March 17, 2015

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Dr. Patricio Gargollo, director of the Program for Complex Urogenital Reconstruction, was recently named associate medical director for pediatric surgery of the Simulation Center.

Gargollo’s role in the new position will be to collaborate with the Simulation Center’s medical director, Dr. Jennifer Arnold, to create an expansion of medical simulation education into the areas of pre-, peri- and post-operative care.

“In essence, we want to expand our center to include surgical simulation training,” Gargollo said. “This will include procedural training for residents, fellows, nurses and advanced practice providers. It will also allow us to use the hospital’s international reputation to reach out to an international surgical audience through telemedicine and live simulation courses.”

Lastly, Gargollo said “my hope is to replicate complex surgical cases through simulation in order to prepare surgeons and other providers who may not have the exposure to the type of difficult cases we encounter here at Texas Children’s Hospital.”

“I am very excited about working with Dr. Gargollo and about this new opportunity for the Simulation Center, our staff and our patients,” Arnold said. “It is vital that we identify leaders and champions in surgery in order to expand the educational and patient safety benefits of health care simulation to our perioperative providers and patients.”

The Pediatric Simulation Center at Texas Children’s Hospital is a multidisciplinary, hospital-based center providing hands-on pediatric and obstetric simulation training in a realistic environment to improve patient safety and patient care. In addition to the physical space, the hospital supports the center by allocating full-time personnel including a medical director, assistant director, lead physician, training specialist, systems specialist and now a surgical director.

The hospital’s dedication to the center stems from the fact that 70 percent of mistakes in medicine are due to human error, not lack of medical knowledge. The Simulation Center trains pediatric health care professionals to react and respond to high-risk pediatric and obstetric scenarios in a life-like simulated environment so that risk to patients is substantially lowered in real life situations.

Simulation is a guided technique that recreates a clinical environment and gives health care professionals exposure to high-risk scenarios without putting actual patients at risk. The simulation training experience includes:

  • Simulation exercises on high-fidelity mannequins that mimic real emergencies to facilitate team communication skills and real-time responses
  • Review of video-recorded simulation
  • Debriefing of learners to review and discuss simulation experience

Gargollo recently participated in the Mata conjoined twin separation simulation. During the simulation he, several other surgeons and operating room staff practiced several aspects the surgery, which ended up lasting just over 24 hours.

“Each and every simulation I’ve participated in has helped me prepare for whatever procedure I was about to perform,” Gargollo said. “The experience is truly invaluable and most definitely contributes to the quality of patient care we offer here at Texas Children’s Hospital.”

Gargollo was recruited to Texas Children’s Hospital to be the director of the Program for Complex Urogenital Reconstruction, which specializes in the care of patients with bladder and cloacal exstrophy, cloaca and neurogenic bladder. He also is the co-director of the Urology Robotic and Minimally Invasive Surgery Program. After earning his medical degree at Harvard Medical School, Gargollo completed a residency in general surgery followed by one in urology at Massachusetts General Hospital. He also did a fellowship at Children’s Hospital Boston.

March 10, 2015

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The Department of Surgery’s Physician Assistant Fellowship Program recently graduated its inaugural class of four fellows and welcomed its second class of six fellows in what the Association of Postgraduate Physician Assistant Programs has called an “innovative fellowship program.”

The only program of its kind in the United States for pediatric surgical services, the fellowship is a 12-month didactic and clinical program designed to extensively train physician assistants in all areas of pediatric surgery. After completing nine rotations in various surgical areas and one month in research, the fellows select two electives for which they want to receive additional training.

The inaugural class of four physician assistants – Lesley Davies, Jackie Guarino, Caitlin Justus, and Cassie Mueller – accepted positions at Texas Children’s Hospital. Davies is with Plastic Surgery and Guarino is with Urology. Mueller works in Trauma and Justus works with the surgical hospitalists at West Campus.

The Department of Surgery received 55 applications for the 2015 term, with 27 of those from outside Texas. Six fellows were chosen. They and their home states are: Chelsea Hartwig (Illinois), Brittney Knudson (Montana), Sara Mullinax (Georgia), Thian Nguyen (Texas), Abby Young (South Carolina) and Kelly Wiseman (Ohio).

“The Department of Surgery at Texas Children’s Hospital has taken a leadership role nationally in physician assistant fellowships, and we have received inquiries from other hospitals that want to establish programs and model their programs after ours,” said Dr. Larry Hollier, chief of Plastic Surgery and medical director of the Physician Assistant Fellowship Program.

