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July 21, 2015

On July 11, Texas Children’s Hospital and Hope for Hypothalamic Hamartomas hosted an educational conference to empower patients and their families affected by a rare and often devastating brain condition.

Hypothalamic Hamartoma (HH) is a noncancerous tumor of the hypothalamus that causes uncontrollable seizures, early puberty, hormonal imbalances and cognitive and behavioral problems. Seizures usually begin in infancy, most often as frequent, uncontrollable laughing spells (gelastic seizure), before different types of seizures emerge.

Texas Children’s neuroscience team along with Dr. Daniel Curry, Texas Children’s director of pediatric surgical epilepsy and functional neurosurgery, and Dr. Angus Wilfong, medical director of Texas Children’s Comprehensive Epilepsy Program, helped organize the HH Family Conference which featured insightful presentations from 11 experts from across the country who specialize in the diagnosis and treatment of neurological diseases.

The conference provided valuable information about exciting research on the horizon and potential new treatments for HH patients, with the hopes of empowering families and caregivers to make educated treatment decisions for their loved ones.

Several guest speakers from Texas Children’s included Drs. Wilfong, Maria Grosch, Marcia Komlos-Kukreja, Michael Quach, Varina Wolf, and Curry, who delivered a presentation on laser ablation technology, a surgical procedure he and Wilfong helped pioneer to treat seizures in children with epilepsy and HH.

Ranked no. 2 in neurology and neurosurgery by U.S. News & World Report, Texas Children’s is the first hospital in the world to use this real-time MRI-guided thermal imaging and laser technology to destroy brain lesions that cause epilepsy and uncontrollable seizures. Unlike a craniotomy – which removes a larger area of skull bone – the MRI-guided laser probe uses a much smaller pathway through the brain to reach a lesion. This minimally invasive surgery has resulted in promising outcomes for HH patients, with 78 percent of them being able to live seizure-free.

“Several of our families have been treated by this new laser ablation surgical procedure that Drs. Curry and Wilfong have worked hard to perfect on our high-risk patients,” said Lisa Soeby, president of Hope for Hypothalamic Hamartomas. “We are thankful for their dedication and passion for what they do and look forward to partnering with Texas Children’s Hospital in the future.”

In addition to providing informative sessions, the HH Family Conference also offered opportunities for families to meet others like them, who are impacted by this rare but treatable condition.

World renowned epileptologist Dr. Helen Cross and two of her colleagues visited Texas Children’s July 9 and July 10 to get more information on the Medtronic Visualase system, which uses real-time MRI-guided thermal imaging and laser technology to destroy lesions in the brain that cause epilepsy and uncontrollable seizures.

This product is not available in Europe, therefore Cross and the other clinicians from Great Ormond Street Hospital for Children are exploring the feasibility of sending some of their patients to Texas Children’s Hospital for treatment.

Cross and Drs. Sophia Varadkar and Martin Tisdall met with representatives from the International Office and later joined neurosurgeon Dr. Daniel Curry and neurologists Drs. Angus Wilfong, Michael Quach and Anne Anderson for a tour of the Magnetoencephalography Lab at the Pavilion for Women, the 12-bed epilepsy monitoring unit and the Blue Bird Clinic for Pediatric Neurology and Neurosurgery. The group also donned scrubs and observed a visualase laser ablation case with Curry and Wilfong, who performed the first of such procedures at Texas Children’s four years ago.

The surgery is performed by first mapping the area of the brain where the lesion is located using magnetic resonance imaging. The catheter is inserted through the skull in the operating room and then the patient is transferred to an MRI unit where the ablation of the lesion is performed. The MRI confirms probe placement in the target, and the magnetic resonance thermal imaging allows the surgeon to see the ablation of the lesion by the laser heat as it happens with an automatic feedback system that shuts the laser off when the heat approaches nearby critical brain structures.

