July 22, 2014

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“Please don’t hurt me. Heal me, and be nice to me.”

In that order, those are our patients’ most basic needs. Preventing errors and not harming patients are the most important responsibilities of every Texas Children’s employee.

Organization-wide Error Prevention Training launched last week to help ensure every one of us is equipped with the information and tools to keep patients safe.

This video explains why preventing errors is so critical and how each of us can make care safer at Texas Children’s.

“We take care of the sickest of the sick at Texas Children’s, and when you’re taking care of that many severely ill children, it’s a real challenge,” said President and CEO Mark A. Wallace. “Everyone recognizes that creating a safe environment – focusing on safety and error omission – is job one. Doing no harm to our patients is first and foremost.”

The Error Prevention work launched as part of the CareFirst initiative, began in January. CareFirst is primarily two things: an intense study of our core clinical areas at the main campus and an aggressive, strategic plan for how we will address our most crucial needs in those areas. The initiative is focused on the main campus Emergency Center, Critical Care units, and the Operating Rooms/PACU, because these areas provide the highly complex services that our most critically ill patients need. While CareFirst centers around expanding to better accommodate the critical needs of these high patient volume areas, its purpose is greater.

“If we don’t have the right environment, the right tools, the right people or the right structure, then it becomes very challenging to deliver the very best possible care – the safest care,” said Surgeon-in-Chief Dr. Charles D. Fraser. “Systems under duress – whether it be in the operating room or the emergency room or the intensive care unit – where there’s duress, then people become fatigued or distracted, and that’s an environment that is ripe for an error.”

The staff and employees involved in CareFirst work are vetting options to create the physical space and support needed in the core patient care areas. Combined with the Error Prevention training that kicked off last week, CareFirst ultimately will advance our efforts to ensure an optimal environment to receive and give the safest possible care.

“CareFirst is about making a promise to every child and woman who comes here that we will not harm them and equipping our facilities to ensure we keep that promise,” Wallace said. “It is far more comprehensive and much more important than expanding and building. It’s about doing what’s right for our employees and medical staff, and most importantly, what’s right for our patients, their families and their care. Ultimately, it’s about putting the care and safety of all of our patients and our people first.”

Error prevention training began in Hematology/Oncology in mid-July and will continue throughout other clinical areas over the next several months. In addition, online training will be provided for all non-clinical employees. Ultimately, every staff member and employee within Texas Children’s will receive error prevention training.

“My wish, my hope for every one of the 10,000 employees that will be going through training, that will hear about CareFirst, is that they stop and think about their individual role in supporting and delivering on zero harm,” said Chief Nursing Officer Lori Armstrong. “Everyone plays a role.”

July 15, 2014

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Texas Children’s Fetal Center staff has taken a closer look at fetal imaging, conducting three separate studies which evaluate the effectiveness and importance of diagnostic tools such as Fetal MRIs for identifying and treating CDH (congenital diaphragmatic hernia), EA (esophageal atresia) and MBA (mainstream bronchial atresia). The three studies were published in the Journal of Pediatric Surgery and confirm the significance of high quality imaging in the perinatal management of different congenital anomalies.

“These three studies show the importance of a correct and precise prenatal diagnosis using high technology and a multidisciplinary team of experts,” said Dr. Rodrigo Ruano, co-director of Texas Children’s Fetal Center and one of the authors on all three studies. “It is incredible that using fetal MRI, it is possible not only to determine if the fetus will survive or die, will need ECMO or not, but also if the fetus will have pulmonary morbidity and respiratory complications related to the congenital diaphragmatic hernia after birth in the NICU.”

In addition to identifying benefits of prenatal imaging, Ruano explains that a multidisciplinary approach – like the one that is used at Texas Children’s Fetal Center – also was shown to have significant benefits. For example, with the combination between excellent quality of prenatal imaging (ultrasound and MRI) and multidisciplinary expertise, one study showed that it was possible to identify prenatally the esophageal atresia in more than 80 percent of cases.

