January 6, 2015

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Historically, it has been difficult to schedule surgery from Texas Children’s Hospital locations outside Main Campus. A pilot project launched a few months ago in the Division of Otolaryngology has overcome this challenge and made scheduling surgery from remote locations easier.

Surgeons now can insert an order into Epic at the time of a patient visit. Previously, when otolaryngologists traveled to see patients, they faxed or transported paper forms to Main Campus or called to schedule surgery.

“Those methods of scheduling surgery from offsite locations were less efficient and rife with opportunities for missed communications,” said Dr. Carla Giannoni, the Texas Children’s otolaryngologist who spearheaded the project.

Now, surgeons can use Epic to immediately submit an order for surgery.

“When I am at a satellite office, I am able to request the exact procedure I want, including special details, without depending on a faxed piece of paper to get to my scheduler at Main Campus,” Giannoni said. “The need to communicate about an upcoming surgery is resolved instead of having to be logged, tracked, and communicated back at a later date and time.”

In addition, the project provides for more secure patient information and increases HIPAA compliance.

“The potential to lose patient information has been eliminated with this new process,” she said. “The program has worked very well for me.”

Plans to roll out this program to other Department of Surgery divisions are underway. Surgical Services Director Trent Johnson said it will likely start early this year in the Division of Ophthalmology.

December 16, 2014

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Six hundred and fifty inpatient beds make up the Texas Children’s Hospital system. On any given day, hundreds of patients come through the hospital doors at Main Campus and West Campus. Whether they walk through our doors on their own, or are transferred from another hospital, these patients require the care of Texas Children’s Hospital specialists.

“Census is patient activity and patient volume across the system,” said Texas Children’s Hospital West Campus President Michelle Riley-Brown. “A high census is an indication that our patient volume is exceeding our capacity to care for patients.”

Reaching that capacity means there are no rooms left to admit new patients. In November, 101 patients had to be turned away. The patients were denied a transfer from another institution because Texas Children’s Hospital was above census.

“We have to always remember that when people come to us, they are bringing their children who are ill for care,” said Surgeon-in-Chief Dr. Charles D. Fraser, Jr. “We have to put ourselves in their position, and respond.”

During the past several months, Texas Children’s Hospital has experienced numerous high census days and on many occasions, the patient volume has exceeded the number of available beds.

“Teams across both campuses are on daily conference calls managing patient flow, management, and so on. Making sure patients get to the right place at the right time,” Riley-Brown said. “It’s managing patients, it’s patient flow, it’s room facilitation, room management and bed control.”

While cold and flu season brings its own challenges to the hospital census, a high census has begun to be the norm for Texas Children’s Hospital. While a high census stresses the system, it’s an opportunity for the staff to show support for one another.

“It is especially important now to work as a team and to make sure we are helping each other,” Riley-Brown said. “It’s always important that everyone is taking care of themselves and of each other to make sure we can do our best to take care of the patients.”

“This is the norm for us now as an organization and we should embrace it and be extremely proud of it,” Fraser said. “It’s unbelievable what we get to do. It’s an unbelievable opportunity, it’s an unbelievable responsibility. These folks have entrusted their children to us. We should feel blessed because of that.”

In response to the increasing number of children seeking our care, the organization has already begun plans to expand capacity at Main Campus through CareFirst and the building of a new hospital in The Woodlands to provide care for many patients in their own community. For more on those initiatives, read here.

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What do Community Coffee, Microsoft and Stryker have in common? All three strategic business partners – and several others – helped us save about $25 million in operational costs.

Delivering on the Vision (DOTV) Non-Labor Initiative was more than just a cost-savings expedition. It prompted us to think like a system and ask ourselves, “What can we do differently to maximize efficiency across the organization?”

In July 2012, Texas Children’s launched DOTV and partnered with Huron Healthcare consultants to identify cost savings opportunities across the organization. They examined several non-labor areas including billing and collection processes, vendor contracting, physician services and clinical care coordination. Fifty-eight initiatives were identified, which yielded $18 million in potential savings and revenue opportunities.

During the second phase – which began in September 2013 – Texas Children’s implemented Huron’s cost-saving strategies systemwide. But, our efforts didn’t stop there. Three non-labor solution teams – administrative support, clinical coordination, and hospital-based services – were tasked with identifying more opportunities to grow our hospital’s savings strategically year-over-year.