“While we have been successful in curing epilepsy through open cranial surgery for quite some time, the benefits of this new approach in reducing risk and invasiveness while providing instant therapeutic has opened the door for more epilepsy patients to see surgery as a viable option,” Curry said. “We were more than happy to share this information with Helen and her team and look forward to working with them and their patients in the near future.”

July 20, 2015

Bench and Bedside is a digest of the previous month’s stories about the clinical and academic activities of our physicians and scientists. We welcome your subsmissions and feedback.

June 30

Blaney’s vision for SAIF helps advance research from bench to bedside

Texas Children’s Small Animal Imaging Facility (SAIF) at the Feigin Center has helped advance scientific investigations. The center allows for collaborations that lead to higher levels of innovative research within the Texas Medical Center. Read more

June 30

Dr. Hugh Allen receives distinguished award from the American Society of Echocardiography

Dr. Hugh Allen, pediatric cardiologist at Texas Children’s Hospital, was presented with the Council on Pediatric and Congenital Heart Disease Founders Award from the ASE. Allen received the prestigious accolade during ASE’s Annual Scientific Sessions. Read more

June 30

Mid-year roundup: NRI publishes groundbreaking research in 2015

Texas Children’s scientific research writer Dr. Rajalaxmi Natarajan highlights some of the 2015 groundbreaking discoveries from the NRI labs of Drs. Benjamin Deneen, Hugo Bellen, Mirjana Malatic-Savatic and Anne Anderson, who continue to pioneer innovative treatments to improve the quality of life for children with devastating neurological diseases. Read more

June 30

Dr. Rachel Rau given Chao Physician-Scientist Award for Leukemia Project

Dr. Rachel Rau received the 2015 Chao Physician-Scientist Award for her project “Defining the Role of DOT1L in DNMT3A-Mutant Leukemia.” Read more

June 23

Texas Children’s Pediatrics launches new mobile health management app

Managing health care decisions and contacting your child’s provider just got easier thanks to Texas Children’s Pediatrics’ new mobile app. The ParentAdvice Center, available for free on iTunes and Google Play, will help families make smart decisions about the level of care needed for their children and offer information about providing symptom relief for minor illnesses or injuries at home. Read more

June 23

The Association for the Advancement of Medical Instrumentation (AAMI) honors Texas Children’s Hospital alarm management team

The Association for the Advancement of Medical Instrumentation (AAMI) has given the AAMI Foundation & Institute for Technology in Health Care’s Clinical Solution Award to Texas Children’s Hospital alarm management team, which combined stakeholders from across the institution in partnership with an innovative healthcare analytics company, Medical Informatics Corp. The team used real-time data to drive decison and change conversations related to alarms to pave the way for quality improvement in the area. Read more

June 16

Dr. Peter Hotez – US Science Envoy

Dr. Peter Hotez, who heads the Sabin Vaccine Institute and Texas Children’s Center for Vaccine Development, works with several leaders in his current position, and he’s recently added leader of the free world to that list. Hotez has been appointed to the role of U.S. Science Envoy by the White House and State Department. Read more

June 16

Maddie’s Mission donates $40,000 plus to CMV awareness efforts, research

Maddie’s Mission, a Katy-based organization dedicated to educating people about a common virus that can cause a serious infection in your unborn baby, recently donated more than $40,000 to the CMV Research Fund to benefit congenital CMV research conducted at Baylor College of Medicine and Texas Children’s Hospital. Read more

June 16

Texas Children’s Urgent Care is on Facebook

Texas Children’s Urgent Care, now on Facebook, was created to respond to the growing need for expert pediatric urgent care. Read more

June 9

Formerly conjoined twin, Adeline Faith Mata, joins family after being discharged from Texas Children’s Hospital

Formerly conjoined twin Adeline Faith Mata joined her family June 9 after being discharged from Texas Children’s Hospital. Her sister, Knatalye Hope, went home in May, less than three months after she and Adeline underwent a successful separation surgery. Dressed in matching striped pastel sundresses, the girls smiled for cameras capturing the monumental moment. They, along with their family, will stay in Houston for the next month before moving back to Lubbock. Read more