“We have fantastic opportunities to improve capabilities with the help of our imaging colleagues and following that all the way to the NICU and long term outcomes,” said Dr. Oluyinka Olutoye, co-director of the Texas Children’s Fetal Center and another co-author of the studies.

According to Olutoye, the studies will help fetal surgeons to better refine their ability to counsel patients, largely due to better predictors of outcomes.

“Our studies showed fascinating data that we now can predict with excellent accuracy the type of lung lesion (MBA instead of congenital adenomatoid malformation) as well as predicting respiratory morbidity related to CDH using fetal MRI and multidisciplinary evaluation,” said Ruano.

Ruano cites the improvement of quality in fetal imaging as one of the key improvements of fetal medicine over the past few years.

July 8, 2014

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Two year-old Zoey Klein ran around the hallways of the congressional offices chasing after Congressman Pete Olson while her older brother, four year-old Will, chuckled at the playful race. The two were blissfully unaware of the importance of this moment in their lives or the fact that the man who played around in the hallways with them is a member of the House of Representatives representing the 22nd District of Texas. Olson is one of several policymakers the children met during their family’s week-long visit to Washington, D.C.

Get a behind-the-scenes look at the trip to Capitol Hill

Zoey and Will are the children of Texas Children’s Hospital Neonatologist Dr. Jennifer Arnold and her husband, Bill Klein who are also the stars of TLC’s The Little Couple. The family visited D.C. along with representatives from Texas Children’s Hospital and patient families from hospitals across the nation to advocate for better health care for medically complex children. The collaborative effort is part of the annual Family Advocacy Day organized by the Children’s Hospital Association to bring awareness to children’s health care needs by bringing patients to The Hill to meet with representatives and senators and speak about important issues.

“It made me realize that the opportunity to be face to face with our politicians is very powerful,” said Arnold. “I felt that regardless of their political views and party lines, they really do want to listen to the people they represent. I also found it was very important not to hold a bias for any politician. Regardless of my views or theirs, children’s health care affects us all and it takes the support of all our legislators to improve it.”

This year was perhaps the most important in the history of the event as the families were asking their representatives to support a new bill which would affect kids with medical complexities. The week before the patient families arrived in D.C., a bipartisan group of representatives introduced H.R.4930, the ACE Kids Act, which stands for Advancing Care for Exceptional Kids. Congressman Joe Barton and Congresswoman Kathy Castor were the original bill authors with representatives Anna Eshoo, Gene Green and Jaime Herrera Beutler signing on to back the proposed legislation. The legislation is a major step in helping families of children with medical complexities who are forced to find care across state lines. Right now, Medicaid does not cover the expense of the health care services that are received if a child has to travel from Louisiana to Texas for specialized care at Texas Children’s Hospital. The bill would also allow for better coordination of care between hospitals.

“For my kids, it will mean the ability to travel across state lines to get the right specialty care for their medical needs without inefficiencies and poor coordination of care,” said Arnold. “For my patients it will allow me the ability to access medical records, tests, and information from other institutions across state lines and prevent the need to duplicate these in my care.

In a packed meeting room, the representatives who have signed on to support the bill along with the family advocates gathered for a press conference to announce the important new piece of legislation. The bill authors say this coordination of care would save between 13 and 15 billion dollars over a ten year time frame by improving processes and looking at how hospitals coordinate and monitor care.

“The legislation allows states who choose to participate, to modify their Medicaid program and transform it to address the health care needs of the sickest and costliest kids – medically complex patients,” said Texas Children’s Director of Government Relations, Rosie Valadez-McStay. “It will transform Medicaid for this population and improve health outcomes, establish pediatric quality guidelines, and move Medicaid for kids into the 21st century.”

