September 26, 2018

Texas Children’s senior leadership has announced that the top three credit rating agencies – Moody’s, Standard & Poor’s (S&P) and Fitch – have affirmed Texas Children’s ratings of Aa2, AA and AA, respectively, as well as a stable financial outlook. Affirmation of the Aa2 and AA ratings are a reflection of the high quality of the Texas Children’s system and its standing as an organization with very low credit risk.

“We are excited to have received affirmation of our ratings from all three agencies,” said Texas Children’s President and CEO Mark Wallace. “These ratings, combined with our stable outlook, will provide us greater access to financial markets and enable us to focus available funds on our ongoing mission to provide the very best care for our patients and families.”

Each year, these agencies analyze financial, operational and strategic data to determine credit ratings. The ratings reflect the agencies’ view of a borrowing organization’s, such as Texas Children’s, capacity and willingness to meet financial commitments as they come due, and thus determine the organization’s creditworthiness. The Aa2 rating and equivalent AA ratings denote Texas Children’s high level of financial stability and our very strong capacity to meet our financial commitments.

“This is fantastic news for Texas Children’s,” said Executive Vice President and CFO Weldon Gage. “Each agency noted similar themes for conferring these ratings, among them our track record of successfully implementing growth strategies and large capital plans, our strong market position and brand equity, and our significant fundraising capabilities.”

Additionally, the agency reports cited Texas Children’s extensive research programs and clinical excellence, its exceptional regional and national presence and reputation, and a historically strong financial position as reasons for the ratings. Long-term, the ratings also signify the agencies’ confidence that Texas Children’s will continue to benefit from its presence as one of the nation’s leading children’s hospitals.

Moody’s, S&P and Fitch have affirmed Texas Children’s positive ratings for the past 22 consecutive years. We are one of less than about 50 hospital systems nationally and among only three hospitals in Texas that demonstrate this level of financial stability.

Sickle cell disease affects more than 100,000 Americans and millions more worldwide. This red blood cell disorder can be treated, but a widely available cure has yet to be found. Texas Children’s hematologist and Assistant Professor of Pediatrics Dr. Vivien Sheehan has recently developed a new sickle cell treatment based on her laboratory research. Sheehan has found that metformin, a commonly used medication for diabetes, has the ability to induce fetal hemoglobin in developing red blood cells.

Since higher levels of fetal hemoglobin reduce sickling in red blood cells of patients with sickle cell disease, the medication could potentially be useful in reducing the severity of sickle cell complications in patients. It also can be taken with another drug that increases fetal hemoglobin, hydroxyurea, to get even more clinical benefit.

Sheehan has been a part of Texas Children’s Cancer Center faculty since 2012, working tirelessly toward advancing sickle cell treatments. During a cancer related conference she attended, it was mentioned that the drug metformin could help with cancer by increasing amounts of proteins that her research showed increased fetal hemoglobin. This led Sheehan to wonder if the drug would increase fetal hemoglobin in cells from patients with sickle cell disease, and sure enough, it did.

“Because metformin is so well studied, so safe, there are millions of people literally taking it,” Sheehan said. “I then went to my Institutional Review Board (IRB) and asked if I could start a clinical trial of metformin in sickle cell patients since it was known to be safe, and wouldn’t cause hypoglycemia even in non-diabetics.”

With funding from Pfizer, in 2016 Sheehan and other researchers were able to launch a clinical trial that is currently assessing the effectiveness of metformin to make fetal hemoglobin in patients with sickle cell cared for here at Texas Children’s Hospital Hematology Center. Pfizer is a world leader in global medical advancement that provides medical research grants and scholarships for new drug development and the latest in cutting edge technology and applications. This not only led to developing the clinical trial, but also led to other acknowledgements and funding such as Sheehan’s Best of ASH recognition, given by the American Society of Hematology at the 2016 annual meeting.

“Her passion truly exudes from her and so a lot of times when you get into conversation with her, you always leave so much more educated because she’s letting you know the newest things that she has learned,” said nurse practitioner Precious Uwaezuoke. “She’s letting you know how her research studies are going. Thus, hearing her speak is always so rewarding and fun. I truly have this huge respect for her just because of how passionate she is about Sickle Cell Disease and our kids.”

Uwaezuoke works closely with Sheehan and the research team, as well as patients, and is responsible for helping to determine who may be good candidates for clinical trials. Fighting sickle cell herself, she knows that at times handling the disease can be very difficult; so she verses how important research is to getting closer to finding a cure for the disease.

