, asked hospitals and health systems nationwide to answer questions regarding their information technology (IT) initiatives in the areas of infrastructure, business and administrative management, quality and safety, and clinical integration. The survey of 680 participants represented 2,146 hospitals – more than 34 percent of all U.S. hospitals.

“This designation is a tribute to the hard work of our Information Services team and clinical and operational partners at Texas Children’s,” said Myra Davis, senior vice president of Information Services. “We use this survey as a benchmark to measure our progress against our peers in the implementation of information technology and to ensure we are making the right technology investments to guide our strategy for improving patient care and safety.”

Texas Children’s was noted for several IS achievements including the implementation of Epic Rover, a mobile software application that uses barcode technology to prevent medication errors and improve the quality and safety of medical administration. This new technology was implemented in September 2015 and its effectiveness in promoting patient safety was recently highlighted in a Voice of Nursing blog.

Epic Rover is an extension of the electronic medication administration record (MAR) in Epic. Once this software is downloaded to an iPod Touch equipped with a scanner or sled, the barcodes on both the patient’s wristband and the prescribed medication are scanned at the patient’s bedside. The medication documentation then flows real-time into the MAR in Epic to ensure that the “five rights” are confirmed – right patient, right medication, right dose, right time and right route of administration.

Texas Children’s was also commended for using innovative alarm management technology to make alarms more meaningful and actionable for direct care providers while eliminating alarm fatigue within patient units. This new application resulted in the organization receiving ECRI’s 10th Annual Health Devices Achievement Award in 2016.

Other IS accomplishments include:

  • Optimizing clinical workflows – Since mobility is a critical factor in optimizing work flows, Epic’s mobile application suite allows providers to e-prescribe medications. Implemented in March 2016, this electronic feature improves the safe and secure transmission of patient health information among providers and optimizes patient experience by eliminating the need to drive to the clinic to obtain a prescription.
  • Advancing population health management – Health tools and registries were recently introduced within Epic for key patient populations such as those with asthma and diabetes. By leveraging data analytics, physicians can track and address patient needs, and easily pinpoint unmet needs and gaps in data or service delivery. Proactive steps can then be taken to ensure patients and their families receive the services they need to make a difference in their care and improve clinical outcomes.
  • Streamlining physician/patient communications – Voalte technology used by nursing, shared services and physicians has streamlined communication across the care continuum by enabling highly mobile staff to receive key notification alerts that require prompt action. The MyChart patient portal continues to grow in usage and capabilities. New options have been added making it easier for patient families to schedule appointments, send non-urgent messages to their care team and pay their bills online via MyChart billing.

“In health care today, health IT maturity is key in advancing outcomes and experience,” said Julie McGuire, director of Enterprise Systems for Information Services. “The Most Wired designation shows that Texas Children’s is leading not only in clinical care but in the use of technology to support and advance clinical care.”

The 2016 Most Wired Survey is published by Health & Hospitals Network. The July H&HN cover story detailing results is available at www.hhnmag.com.

71316Dreileenbrewer175Medical Director of Renal Transplantation Eileen Brewer, MD, recently received an achievement award for her work on the United Network for Organ Sharing (UNOS) Pediatric Transplantation Committee.

Brewer has been a member of the committee since 2009 and was chair of the committee in December 2015 when, after decades of hard work, the UNOS Board passed pediatric bylaws that establish specialized guidelines for surgeon and physician leadership for all hospitals with pediatric transplant programs.

“Dr. Brewer faced many tough questions about the bylaws and handled these questions with the mettle of a seasoned practitioner and diplomat,” said Christopher Wholley, a UNOS policy analyst. “It’s been a pleasure to work with her.”

Dr. John Goss, the medical director of Transplant Services at Texas Children’s Hospital, said Brewer’s work on the Pediatric Transplantation Committee has yielded some great work for the pediatric transplant community.

“This was a huge undertaking and we are very proud of her,” he said.

Brewer is an internationally known expert in pediatric renal diseases, dialysis, transplantation and hypertension. She is past president of the American Society of Pediatric Nephrology, former Council Member of the International Pediatric Nephrology Association and organizer of International Workshops on Hypertension in Children and Adolescents in 2001, 2004 and 2007.

She has been an active clinician and clinical researcher throughout her career, publishing more than 90 journal articles and 30 book chapters. She is frequently invited to speak at scientific meetings and workshops nationally and internationally.