June 9

Dr. Arnold serves as ambassador to grassroots advocacy

Dr. Jennifer Arnold is serving as the face of Speak Now for Kids, a grassroots advocacy effort to get patient families and health care providers promoting issues that matter to pediatric patients. Arnold explains how you can help. Read more

June 9

Texas Children’s/AAP Member in Action: Dr. Julie Katkin

Texas Children’s pediatric pulmonologist Dr. Julie Katkin has been an active, engaged member of the American Academy of Pediatrics for several years. Learn how Texas Children’s partnership with the AAP helps physicians advocate for their patients. Read more

June 9

Pediatric anesthesiologist receives honor from Baylor College of Medicine

Texas Children’s Pediatric Anesthesologist and Baylor College of Medicine Associate Professor Dr. Olutoyin Olutoye recently received the college’s Rising Star Clinician award. Read more

June 9

Texas Children’s pediatric urologists honored by Society of Pediatric Urology

Dr. Jason Au was awarded the top prize for his case presentation, “Urologic Considerations in the Seapration of Conjoint Twins.” Dr. Chester Koh was appointed to serve a three year term on the Society for Pediatric Urology Executive Council. Read more

July 14, 2015

Since Dr. Charles D. Fraser Jr. was made surgeon in chief five years ago, he has taken a morning each year to formally talk about the successes, challenges and goals of the Department of Surgery. This year’s talk happened July 10 in the packed Texas Children’s Hospital auditorium and focused on how far the department has come during the past five years.

“You are a tremendous department,” Fraser said to the group before delivering his presentation. “The work you are doing is extraordinary.”

Representing 600 employees and at least 9 different subspecialties, the Department of Surgery is dedicated to caring for and improving the health of children through patient care, education and research.

The department’s more than 80-member surgical team treats children in and around the greater Houston area via our five Health Centers and two, soon to be three, hospitals. The team also sees patients at other hospitals around the country and the globe.

Annually, Texas Children’s surgeons perform 25,000 operative cases and 115,000 clinic visits, including 90 fetal procedures and about 20 neurological laser ablations.

Fraser said his goal for the department has been and will continue to be three fold:

Deliver the best possible pediatric surgical care.
Be preeminent in pediatric surgical research.
Be the epicenter in educating tomorrow’s leaders in pediatric academic surgery.

In all areas, Fraser said, the department has improved. In terms of delivering the best possible pediatric surgical care, the Department of Surgery offers an expanded pallet of services, has fostered relationships with various other entities both inside and outside the hospital, and has created an organized effort to improve the quality of care provided at Texas Children’s Hospital.

The result of such efforts can be seen in the number of people visiting the Department of Surgery each year. The number of surgical outpatient visits last year was up 70 percent compared with 2009. That number was up 14 percent compared with 2013. The number of surgical cases, operating room hours and Texas Children’s Pediatric referrals also has gone up every year for the past five years.

“Our outcomes have garnered us a lot of attention,” Fraser said, highlighting the separation of conjoined twins Knatalye Hope and Adeline Faith Mata as well as Baby Audrina, who was born with her heart outside of her chest. “Your tireless effort to get the job done has paid off.”

As for research, the Department of Surgery still has room to grow. However, conducting pediatric surgical research has become an important part of the department’s portfolio, bringing in National Institutes of Health funding, seed grants and significant publications.

A product of the department’s dedication to such research is the Edmond T. Gonzales Jr., Surgical Research Day, which provides a forum for researchers to unveil their work highlighting remarkable advancements in the field of pediatric surgery. This year, almost 300 clinicians attended the event.

“We will continue to invest in research and we will continue to be good stewards of the money we receive,” Fraser said.