“We engaged our employees at every level of the organization to pitch their cost-savings ideas,” said Texas Children’s Revenue Cycle Director Carrie Rys, who was the co-leader of the Administrative Support Solutions Team. “Our three teams generated $5 million in potential savings.”

The DOTV Initiative uncovered 91 cost-savings ideas amounting to potentially $25 million.

“We negotiated and leveraged our vendor relationships to maximize the full value of every contract,” said Texas Children’s Vice President Diane Scardino, who co-led the DOTV Non-Labor Solutions Team. “When we asked the right questions, we discovered bigger savings and revenue opportunities.”

“One of our pathology frontline managers picked up on a workflow that had left out the billing on a pathology test that had existed for years,” said Texas Children’s Pathology Director Ann O’Connell. “After updating the workflow, more than $1 million in annual gross patient revenue is now generated.”

Other impressive ways we Delivered on the Vision include:

  • Microsoft License Optimization: We assigned shared clinical workstations a device license instead of a per user license (as we have more clinical users – physicians, nurses, clinicians – than devices), which saved the hospital $857,000. Also, we were able to negotiate lower costs for our annual support benefits equal to $100,000 in savings.
  • 340B Drug Purchasing: When we purchased medications at the 340B discounted price for our Medicaid patients, we saved $10.3 million for Texas Children’s Main and West Campus in FY14.
  • Surgery: We restructured our Stryker contract so that anytime a new product/service line was added, all previous lines received a savings percentage to ensure we were duly compensated each time their business increased. Additionally, implants around spine surgeries were negotiated with three vendors to meet the physician preference needs of spine surgeons across two service lines – Orthopedics and Neuroscience. We used a benchmark tool and leveraged the support of our surgeons to negotiate more than $1 million in annualized savings.
  • X-ray services: When we purchased five digital X-ray machines in bulk this year, we saved more than $200,000. We leveraged the buying power of a system by aggregating our purchases to drive price concessions from two vendor partners.
  • Community Coffee: Being alert of contract errors helped us trim our expenses. When an administrative employee asked why it was more expensive to buy Sweet N’ Low at the contracted price versus buying it in bulk at the store, our Supply Chain team found Community Coffee had not adjusted its rates appropriately, which resulted in a $58,000 rebate check.
  • Pest Control: We saved $6,727 by streamlining the hospital’s pest control services to one vendor at a reduced cost, which made the process of ordering and tracking supplies easier and more efficient.

“We have a lot of negotiation power that we don’t always use,” said Chanda Cashen Chacón, vice president of Women’s Services at Texas Children’s Pavilion for Women. “When we think like a system, we achieve better and bigger results.”

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No parent ever wants to hear their child will need to have surgery – whether it’s a routine procedure that only takes minutes or it’s something more serious. That’s why the Department of Surgery goes out of its way to make the surgical experience at Texas Children’s a good one for patients as well as their families.

The department’s most recent effort to ensure a positive surgical experience is had by all is a video for parents that talks about what to expect when their child has surgery at Texas Children’s. The video, available in English and Spanish, covers eating and drinking instructions, what to bring to the hospital and what parents will experience while their child is in surgery.

After doing more than 25,000 surgical procedures each year, we know parents need to be prepped for surgery just as much as their children do. We hope this video helps parents who are going through that process.

“Our goal in the Department of Surgery is to have our patients and their families prepared as well as possible for the surgical experience,” Chief of Plastic Surgery Dr. Larry Hollier said. “Setting appropriate expectations is crucial to patient satisfaction. This surgical video covers all important issues pertinent to the patient’s arrival, registration, surgery, and discharge.”

Other efforts the Department of Surgery has made to enhance the surgical experience for patients and families at Texas Children’s include:

  • Pre-surgery paperwork have been streamlined to lessen parent’s preparation load before they bring their child in for surgery.
  • A greeter program has been implemented to help patients and their families more easily find our surgical admission areas. Greeters wearing blue vests are positioned at various entrances of the West Tower, the Abercrombie Building and the Clinical Care Center to help guide surgical patients to such locations.
  • Colorful, kid-friendly animal signage has been posted inside and outside the elevators, lobby, hallways and connecting bridges at the Clinical Care Center and the West Tower to improve navigation to the surgical suites at those locations.

All of these efforts have been based on feedback from parents, something the Department of Surgery is always eager to hear. While taking care of our patients is our top priority, we like to take care of their parents too.