“This is a big deal because having sickle cell is not easy. It affects way too many people for us to only have developed one therapy 20 years ago,” Uwaezuoke said. “To be able to see something come to fruition like this because somebody had a dream, and chased it and didn’t let it fall to the wayside is exciting. Anytime somebody wins after trying a therapy and it actually helps them, I feel like I won as well.”

Following the clinical trial, the next step will be commercialization. Sheehan says that the progress is very exhilarating and that it is amazing for a process of this magnitude to have been executed in just four years.

“Usually it takes around 15 years,” Sheehan said. “That’s the average time it takes to develop a drug from the bench to the bedside, and that’s a pharmaceutical company with all of their staff. So now we’re in 2018, we’re almost done with the first arm of our clinical trial, patients taking both hydroxyurea and metformin, and can now analyze and publish our results.”

Overall, preliminary research results show fetal hemoglobin induction, the repair of blood vessels, which is so important to help prevent complications of stroke, retinopathy, renal failure, and the other issues that cause a lot of damage or even death to some patients with sickle cell disease.

“Ultimately, I needed to determine whether patients were having more pain crises or less pain crises on metformin and whether they’re needing more transfusions or fewer transfusions”, Sheehan said. “So I compared the time period before they started the drug to the time period on metformin and they were having fewer pain crises and they were needing fewer transfusions.”

Sheehan says that research is key to improving the use of the tools that we already have. She is now looking for a few more participants to complete the second arm of the clinical trial, patients not on hydroxyurea, and also add adult patients up to the age of 40 years. Sheehan has formed a collaboration with University of Texas Health Sciences Center’s Comprehensive Sickle Cell Center and Dr. Juneja and Dr. Idowu to be able to enroll these patients.

“It’s the only way to advance in a meaningful way. You can make incremental advances just by improving access to care or use of the drug, but you’re not going to make a big, significant change without research. Those with Sickle Cell are doing better through childhood, but they’re still not living longer in adulthood and I think it’s the lack of therapies that will continue to work in our older patients and I feel like this is going to be one of them and I want to see it improve life spans and not just number of years, but health.”

September 18, 2018

Imagine you’re the parent of a newborn with an arm injury. During your admission you’re told not to move the arm and to protect it all times. Now imagine coming back for your clinic appointment and hearing that it’s time to start moving the arm at home – unsupervised. For parents of children with brachial plexus birth palsy, this moment can be daunting.

Brachial plexus birth palsy occurs when there’s a stretch or tear in the bundle of nerves known as the brachial plexus, located near the neck and upper arm area. These injuries may cause weakness, pain, sensory loss and functional impairment. Sometimes the nerves need time to recover, anywhere from a few days to a year. Other times surgery might be required. Regardless, a focus on treatment during the waiting period can help prevent the shoulder joint from becoming stiff. The only way to keep the joint loose is through passive exercises, which must be performed early and often by the patient’s family.

“If we can find a way to keep these shoulders loose, we can eliminate many of the problems we see down the road,” said Dr. Chris Pederson, head of Texas Children’s Pediatric Hand and Microvascular Surgery programs. “Unfortunately, for a lot of parents performing the exercises can be an intimidating task.”

To help empower parents, Texas Children’s brachial plexus clinic recently teamed up with engineering students at the Oshman Engineering Design Kitchen at Rice University to develop a model that allows parents to practice movement exercises in clinic before performing them on their children at home. The project was part of an ongoing collaboration with Rice begun in 2014 by Texas Children’s Brachial Plexus Clinic Coordinator James Northcutt.

“I originally pitched the idea for the brachial plexus model to the freshman design class at Rice in the fall of 2017,” Northcutt said. “Using the model, I wanted parents to be able to identify the different parts of the shoulder and shoulder blade and feel the difference between a stiff shoulder and a healthy shoulder. And ultimately, I wanted to help alleviate the anxiety parents feel about moving their child’s arm by giving them the opportunity to practice the exercises on the model first.”

Northcutt met with the students monthly to serve as clinical lead on the project, providing information about anatomy, biomechanics, caregiver needs, therapy concerns and overall device application. Less than a year later, design team “Can’t Brachius,” produced a professional and well-functioning prototype. But it needed to be tested by parents. Mayra Oliver was the first.