“Models in place like Texas Children’s and others across the country really demonstrate that effective and aggressive care management reduces emergency room use, hospitalization and it really does drive down costs while improving quality,” said Patrick Magoon, President and CEO of Ann and Robert H. Lurie Children’s Hospital of Chicago.

For the 30 families who traveled to The Capitol to speak with their representatives and senators, it was an important moment in history. A chance to make a difference by speaking up for the health care needs of children like themselves, those who require a specialized team to care for their unique needs. Valadez-McStay said the trip is an opportunity for families like the Klein’s to be the voice of all children with medically complex conditions.

“Children don’t choose to be born poor. They don’t choose to be born sick,” said Director of Government Relations Rosie Valadez-McStay. “We need to create a health care system which allows all children to access the best care and this bill is a step in the right direction.”

Congressman Barton urged everyone to speak up because the only way important pieces of legislation move in congress is when voters speak up about why it’s important to them. It’s a chance for health care workers, patient families and anyone who cares for the health of children in our country to step up and join Speak Now for Kids, the grassroots effort which brings attention to this important cause.

“There are 5,000 to 6,000 bills introduced in every congress and less than 500 become law,” said Barton. “This is a bill that has a chance but it won’t go anywhere unless those across the aisle begin to feel that this bill needs to move. You have the ability to contact your congressmen and women to ask them to sign on as co-sponsors.”

As Zoey and Will made their way around The Hill carrying a sign which read, #Speaknowforkids, they may not have known the difference they were going to make, but it was one that may affect children’s health care, and their own, well into the future.

Three ways to join their efforts today:

Call, write, and reach out. Lawmakers are elected by you to stand up for you. Make your voice heard. Contact their offices and let them know why you care about Medicaid reform for medically complex children. Click here to find out who represents you.

Get social with your policymakers. Find the social media pages for your representatives and senators and post messages on their pages about why you want them to support the ACE Kids Act.

#Speaknowforkids. Use this hashtag and saturate social media with your stories about why this bill matters to you, your patients, and your family.

July 1, 2014

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This summer, the city of Houston is honored to host the 2014 Transplant Games of America. Running from Friday, July 11, to Tuesday, July 15, this biannual, Olympic-style event celebrates patient and family athletes who have been touched by the life-saving gift of organ transplantation. Participants from all over the country will journey to Houston to compete in a variety of sporting events from track and field to swimming, among many other events.

As a major sponsor of this event, Texas Children’s Hospital would like to extend the opportunity to its employees to volunteer. Anyone interested should register through the Transplant Games of America website. All times are tentative and are subject to change.

Visit http://www.teamtexastransplant.com/ for more information about the Transplant Games of America.

June 24, 2014

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Representatives from Texas Children’s Hospital are joining children’s hospitals from across the nation in Washington, D.C.this week for the annual Children’s Hospital Association (CHA) Family Advocacy Day. CHA recently launched Speak Now for Kids, a grassroots initiative to advocate for medically complex children.

Dr. Jennifer Arnold, neonatologist and medical director of Texas Children’s Simulation Center, along with her husband, Bill Klein, and their two children, Will and Zoey, is representing Texas Children’s Hospital at the event. Arnold provides the insightful perspective of a physician, former patient and a mother of two children with medical complexities.

“Everyone, including our policymakers, needs to know the best place for children with complex medical conditions is a children’s hospital, where experienced specialty care is available for their needs,” Arnold said. “It ultimately gives children the best chance at a healthy and happy life.”

Family Advocacy Day convenes hospital representatives and their patient families to speak to their members of Congress about supporting legislation to create pediatric centers of excellence at children’s hospitals to care for the most vulnerable patients: medically complex children on Medicaid. The legislation – titled “Advancing Care for Exceptional Kids Act” (or ACE Kids Act) –  will ensure that children are able to receive the care they need from a center equipped to provide comprehensive care, even if the hospital is in another state.