December 9, 2014

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Texas Children’s announced on December 4 our plan to build an eight-bed special isolation unit at Texas Children’s Hospital West Campus. This unit will be designed for children with highly contagious infectious diseases, such as pandemic influenza, enterovirus D68, Ebola, and many others. Additionally, we announced the state’s designation of our organization as a pediatric Ebola treatment center.

About the isolation unit

This new isolation unit at Texas Children’s will be similar to the four other biocontainment units in the country. Such units are equipped and staffed to care for patients with contagious infectious diseases.

“We will build a state-of-the-art isolation unit designed and staffed to provide the highest quality care and treatment for infants and children with serious or life-threatening infectious diseases of public health significance, always with the greatest possible margin of safety,” said Texas Children’s Physician-in-Chief Dr. Mark W. Kline. “We believe this will be an indispensable resource to our local community, Texas and the nation.”

This new unit will incorporate all of the latest scientific and technological approaches to biocontainment, including negative air pressure, laminar air flow, high-efficiency particulate air (HEPA) filtration, separate ventilation, anterooms, biosafety cabinets, a point-of-care laboratory, special security access, autoclaves and incinerators. There will be two levels of protection from airborne particles, as well as a comprehensive waste management plan, among other safety features.

It will be fully equipped to care for any infant or child with a serious communicable disease, with all of the measures available to assure safety of the health care team, other patients and their families. A point-of-care biosafety level 3 laboratory will enable the care team to monitor the progress of patients and perform rapid detection methods to identify unusual pathogens. Housed at Texas Children’s Hospital West Campus, the unit is anticipated to have capacity for eight patients, all in private rooms.

This specialized unit will be led by Dr. Gordon Schutze, who will serve as medical director, as well as Dr. Judith Campbell and Dr. Amy Arrington, who will be the unit’s associate medical directors. It will be staffed by an elite team of experienced critical care and infectious disease nurses and physicians, all of whom will have successfully completed an intensive advanced certification course and practicum in infection control, hospital epidemiology and management of infectious diseases in the critical care setting. The staff will maintain their certification through participation in ongoing educational activities.

Kline said Texas Children’s is working with the Centers for Disease Control and Prevention to design, build, equip and staff the unit, which is expected to be operational within nine months and cost approximately $16 million to build.

“I could not be more impressed with Texas Children’s desire to run towards issues of critical importance to the health and well-being of the children of Texas and our nation,” said Dr. Brett Giroir, director of the Texas Task Force on Infectious Disease Preparedness and Response and chief executive officer of the Texas A&M Health Science Center.

Caring for potential Ebola patients

Since the summer, Texas Children’s has been implementing a detailed plan to identify, isolate and treat suspected cases of Ebola, if necessary. As a result, following a visit from the CDC, the State of Texas designated Texas Children’s as a pediatric Ebola treatment center.

As part of the hospital’s preparation, specific protocols were developed outlining steps staff would take if and when a patient with Ebola symptoms arrived at a Texas Children’s facility. Additionally, in order to decrease the risk of exposure and provide the complex care required, the hospital identified specific areas and units responsible for caring for any patient with Ebola. The health care workers in those areas have received intense, ongoing training and simulation to help them prepare.

“This unit is part of the hospital’s long-term vision to care for children with the most serious and complex medical conditions,” said Michelle Riley-Brown, president of Texas Children’s Hospital West Campus. “Our leadership’s decision to build this new isolation unit at West Campus speaks volumes about our staff and employees’ skill, expertise and experience here. Our agility and responsiveness were tested just a few months ago when we had a patient with suspected Ebola under investigation. Our handling of that case demonstrated our competency here at West Campus, and it boosted the entire organization’s confidence in the readiness across the system.”

West Campus staff and employess helped lead the way for the organization to refine our protocols for care, and now Texas Children’s will lead the way for centers across the country. If you have questions about the unit or an interest in being trained to be part of the care team that will staff this unit, please contact your leader for more information.

Return to Ebola Response site.

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Dr. Simon Kayyal, an assistant professor of Pediatrics and Neurology at Baylor College of Medicine, recently joined Texas Children’s neurology team. He will develop and co-lead the Neuro-Neonatal Intensive Care Unit (Neuro-NICU) with Texas Children’s Neonatologist Dr. Jeffrey Kaiser, a professor of pediatrics, obstetrics and gynecology at Baylor College of Medicine.