When she was first told she’d need to perform exercises on her infant son, Raphael, Oliver was nervous and worried. But a demonstration of the model and the opportunity to use it herself had her feeling much more confident.

“When I first knew that Raphael was hurt, I was scared I’d do the exercises wrong and hurt him or somehow make his injury worse,” Oliver said. “Being able to feel the different parts of the shoulder on the model and then on Raphael, and then feeling the way the healthy shoulder should move freely, as opposed to the stiffness of an injured shoulder, was very helpful. I think this model will be very useful in helping families feel less nervous about doing the exercises.”

Using a survey developed in conjunction with the Rice design team, Northcutt will begin conducting a randomized control study over the coming months to determine the device’s efficacy both in educating families and in preparing them for the performing the exercises at home.

“I look forward to finding out more about our parents’ needs in helping these infants grow up to function at the highest level,” Northcutt said. “This project represents an attempt to improve patients’ futures by equipping parents to be informed, active care team members.”

The Brachial Plexus Clinic is part of Texas Children’s Brachial Plexus Program, which comprises plastic surgery, orthopedic surgery, physical medicine and rehabilitation, and occupational therapy. The clinic provides comprehensive care for brachial plexus injuries including specialized assessment, developmental and functional screening, primary nerve surgery when indicated, secondary orthopedic surgery for the shoulder and lower arm when indicated, and preoperative and postoperative care in the therapy setting. The brachial plexus team provides high-level, evidenced-based care, utilizing ultrasound to monitor shoulder integrity in infants recovering from brachial plexus injury, providing specialized splinting for prevention of joint contractures in the arm, and implementing best surgical practices for primary nerve and secondary orthopedic procedures.

Through dedication, hard work, research and partnership, Texas Children’s Newborn Center has lowered its rate of a serious lung condition in premature infants by more than 13 percent over the past year.

The center’s current rate of Bronchopulmonary Dysplasia (BPD) is below the national average for the first time in a decade and is well below what is expected based on the size of the unit and the type of patients cared for in the NICU at Texas Children’s Hospital, according to the Vermont Oxford Network, an organization that helps hospitals track outcomes of premature babies and allows comparison to other institutions across the country.

“This is a dramatic improvement for us,” said Dr. Monika Patil, one of the neonatologists involved in Texas Children’s campaign to lower BPD rates. “We now have the lowest rate of BPD since we joined the Vermont Oxford Network in 2006.”

Patil said every team member in the Newborn Center contributed to this outstanding achievement and that their work has been directed by the Avoiding Lung Injury (ALI) team. ALI is a multidisciplinary group focused on improving the respiratory outcomes of very low birth weight infants in the NICU through quality improvement projects. This team was created by Dr. Lakshmi Katakam, medical director of the NICU, and Dr. Gautham Suresh, chief of Neonatology, with the vision of empowering NICU staff to tackle one of the most important determinants of long-term outcomes in premature babies – that is, whether or not a premature infant develops BPD.

BPD is one of the key conditions that influences long-term outcomes in a low birth weight infant, Katakam added. And, for many infants, it determines whether they go home on oxygen or ventilator. That’s why close monitoring of these patients is so important.

What ALI has found, and clinicians have worked to implement, is that rates of BPD can be lowered if infants who need respiratory aid are treated with gentler modes of therapy that protect the premature baby’s lungs from being injured , such as Continuous Positive Airway Pressure (CPAP) instead of being intubated and placed on a ventilator. If intubation and assistance of ventilator are necessary, the group discovered infants fare better if clinicians closely watch the amount of ventilator support and oxygen being administered, only giving infants what they needed when they need it.

To implement and maintain these changes, the Newborn Center is trying innovative staffing models that enable nurses and respiratory therapists to become even more involved in respiratory care of premature patients. Instead of tending to more than one patient during their shift, nurses caring for infants on CPAP are now assigned to care for only one patient at a time during the first few days of life when premature babies’ lungs are most vulnerable to injury. There is also a team lead respiratory therapist that offers an extra layer of support and keeps a watchful eye to ensure that CPAP is successful.

“This method of care is highly involved and requires a lot of support from our nurses and respiratory therapists, but is what’s best for our patients during such a critical period in their lives,” Katakam said. “It’s also what sets us apart from other institutions that might not have the resources to give patients such individualized care.”

To ensure such close care is continued, the Newborn Center is working alongside nursing leaders, Rebecca Schiff and Heather Cherry, to perform a nursing research project to improve CPAP management. The project is focused on understanding the correlation between nurse-patient ratios and respiratory outcomes in infants on CPAP.