Arnold, her family and families from other children’s hospitals are meeting with members of Congress to advocate for Medicaid reform for children with medical complexities, the reauthorization of the Children’s Health Insurance Program (CHIP) and funding to train pediatric residents.

“It is my love as a parent, my duty as a physician and my experience as a patient which compels me to raise awareness for this important issue,” Arnold said.

The families speaking in Washington, D.C., this week represent the voices of the thousands of children being treated at centers of excellence like Texas Children’s Hospital every day. As a Texas Children’s employee, you can help spread the message about why children’s hospitals are the best place for kids with complex medical.

5 ways you can Speak Now for Kids:

  1. #Speaknowforkids. Use this hashtag and saturate social media with your stories about why children’s hospitals matter.
  2. Get social with your policymakers. Find the social media pages for your representatives and senators and post to their pages about why you want them to speak now for kids.
  3. Call, write, and reach out. Lawmakers are elected by you to stand up for you. Make your voice heard. Contact their offices and let them know why you care about Medicaid reform for medically complex children. Click here to find out who represents you.
  4. Share a story. Encourage patient families to share their stories here.
  5. Educate. Talk to your network of friends and family about how programs like Medicaid matter to all children and encourage them to get involved.
June 10, 2014

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U.S.News and World Report released its 2014-2015 Best Children’s Hospitals list today, and Texas Children’s Hospital maintained the no. 4 spot among the 183 children’s hospitals surveyed by the publication. Also, Texas Children’s once again is listed on the Honor Roll, which recognizes hospitals with top 10 rankings in at least three specialties.

“We are thrilled that U.S.News continually recognizes our hospital as one of the best children’s hospitals in the country,” said Texas Children’s President and CEO Mark A. Wallace. “These results are a testament to our organization’s focus on quality and safety and the dedication of our staff and employees, and it’s just another indication of what we all have known for some time: that we are doing tremendous work here at Texas Children’s.”

U.S.News annually ranks the top 50 pediatric centers in 10 specialty areas. In the 2014-15 rankings, U.S.News surveyed 183 pediatric centers to obtain clinical data in 10 specialties. Eighty-nine hospitals ranked in at least one specialty, and 10 hospitals were named to the Honor Roll below:

Ranking Hospital Points Specialties in top 10
1 Boston Children’s Hospital 20 10
1 Children’s Hospital of Philadelphia 20 10
3 Cincinnati Children’s Hospital Medical Center 15 9
4 Texas Children’s Hospital, Houston 14 9
5 Children’s Hospital Los Angeles 8 6
6 Children’s Hospital Colorado, Aurora 7 5
7 Nationwide Children’s Hospital, Columbus, Ohio 6 6
8 Ann and Robert H. Lurie Children’s Hospital of Chicago 6 4
9 Children’s Hospital of Pittsburgh of UPMC 5 5
10 Johns Hopkins Children’s Center, Baltimore 4 3

The 10 children’s hospitals on the 2014-15 Honor Roll ranked at or near the top in three or more specialties. The order is by total points. If a hospital ranked among the highest 5 percent in a specialty, it received 2 points, and if a hospital ranked in the next 5 percent, it received 1 point. Boston Children’s Hospital and Children’s Hospital of Philadelphia again tied for the top spot. Texas Children’s is separated from the no. 3 position by a single point. This year’s ranking demonstrates some significant gains among several Texas Children’s services. Here are a few highlights:

  • 7 services improved in the rankings
  • 9 services scored in the top 10 (compared to 6 in 2013)
  • 6 services were ranked among the top 5 (compared to 3 in 2013)

“Texas Children’s results on this year’s survey reflect the diligent efforts of the steering committee we formed last year to focus on the U.S.News survey,” Wallace said. “The process of compiling and refining our data is an ongoing challenge, which will continue to improve under the excellent leadership of Angelo Giardino, Tom Luerssen, Mary Jo Andre, Terri Brown and Colleen Jones.”