Kayyal received his medical degree from the University of Texas Medical School at Houston before completing his residency in pediatrics and child neurology at UT Southwestern Children’s Hospital of Dallas.

During his postdoctoral training, Kayyal observed many children and adolescent patients with irreversible brain injuries, which immediately sparked his interest in neonatal neurology. Kayyal thought, “The earlier we diagnose and treat neurologic disease, the better chance we have for improving the developmental and overall outcome of our premature and critically ill infants.”

This common goal fueled Kayyal’s passion to collaborate with neonatologists to develop Texas Children’s Neuro-NICU program. “Our goal is to help babies born with severe neurologic issues be able to enjoy life without impairments,” said Kayyal, who will also create a protocol to determine where newborns will follow-up once they have been discharged from the Neuro-NICU.

Just like a cardiovascular NICU houses newborns with heart disease, infants with neurologic disease would be treated in the Neuro-NICU where they would receive multidisciplinary care from specialists in neonatology, neurology, neurosurgery, developmental medicine and neuroradiology. The plan is to also include an MRI machine in the Neuro-NICU that would eliminate the need to transport unstable infants to other parts of the hospital.

“We want to minimize families’ anxieties during this critical time,” said Kayyal. “When they see neurologists, neonatologists, and neurosurgeons working in unison to determine the best treatment plan for their child, they know their infant is receiving the best care possible to improve their outcomes.”

The Neuro-NICU service will eventually include Texas Children’s other neurology services, like the hypothermia program led by Dr. Kaiser. The hypothermia program provides whole body cooling treatment for newborns who are oxygen deprived at birth, reducing their potential risk for severe neurologic damage.

“Dr. Kayyal is bringing an exciting vision to the neurology team with plans to better serve our patients and their families,” said Dr. Gary Clark, chief of Neurology and Developmental Neuroscience at Texas Children’s. “We are pleased to have him join our team to bring more capabilities and expertise to our division.”

In addition to this new role, Kayyal lectures medical students rotating through the neurology clerkship to help them prepare for the neurology shelf exams. He also provides specialized lectures to residents and fellows to prep them for the board exams and get better acquainted with the hospital and outpatient settings.

“I am excited to pursue my passion at Texas Children’s and work alongside some of the best physicians in our specialty,” said Kayyal. “Returning home to Houston is an added plus.”

December 2, 2014

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Texas Children’s cares for some of the country’s most critically ill patients, and safe, quality care for every patient is the most important responsibility of each staff member and employee here. Equipping our staff and employees with the knowledge and tools to take preventive action is key to creating an environment of safe patient care.

In an effort to illuminate the importance of everyone’s role, each month we will share patient safety stories that help heighten staff and employee alertness and accountability and, ultimately, reduce harm. This month’s story is a reminder that being familiar with your surroundings and knowing what to do in an urgent situation can help improve the outcome.

Jason* was a relatively healthy 9-year-old boy when he was admitted for a routine operation. After the procedure, he went to the PACU for recovery. There, a PACU nurse noted Jason’s ECG monitor tracing looked unusual. An electrocardiogram (EKG or ECG) is a test that checks for problems with the electrical activity of the heart and then translates the heart’s electrical activity into line tracings on paper.

The nurse asked the anesthesiologist to review Jason’s ECG tracing, and shortly afterward, Cardiology was called. Jason was evaluated and diagnosed with Wolff-Parkinson-White (WPW) syndrome, a rare heart condition that causes rapid heartbeat and has been associated with sudden death.

The nurse’s attentiveness made the diagnosis of WPW possible. Jason had a corrective procedure this summer. The subsequent evaluation and the procedure will help ensure that he does well with this diagnosis and has the best possible outcome.

Actions everyone can take:

  1. Ask a question. If something doesn’t look quite right – whether it’s an issue with a patient, coworker or a process – question it.
  2. Request a change. Identify the person who can help you change the situation, and bring the matter to their attention.
  3. Voice a concern. Don’t dismiss your intuition or assume someone else will notice the problem. Your voice might be the life-changing difference for a patient.
  4. Go up the chain of command. Always know that you can go up the chain of command if necessary to bring the matter to someone else’s attention.

* Patient safety stories are based on events at Texas Children’s Hospital. Patient names and some of the circumstances of the event may have been changed to protect patient privacy.

For the latest quality and safety information, visit the Patient Safety website on Connect.