Additional leaders of the fellowship program are: Ryan Krasnosky, director of the program; Kristen Daniels, academic director; and Jordan McAndrews, fellowship coordinator.

Applications for the 2016 fellowship program are now open. Candidates can apply online at Texas Children’s Hospital’s employment page.

To hear from members of the first Physician Assistant Fellowship Program class, read the following Texas Children’s blog posts:

March 3, 2015

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Texas Children’s Hospital began with a promise more than six decades ago. It was a promise to the community that we would be here to take care of their children – all of them, regardless of ability to pay – for many years to come. Today that promise is even stronger and more evident and has broadened to include the women who now come to us for care.

It stands to reason that Texas Children’s next chapter would be ushered in with a bold capital campaign that will help ensure we can respond to the growing need for care. Texas Children’s has launched Promise, a $475 million comprehensive campaign.

“We are so excited about the Promise campaign,” said Laura Shuford, vice president of Development. “Supporting a fundraising effort that has a goal of providing the best possible care to even more children is a cause that speaks to the heart and one that so many people can relate to.”

The Promise campaign focuses on five key initiatives:

  • CareFirst, for the expansion of our Critical Care services, ORs/PACU and Emergency Center at the Main Camp
  • Texas Children’s Hospital The Woodlands, our new 548,000-square-foot dedicated pediatric hospital serving the growing communities north of Houston
  • Endowed Chairs, which are a powerful tool in recruiting and retaining world-class physicians and scientists
  • Divisions and Centers of Excellence to provide ongoing support for specialty care programs and projects
  • Charity Care and hospital priorities, to help alleviate the financial burdens families take on with complex medical care and to provide flexible funds to address the hospital’s most pressing needs at any given time

Of the $475 million campaign total, $350 million of the funds raised will support the CareFirst expansion and renovation projects, scheduled for completion in 2020, and The Woodlands campus, currently under construction and scheduled for completion in 2017. These two initiatives are the hospital’s top priorities.

“This is one of the biggest challenges Texas Children’s has ever faced,” said Texas Children’s President and CEO Mark A. Wallace. “But I know we can meet the challenge head on and keep the promise we made so many years ago – and the promise we make every single day – to serve all the children and families who come to us for help.”

How you can help
You can help us spread the word about the Promise campaign and the impact it will make right here in Houston and beyond. Visit texaschildrens.org/promise and share the page with family and friends who may be interested in supporting our efforts.

February 24, 2015

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Many of you read the announcement about our CareFirst plans in November, and just a few weeks ago, you began seeing the CareFirst window clings and banners around the Main Campus. The CareFirst initiative will drive our reinvestment in the programs our most critically ill patients need – primarily in the Critical Care units, operating rooms, Heart Center, Emergency Center and many of our Diagnostic and Therapeutic Services.

We recently spoke with a mother whose child spent three months in our pediatric intensive care unit. The mother, along with President and CEO Mark A. Wallace and some of our leaders who are driving the capital project, explain what CareFirst will really mean to our patients, their families and our staff and employees.

Below are some key facts and figures about the CareFirst project.

19 floor expansion to create Pediatric Tower E, which will include:

  • 129 critical care beds
  • 7 additional high-technology ORs
  • 1 new radiology suite
  • Completed in 2018

West Tower renovation to include:

  • 57-bed emergency center with 12-bed short-stay unit
  • Completed in 2020

640,000 square feet of new space will be added overall.

$575M is the total cost of the project.

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Texas Children’s Mobile Clinics are now equipped with EPIC, allowing medical staff to offer a more thorough continuum of care.

“We aim to find medical homes for all our families,” said Dr. Sanghamitra Misra, medical director of the Texas Children’s Mobile Clinic Program. “Now that we are entering our clinic notes into EPIC, any practitioner within the Texas Children’s system can read our notes to understand a patient’s history and diagnoses. This provides continuity of care that we have never had before.”

As a result, follow-up care, even if it takes place in the emergency room, can be more coordinated. With a simple keyboard stroke, medical staff organization-wide can access information about patients treated at the mobile clinics. In turn, staff at the mobile clinics can track their patients’ follow-up care.