July 6, 2016

7616zikaclinic640Texas Children’s Pavilion for Women recently opened a Zika clinic to ensure women, mothers and babies continue to receive the highest quality health care during every important stage of their lives.

Located on the third floor of the Pavilion for Women in the Baylor Ob/Gyn clinic, the Zika clinic focuses on women who have traveled to Zika-affected countries, have shown symptoms of the Zika virus or have partners who have traveled to Zika-affected countries and/or have shown symptoms of the Zika virus.

Zika is transmitted primarily through mosquito bites. In recent months, the virus has heightened concern among pregnant women since the virus may increase the risk of microcephaly, a rare neurological birth defect that causes babies to be born with abnormally small heads.

“It’s very important that we have a Zika clinic here at the Pavilion for Women,” said Dr. Kjersti Aagaard, a Maternal-Fetal Medicine physician and vice chair for Research in the Department of Obstetrics and Gynecology at Texas Children’s and Baylor College of Medicine. “In an emerging disease, where new evidence arises daily, having a dedicated group of providers who can keep up with large amounts of crucial information, understand what testing to perform, and discern clinically important information and how to readily apply it are critically important.”

In addition to blood, urine and amniotic fluid tests and counseling, the clinic offers a targeted diagnostic ultrasound that can be performed as early as 15 weeks into pregnancy to determine if there are any concerning developmental signs for Zika infection in a fetus. Physicians and staff at the clinic are thoroughly prepared to safely and confidently treat any patient who exhibits symptoms of the Zika virus.

The Zika clinic is a direct outcome of a recently created task force that convened earlier this year. Under the guidance of Texas Children’s Ob/Gyn-in-Chief Dr. Michael Belfort and Maternal Fetal Medicine Division Director Dr. Gary Dildy, a task force of physicians and researchers from Baylor and Texas Children’s have developed management and research strategies based on important screening criteria outlined by the Centers for Disease Control for pregnant women who may have been exposed to the Zika virus. This task force has been led by Aagaard alongside Drs. Carey Eppes and Martha Rac.

The Zika clinic sees patients on Friday mornings from 8 a.m. to noon. The clinic is staffed by one registered nurse, one medical assistant and the physician team includes Drs. Eppes, Aagaard, Rac and Magda Sanz Cortes.

The clinic will initially see patients who are internally referred by either Baylor Ob/Gyn, Partners in Ob/Gyn Care or The Women’s Specialists providers. Patient referrals to the Zika clinic from outside physicians will be accepted and expanded this summer once internal patient volume demands are addressed.

Recent Connect articles related to Zika:
Senator Cornyn visits Texas Children’s to attend roundtable on Zika virus
Zika virus cases surface in Texas, travelers to epidemic regions most at risk

7616drlotze175Dr. Timothy Lotze recently received the 2016 Program Director Recognition Award from the American Academy of Neurology (AAN). The award acknowledges excellence on behalf of neurology program directors whose leadership, creativity and innovation are crucial in ensuring the future of neurology.

“This is a huge accomplishment for a pediatric neurologist as our physicians are competing with adult neurology program directors as well,” said Texas Children’s Chief of Neurology Dr. Gary Clark, who nominated Lotze for this distinguished award.

As director of the Pediatric Neurology Residency Training Program at Baylor College of Medicine since 2005, Lotze’s contributions to resident education include expanding the child neurology residency to five approved slots per year and enhancing trainee exposure to clinical research and subspecialties, such as genetics, to help residents understand the roles of modern genetic testing in the discovery and diagnosis of neurological diseases.

In addition, Lotze has developed educational programs that are very forward thinking. For instance, as child neurology training requires education in adult neurology, Lotze established integrated rotations that combine adult and pediatric neurology training in specific areas. These include clinics in neuromuscular disease, movement disorders and multiple sclerosis. Through this type of training, residents better understand the full spectrum of such conditions through the lifespan to include how children transition from a pediatric to an adult care environment with various chronic conditions.

“When I tapped Dr. Lotze to lead our program, I recognized rare qualities in him that would make him invaluable as a program director,” Clark said. “His innovative approach to resident education, his adoption of technology, and his development of educational assessment tools combined with his warm, supportive personality is why I believe he is the best program director in child neurology in the United States.”

In recognition for his teaching and leadership in academic medicine, Lotze has also received two Fulbright and Jaworski LLP Faculty Excellence Awards from Baylor. His tireless dedication to training the next generation of pediatric neurologists has won the appreciation and support from his former trainees.