As for leading in educating tomorrow’s leaders in pediatric academic surgery, the Department of Surgery has made great strides, hosting several educational conferences, recognizing excellence and fostering achievement. In addition, Fraser said the department has created a distinct sense of community, participating in Texas Children’s events together, working collaboratively on setting priorities, and promoting and celebrating their own successes.

“We are one team and we are focused on the relentless pursuit of excellence,” he said at the end of his Friday talk. “Dream big, work hard and keep the faith.”

With the opening of the outpatient and subspecialty building at Texas Children’s Hospital The Woodlands just 15 months away, steps are being taken to ensure the transition for staff, patients and their families is seamless.

One such step was taken June 25 and 26 when staff and leaders at the Woodlands Health Center and staff and leaders at the West Campus Outpatient and Subspecialty Building met and discussed what it’s like to go from working at a small community health center to a community hospital.

The 60-member staff at the Woodlands Health Center will move into the Woodlands Outpatient and Subspecialty Building in October 2016. The building will be adjacent to Texas Children’s Hospital The Woodlands, which will open its doors in the fall of 2017. A similar situation occurred five years ago when West Campus Outpatient and Subspecialty Building started seeing patients. The nearby West Houston Health Center closed and its staff moved to the outpatient and subspecialty building.

“The staff at West Campus has been through this and has a lot of good advice to offer,” said Julie Barrett, who recently was named director of outpatient and clinical support services for Texas Children’s Hospital The Woodlands. “During the recent field trip, they alleviated a lot of our anxiety about the move and got us really excited about working in a community hospital setting.”

Some of the topics covered at the meeting included differences between a hospital setting and a health center, lessons learned from West Campus’ transition, operational challenges, and relationship with Main Campus. In addition to the panel discussion, health center staff also had the opportunity to tour West Campus.

“The overall experience was extremely beneficial to our health center employees, many of whom have never worked in a larger hospital setting,” said Diane Scardino, vice president of medical subspecialty practices and Health Centers at Texas Children’s. “They needed to see and hear what their new setting will be like from people who have been in their shoes.”

Scardino and President of Texas Children’s Hospital The Woodlands Michelle Riley-Brown will continue to work together to provide additional training that will help staff understand and navigate the differences between working at a stand-alone health center versus one that is part of a community hospital.

Once completed, the Woodlands facility will be a 560,000-square-foot complex and will offer inpatient and outpatient specialty pediatric care. Facilities will include 22 emergency center rooms, 85 outpatient rooms, five radiology rooms, four operating rooms and 32 acute-care and 12 PICU beds with future expansion plans for up to 200 beds.

Along with serving families throughout The Woodlands Area, Texas Children’s anticipates serving families in counties throughout Greater North Houston, including Montgomery, Walker, Grimes, Liberty, Harris, Polk, San Jacinto and Hardin.

In November, Riley-Brown was named president of the hospital and Dr. Charles Hankins was named chief medical officer of the institution. Riley-Brown and Hankins assumed their positions as the Woodlands leadership team in January.

“We are working hard every day to prepare for the opening of Texas Children’s Hospital the Woodlands,” Riley-Brown said. “These site visits to the West Campus were important to host for the Woodlands Health Center staff, as it allowed them to get a glimpse into the similar capabilities of the future Woodlands hospital and outpatient services.”

July 7, 2015

It’s 9 a.m. and outside the new radiology reading room a group has gathered to talk through the day’s challenges and prepare for the day ahead. Yesterday, several patients cancelled appointments due to heavy rainfall, and today there will be more appointments than expected to make up for it. With a team there to talk through the situation and challenges, the problems are quickly resolved. Dr. Lane Donnelly, associate radiologist-in-chief, asks if the right amount of staff are here to take care of this higher demand. Next, he talks about any other concerns. One MRI machine is down, which may slow down the process, but an alternative plan has been put in place to move patients through the system as seamlessly as possible.

The morning huddle operation was brought to Texas Children’s by way of Donnelly who had devised similar processes in his previous roles at other institutions.