“We often care for children on the mobile clinics who suffer from chronic illnesses and need follow-up care,” Misra said. “With Epic, we can more easily get them into a medical home and, if needed, a referral to a Texas Children’s specialist.

Texas Children’s Pediatric President Kay Tittle said the move to putting the mobile clinics on EPIC is a positive one that will provide better documentation of the patients seen through the Mobile Clinic Program.

“Our patients will benefit from it and so will our medical staff,” Tittle said. “It’s a win-win for everyone involved.”

The Texas Children’s Mobile Clinic Program is composed of two clinics: The Superkids Mobile Clinic and the Ronald McDonald Care Mobile. The mission of the program is to provide underserved children in the Houston area with comprehensive health care and preventive education.

During the school year, the Super Kids Mobile Clinic travels primarily to Houston Independent School District schools, community centers and churches in the Southwest Gulfton area. The Ronald McDonald Care Mobile travels primarily to HISD schools, community centers and churches in the Southeast Hobby area.

The clinic provides free vaccinations to those who qualify for the Texas Vaccines for Children program and also provides free well child visits, sick visits and hearing or vision screenings for uninsured children in the Houston area. In addition, both mobile clinics have pharmacies that are stocked with common medications. The providers can perform common laboratory tests. Lastly, providers and staff members educate all patients coming through the clinic about the different insurance options available to them.

In the summer, the clinics travel throughout the Houston area and sometimes even further to provide free vaccines to children before the school year starts.

February 17, 2015

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Quality is key, but convenience also plays a big part in the decision-making process when parents are looking for subspecialty and therapy services. That’s why Texas Children’s works hard to make such services convenient to families throughout the greater Houston area.

The organization’s most recent efforts focus on Kingwood, where Texas Children’s Specialty Care at Kingwood Glen opened January 5, and Texas Children’s Hospital Outpatient Therapy at Kingwood Glen and Texas Children’s Hospital Sports Medicine Therapy at Kingwood Glen opened in October.

Texas Children’s Specialty Care at Kingwood Glen offers medical services in cardiology, pediatric surgery, plastic surgery and pulmonary medicine. The specialty center also offers diagnostic services in cardiac echosonography, EKG/Holter/Event Monitors, pulmonary function testing, X-ray and ultrasound. Orthopedics, urology and point-of-care testing will be offered in the late spring or early summer.

Staffed by pediatric specialists from Texas Children’s Hospital and Baylor College of Medicine, the 4,874-square-foot facility at the corner of Farm to Market Road 1960 and West Lake Houston Parkway in Humble has six exam rooms, an X-ray room, a casting room and a lab. The Specialty Care Center at Kingwood Glen joins four existing Health Centers in the greater Houston area. Those centers are strategically located in Clear Lake, Cy-Fair, Sugar Land and The Woodlands. Texas Children’s Hospital West Campus Outpatient Services also offers outpatient specialty services.

“The hospital is excited to have dedicated, physical space for pediatric specialty services in the northeast area of greater Houston,” said Diane Scardino, vice president of medical subspecialty practices and the Health Centers at Texas Children’s. “By providing a community-based location, it is our hope that children and families will have better access to the nationally recognized Texas Children’s Hospital subspecialty network.”

Texas Children’s Hospital Outpatient Therapy at Kingwood Glen and the Texas Children’s Hospital Sports Medicine Therapy at Kingwood Glen occupy a 12,666- square-foot space in the same strip mall as the specialty care center. Therapy services offered at the locations include physical, occupational and speech therapy as well as orthopedic and sports medicine therapy. Women’s health therapy services will soon be offered at the sports medicine location.

Staff at the therapy and specialty care locations work together to provide the most comprehensive care to Texas Children’s patients and join a network of community-based initiatives that serve the greater Houston area.

“We are thrilled to also bring dedicated therapy services to the community,” said Tabitha Rice, senior vice president for clinical support services. “Many of our patients require therapy multiple times per week, so having access to these services so close to home makes a significant difference for the families we serve.”

Jamie and Jeremy Platt use Texas Children’s network of subspecialty and therapy services often and are grateful they exist.

The couple takes their 2-year-old son, Logan, to Texas Children’s Health Center in Cy-Fair twice a week for physical therapy and once a week for speech, language, feeding and occupational therapy. They also visit the health center regularly for either an X-ray, a consult or a follow-up. Most recently, they came for an ultrasound.