“Dr. Lotze’s professionalism, dependence on evidence-based medicine and patient compassion and advocacy strongly influenced me during my training,” Dr. Amber Stocco said. “He taught me how to care for a complex patient with an organized, systematic approach while not losing sight of the family and the child.”

Lotze was one of two recipients of the 2016 Program Director Recognition Award. Congratulations to Lotze for this much deserved award.

June 28, 2016

62916usnews640It’s one of parents’ worst fears – their child has a complex or life-threatening illness. How do they decide where to go for the comprehensive care their child needs?

Over the years, the U.S. News & World Report Best Children’s Hospitals rankings have helped thousands of parents identify top sources of care for children with the most difficult medical problems. And Texas Children’s Hospital has consistently been among them.

On the 2015–16 Best Children’s Hospitals Honor Roll, which recognizes pediatric centers that are highly ranked in multiple specialties, Texas Children’s, working closely with academic partner Baylor College of Medicine, ranked no. 4 in the nation for the fifth consecutive year. It is the only children’s hospital in Texas on the Honor Roll.

“We’re rightfully proud of the great work that Texas Children’s does day in and day out on behalf of sick children and their families, but we know we have room for improvement,” said Texas Children’s Physician-in-Chief Dr. Mark W. Kline. “To the degree that the U.S. News survey can help us develop a blueprint for being the world’s best and highest quality pediatric health care institution, we are pursuing that.”

In a process that has become increasingly rigorous and data driven, the U.S. News rankings enable hospitals to look in the mirror and scrutinize themselves.

“Do we like the reflection? Are we as good as we think we are?” asked Dr. Angelo P. Giardino, senior vice president and chief quality officer at Texas Children’s. “In many cases, we are, and we’re thrilled because we are a really great children’s hospital. But there are opportunities where we look in the mirror and we say, ‘We could really do that better.’”

Rankings evolve

Beginning in 1990, as part of the Best Hospitals list, the pediatric rankings were 100 percent reputational for more than 15 years, based entirely on a survey of pediatricians and pediatric specialists across the country, asking them to identify the best children’s hospitals.

When U.S. News decided to rank pediatric hospitals separately from adult hospitals, the publication faced a challenging absence of data. While adult hospital rankings were drawn from Medicare data, no comparable source of information about children’s hospitals was available. As a result, U.S. News enlisted RTI International, a nonprofit research and consulting firm that was already the contractor for the Best Hospitals rankings, to develop a methodology for obtaining data directly from the hospitals and to analyze the results.

The first rankings incorporating such data were published in 2007 as General Pediatrics. Texas Children’s Hospital was listed among the top 30 children’s centers.

In 2008, rankings in six specialties, including cancer and neonatal care, were added to the children’s hospital rankings. In 2009, a newly created Honor Roll listed the 10 children’s hospitals out of 160 surveyed that were ranked in all the specialties, which had been increased from six to 10.

The 2015-16 Honor Roll required a hospital to rank in the top 10 percent in three or more specialties. Only 12 pediatric hospitals qualified among 184 surveyed nationwide. Texas Children’s has appeared on every Honor Roll.

In 2015, Texas Children’s ranked no. 2 in three specialties: cardiology/heart surgery, neurology/neurosurgery and pulmonology. Texas Children’s ranked among the top five hospitals in six specialties and in the top 30 hospitals in all 10 specialties.

“The original purpose of the Best Hospitals rankings was to inform patients and families and help them make decisions,” said Health Rankings Editor Avery Comarow, who has directed the Best Hospitals projects since their beginnings. “I now recognize that we don’t necessarily have to just reflect performance. We can also drive it by incorporating metrics that reflect that goal. Every year, our contractor, RTI International, meets with medical experts to evolve the methodology in ways that not only reflect what children’s hospitals are doing, but ways in which they could and should be doing better.”

Quality framework

Today, the U.S. News Best Children’s Hospitals rankings use a well-accepted framework for evaluating the quality of health care:

Structure: hospital resources related to patient care, such as the ratio of nurses to patients, specialized clinics and programs, and certification by external organizations.

Process: compliance with best practices in diagnosis, treatment, prevention and patient education. As a part of the process, reputation now counts as 16.7 percent of the overall score, down from the original 100 percent.

Outcomes: factors such as rates of survival, infection, mobility and cure.