“It improves our coordination and ability to identify and track issues,” Donnelly said. “It builds in support by bringing everyone together to resolve issues efficiently.”

The daily readiness process takes place every morning within the Radiology Department to ensure that the hospital’s imaging services are ready for patients. Present for this meeting are radiologists, radiology nurses and techs, other support services staff, such as representatives from information services and biomed, along with leaders within the department. Each day the team discusses safety, methods, equipment, supplies and work staff adequacy. This process is made to ensure that every machine and every staff member is properly equipped and ready to handle various cases throughout the day in our diverse imaging facilities throughout the hospital and our community locations.

The huddle is also a communication vehicle to share lessons-learned and best practices.

“I think the sense of our team changes because of this new process,” Donnelly said. “The informal huddle allows for better collaboration.”

The huddles are held just outside a new ballroom style reading room built to bring together radiologists who were previously spread throughout the organization at various locations on Main Campus. Radiologist-in-Chief Dr. George Bisset said this new process is just one of the many ways this new expansion and the concentration of the radiology services have helped the team and its partners.

“The greatest thing that this new area provides is teamwork,” Bisset said. “It is also a positive move for our clinicians who can now visit our large reading room, which serves as a one-stop-shop to receive all information on imaging for their patients.”

Radiologists have better access to their leaders and to each other. Fellows and residents are given access to all areas of radiology and can be educated on rare cases when they arise, even if it’s not within the area of their current rotation.

June 30, 2015

Last week, Chief Nursing Officer Mary Jo Andre met with a room full of nursing leaders at the monthly Nursing Congress meeting to outline the framework of an aggressive 100-day plan for nursing.

Andre said she and other leaders are examining all nursing feedback from the past several months to determine where to prioritize efforts to improve the overall work environment/satisfaction of the care team. She shared her vision to modify the patient care manager role to allow more time for leadership and management in support of care at the bedside. Andre encouraged ideas for cultivating staff satisfaction in support of nursing retention with a renewed commitment to a healthy work environment and a culture of transparency.

“In my 29 years at Texas Children’s, I have learned the importance of being transparent, and I want our nurses to know I take my promise seriously,” Andre said. “I also want that same assurance of transparency from all of you. I know we will have the strongest nursing team if we are able to collaborate together through open dialogue around what your needs are.”

During the meeting, she asked for feedback and followed up with a survey to all nurses and nursing leaders. Andre plans to use the survey to help prioritize areas of concern and immediate improvements needed. Once the survey closes, the feedback will be used to refine the 100-day plan, which Andre aims to share with the organization in July. Among the items on her agenda as she examines plans for the next 100 days are:

Patient care assistants (PCA): the need for additional PCA positions to support optimal patient care delivery
Patient care managers (PCM): the need to allocate more of their time to mentoring/coaching staff and leading their teams
Float pool: the need to build a float pool to reduce dependence on contract/OT utilization
Resource nurse role: the need to adjust this role and grandfather in non-BSN nurses and others that previously served in the charge nurse role
Flexible staffing: the need to build a different model that enables more nurses to work part-time/per-diem

In addition, Andre emphasized the need for all nurses to stay at Texas Children’s and help with building and implementing this plan for change. She explained that nursing turnover at Texas Children’s, while in line with the national average, presents particular challenges as the organization is trying to significantly grow the nursing workforce. Andre asked nursing leaders to take immediate action to encourage and retain nurses on their teams and said she hopes many of the changes proposed in the 100-day plan will improve nursing satisfaction and retention as well as ensure continued excellence in quality and outcomes.

“I wholeheartedly believe our nurses are at the heart of our organization and our mission, and I strongly support the improvements we will begin making in the next 100 days and beyond,” said John Nickens, executive vice president over nursing. “We have tremendous support from leaders across the organization, and I know it will take every one of you to help our nursing team be the best it can be.”

All staff nurses are asked to complete this short survey by Friday, July 3 to help Andre and her leadership team as they strategize and set a framework for next steps.

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