Texas Children’s made these notable gains amid several changes to this year’s survey. This year, the weight of the reputational score decreased from 25 percent to 16.7 percent, and the best practices and infection prevention rate both increased in weight, from 4.2 percent to 8.3 percent. Also, two additional outcomes were scored in neonatology, and one additional outcome was scored in orthopedics and gastroenterology/GI surgery. Five-sixths of each hospital’s score relied on patient outcomes and the care-related resources each hospital makes available. The remaining one-sixth of the score is derived from a survey of 450 pediatric specialists and subspecialists in each specialty over three years. The physicians were asked where they would send the sickest children in their specialty, setting aside location and expense.

Texas Children’s, working closely with academic partner Baylor College of Medicine, continues to pioneer advancements in pediatric healthcare and earns the U.S.News honor roll distinction by being ranked among America’s best in:

  • #4 Cancer
  • #2 Cardiology & heart surgery
  • #5 Gastroenterology (digestive disorders)
  • #6 Neurology & neurosurgery
  • #2 Neonatology
  • #4 Nephrology (kidney disorders)
  • #4 Pulmonology
  • #7 Urology
  • #8 Diabetes & endocrinology
  • #34 Orthopedics

“Our high rankings demonstrate the commitment we have to achieving quality outcomes, tracking those outcomes and using them to markedly improve the care we deliver,” said Texas Children’s Surgeon-in-Chief Dr. Charles D. Fraser Jr.

This year’s methodology reflects a number of improvements that better differentiate hospitals based on outcomes, best practices and infection prevention. Texas Children’s Physician-in-Chief Dr. Mark W. Kline said the results are a reflection of the work of a gifted, dedicated staff.

“Texas Children’s has more pediatricians and pediatric subspecialists than any other hospital in the world,” Kline said. “But more importantly, we have many of the world’s most talented and dedicated physicians, educators, scientists, nurses and other health professionals, and working together, our team is driving innovation and advancement in pediatric health care. I’m proud of their commitment.”

The 2014-15 edition of Best Children’s Hospitals is available online at www.usnews.com/childrenshospitals.

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Many hospitals have Neonatal Intensive Care Units (NICUs), but not all NICUs are the same.

Texas Children’s Newborn Center is one of the only level IV NICUs in the Houston region that is able to provide babies with the highest level of care. In fact, many area hospitals with less advanced NICUs transfer infants to us when more experience and specialized care is required.

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The American Academy of Pediatrics differentiates between units by defining levels of care based on the complexity of medical conditions the facility is equipped to treat. We hope this will help you better understand the different levels of care in the NICU:

Level I: Regular nursery care available at most hospitals that deliver babies

Level II: Intensive care for sick and premature infants

Level III: Comprehensive care for more seriously ill newborns

Level IV: Major surgery, surgical repair of serious congenital heart and anomalies that require cardiopulmonary bypass and/or extracorporeal membrane oxygenation (ECMO) for medical conditions. Level IV units include the capabilities of level III with additional capabilities and considerable experience in the care of the most complex and critically ill newborn infants and should have pediatric medical and pediatric surgical specialty consultants continuously available 24 hours a day.

Many area hospitals have level II or III NICUs, but are not equipped to provide the most advanced level of care some newborns need. Our combined level II and III NICUs offer specialty care for newborns. An additional level IV NICU located across the connecting bridge gives babies more extensive support and access to dozens of pediatric subspecialists.

Texas Children’s Newborn Center was recently ranked no. 2 in this year’s U.S. News & World Report survey, a gain from last year’s no. 17 ranking. As you know, U.S. News ranks the top 50 pediatric centers in 10 specialty areas, so being recognized within the top two is no small feat.

Our commitment to improving neonatal outcomes is really something to be proud of, and I am grateful that our diligent efforts are making a positive impact in the lives of so many babies.

For more information about Texas Children’s Pavilion for Women and our Neonatal Intensive Care Unit, visit here and to take a video tour of our NICU, visit here.