The increasing emphasis on quality measures had strong support from the late Dr. Bernadine Healy, a former director of the National Institutes of Health, who was health editor of U.S. News before her death in 2011.

“Her expertise and perspective were invaluable,” Comarow said. “She had such a strong sense of the things that were important to patients and families. She brought that same perspective to some of the choices that we made in trying to decide which measures to highlight, what sort of weight to give them, how many hospitals we should assign rankings to, and where we would run out of meaningful data as opposed to numbers that looked OK but were not terribly reliable statistically.”

As U.S. News shifted the emphasis toward quality measures, Texas Children’s shifted coordination of the survey response from its Marketing/PR Department to its Quality and Safety Department.

Team effort

The evolution into quality led us to bring all the chiefs of medical and surgical services to the table,” said Mary Jo Andre, senior vice president and chief nursing officer and former senior vice president of Quality and Safety. “The more that quality and best practices were built into the survey, the more accountability of the survey shifted from an administrative standpoint to the medical staff.”

To help build physician engagement, Giardino and Thomas Luerssen, chief quality officer – surgery, were appointed quality officers for Pediatrics and Surgery, respectively, in 2013. The next year, Giardino was named to his present position as chief quality officer of Texas Children’s, and Eric Williams, succeeded him as quality officer for Pediatrics. They work closely with teams of physician section chiefs, practice administrators and data specialists.

Although only 10 clinical areas are ranked, a total of about 20 different services contribute to the survey, such as Radiology, Emergency Services, Intensive Care, Social Work and Nutrition. For example, nursing certification, attention to safe practices and increasing specialty roles of nurses appear in each section of the survey. Texas Children’s receives points for safety because of the hospital’s Magnet certification by the American Nurses Credentialing Center.

“Any outcome is a partnership of nursing and physicians,” Andre said. “The question directly related to nursing is about staffing. Seeing how we compared to the rest of the country has been a good thing for nursing, because it’s driven us to have higher standards as well.”

More than 100 people at Texas Children’s contribute to the survey each year, submitting more than 1,500 survey elements in all. Texas Children’s also is represented in four of the working groups that RTI consults each year in continuing to refine the methodology. Involvement in quality improvement at Texas Children’s is even more far-reaching. More than 400 staff members have been trained in Advanced Quality Improvement.

“Quality improvement, which Texas Children’s is passionate about, extends everywhere,” said Dr. Charles D. Fraser, Jr., chief of Congenital Heart Surgery and surgeon-in-chief at Texas Children’s. “Quality starts immediately when the patient or family arrives here. Everyone is important, whether you’re in housekeeping or food services, the cardiac intensive care unit or are an administrative executive. Everyone is responsible for quality.”

Gap analysis

Texas Children’s analytics team provides data to each section chief with a detailed analysis of the gaps between the section and comparable data from top-ranked peer institutions in the Best Children’s Hospitals rankings. The service chiefs and their clinical and administrative teams review the data closely and objectively, identifying gaps and opportunities to improve quality, access or outcomes.

For example, in Texas Children’s Diabetes and Endocrinology section, gap analysis revealed several opportunities for improvement that are being addressed. To help deal with limited patient access, four new pediatric endocrinologists have been hired. To reduce disease complications, timely alerts now appear on physicians’ computers, reminding them to schedule their patients for tests for thyroid problems, kidney complications and early signs of diabetic retinopathy, which is associated with blindness.

“The U.S. News rankings are a wonderful opportunity to shine a light on potential problem areas and to allow us to make the care that we deliver better, more effective and more patient centered,” said Dr. Jake Kushner, chief of Diabetes and Endocrinology at Texas Children’s.

The rankings not only help identify gaps where improvements are needed, but also provide data to build the case for needed changes.

“Many of the service chiefs and practitioners have said, ‘We’ve been wanting this – this process, this equipment, this type of clinic – for years, and here it is in the survey,’” said Terri Brown, assistant director of Clinical Outcomes and Data. “So they are able to leverage the survey to help achieve what they already know to be good ideas.”

As the Best Children’s Hospitals survey focuses more and more on ways to improve outcomes, the transparency and accountability of the published rankings are helping to improve children’s health care nationally.

“If you look at the hospitals on the Honor Roll, we’re all delivering great care to children and families,” Giardino said. “Everybody’s working hard to get better. So the bar keeps moving higher. And that’s the whole point.”