“It is such a relief to be so close and have a health center right around the corner from our house,” Jamie Platt said. “There have been times where I’ve forgotten either medical equipment or a device or something that I need to bring in for Logan and I’ve been halfway there. I have time to turn around, go back home and get it, and come and still make our appointment right on time.”

In addition to convenience, Jeremy Platt said the health center offers superb care and that the staff at the center has helped Logan do things he and his wife never thought he could do, such as walk, talk and eat on his own.

“He loves doing what he’s doing here,” Jeremy said. “It’s like a kid getting to go to school.”

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Around 100 BC acupuncture simulation was used and recorded in China. The long history of simulation has helped health care workers learn difficult procedures and manage high risk or complex patient care situations before they’re done on actual patients. It’s a sort of “practice” for real life situations in the clinical world. In 1910 life-like simulators were created. While Texas Children’s has been practicing simulations for many years, five years ago, under the leadership of Dr. Jennifer Arnold, neonatologist and medical director of Texas Children’s Simulation Center, the simulation center was created. It is a dedicated space in the Feigin Center which gives caregivers a safe space to practice life-like situations with simulators which react just as humans would.

In November, simulation experts from the Center for Medical Simulation (CMS) at Massachusetts General Hospital and Harvard Medical School held a four-day course, the Institute for Medical Simulation (IMS) course, for health care providers interested in or already leading simulation efforts across Texas Children’s. The course is one of the most comprehensive and immersive simulation training programs available and focuses on how to implement best practice simulation for improving quality, patient safety, and education. Four days of theory, practice, and reflective feedback create a truly experiential education where our simulationists develop a strong and comprehensive understanding of how to most effectively use simulation within their departments and educational programs.

“The goal of bringing the IMS course to Texas Children’s is to transform our simulationists to be outstanding simulation educators,” Arnold said.

“This course is a chance to have top experts in the field teach us about debriefing after a simulation exercise,” said Cara Doughty, Emergency Center physician.

Debriefing during or after simulation is singularly the most critical aspect to a successful simulation activity. It is where the learning occurs. Debriefing involves a discussion led by a trained expert reviewing what went right, how each person performed, what should have been done differently and how this situation could be improved in the case of a real-life scenario. It also is the most challenging aspect of implementing simulation, typically debriefing techniques are not instinctive to most healthcare providers and require rigorous practice.

Simulations can take place both at the Simulation Center and in real patient care settings like the operating rooms. Bonnie Eaton, a nurse in the operating rooms, has seen a great benefit with being involved in these courses as well as encouraging more simulations for operating room staff.

“It’s reassuring to the staff to have the ability to practice these scenarios before they are experiencing them with real patients,” said Eaton. “In the ORs, we are trying to develop a program to get all of the staff involved in simulations.”

Arnold has been a major advocate of bringing more simulation training activities to all areas of the hospital. Currently, simulations are done with clinicians from almost every area of the hospital and simulation scenarios have helped the staff prepare for major surgeries like the Mata conjoined twins separation surgery, and even for the possibility of a patient with Ebola visiting the hospital. Simulations play a key role in preparing the staff for these rare cases and helping determine the best course of action.

The simulation experts from CMS come from diverse backgrounds, but all have simulation educational expertise in common. Dan Raemer, PhD, has a background in bioengineering and is an expert in teamwork and crisis resource management. Walter Eppich, MD, Med, is a pediatric emergency medicine physician and is an expert in debriefing and faculty development. Kate Morse, PhD, MSN, RN, is a critical care advanced practice nurse and an expert in interprofessional education.

“Having Drs. Raemer, Eppich, and Morse here really re-energized the overall simulation program at Texas Children’s Hospital,” said Kelly Wallin, assistant director of Texas Children’s Simulation Center. “It is vital that we continue to develop and support a strong expert team of simulationists across the institution so we can implement simulation activities in all patient care areas.”

Not only did the visiting faculty lead a 4 day course for 20 simulationists here at Texas Children’s Hospital, but Dr. Raemer gave two innovative grand round presentations, one to pediatric surgery and the other to pediatrics. Simulation is becoming a more recognized and even standardized quality and safety tool across the nation and even internationally.

“We need to support and develop simulation activities not only to be a leader in quality, safety and education, but also to better serve our patients,” Arnold said. “The simulation center resides within the Quality and Safety Department at Texas Children’s Hospital because we recognize the value of it to patient care outcomes and safety.”