In addition, the ALI group is continuing its efforts to research and implement strategies for minimizing time a newborn spends on the ventilator by extubating as early as possible, using gentle ventilation modes, optimizing use of medications proven to be effective in reducing BPD, and minimizing exposure to oxygen, which can be harmful to premature infant’s lungs and eyes, if used in excess.

The ALI team is hosting a regional respiratory care conference on October 19 at Texas Children’s Hospital. NICU providers from all across the country will share their experiences and learn from experts at Texas Children’s. For more information about the First Annual Baylor Avoiding Lung Injury conference, please contact Katakam at Katakam@bcm.edu or ext. 6-1365. Online registration is available at https://www.bcm.edu/bali-conference.

“We are very excited about our progress but still have a long way to go,” Katakam said. “Preventing BPD is an ongoing effort but our team is determined and energized to do everything we can to prevent lung injury along a premature infant’s journey, from the time a baby takes the first breath in the delivery room to the time they leave our NICU.”

Excluding those mentioned above, those involved in the NICU’s effort to lower the rate of BPD in premature infants include:

  • Isa Baruah
  • Dr. Rebecca Cavazos
  • Dr. Milenka Cuevas
  • Dr. Shaeequa Dasnadi
  • Anne Debuyserie
  • Dr. Cary Fernandes
  • Jennifer Gallegos
  • Dr. Behru Gandhi
  • Suzanne Iniguez
  • Sheela John
  • Maxine Keller
  • Dr. Brian King
  • Dr. George Mandy
  • Jessica Ramirez
  • Dr. Rita Shah
  • Kymberly Sherwood
  • Dr. Binoy Shivanna
  • Dr. Nathan Sundgren
  • Eva Vuong
September 10, 2018

As the opening of the new Heart Center in Legacy Tower quickly approaches, one grateful patient family is commemorating their journey with Texas Children’s with a building project of their own.

Heartwood Acres is a new subdivision being developed by Rodgers Homes & Construction, a business owned and operated by Jenny and Philip Rodgers, who came to Texas Children’s in 2014 after a routine 20-week ultrasound revealed their baby had hypoplastic left heart syndrome. Their doctors in Shreveport, Louisiana, explained that repairing this rare, complex and life-threatening heart defect would require highly specialized care that wasn’t available locally, including at least three open-heart surgeries, the first just a few days after birth. But even with surgical intervention, survival wasn’t certain. The couple was devastated.

“When they told us something was wrong, everything changed,” Jenny recalled. “I cried for months. It was as though we were mourning the loss of the family life we’d envisioned.”

After researching fetal cardiology and surgical options at top regional and national hospitals, they decided their best chance was treatment at Texas Children’s. From the moment they walked in, they knew they’d made the right choice.

“We were immediately blown away by the facilities and how state-of-the-art everything was, but what really floored us were the people,” Jenny said. “Everyone was incredible and comforting. Dr. Nancy Ayres, our fetal cardiologist, met us in the hallway and stayed with us all day. We felt like we were being taken care of from day one.”

Prior to delivery, Jenny moved to Houston to be closer to Texas Children’s, where she would remain until after her baby’s second open-heart surgery. On May 19, 2014, after months of careful planning and monitoring at Texas Children’s Fetal Center®, Jenny gave birth to Aiden at Texas Children’s Pavilion for Women. Just four days later, Dr. Jeffrey Heinle, associate chief of Congenital Heart Surgery, performed the first of Aiden’s surgeries at Texas Children’s Heart Center®. The family stayed in Houston until Aiden was ready for his second surgery, performed when he was only four months old. Less than a month later, they were discharged to return home to Louisiana.

Today, Aiden is a happy four-year-old who loves superheroes and playing soccer. And though there’s another procedure on the horizon, part of Aiden’s three-stage palliative surgical path, Jenny knows her son and family will be in the best hands possible at the No. 1 heart center in the country according to the 2018-2019 U.S. News & World Report hospital rankings.

“Heart parents are fiercely proud of their heart centers,” Jenny said, laughing. “So we’re excited that ours is the actual No. 1 heart center, especially because the rankings are so comprehensive. That kind of transparency is vital for families that need to make important health decisions. The U.S. News rankings are an easy-to-understand resource that I give to any family I meet that’s in need of specialized care.”

Of added comfort to the Rodgers family is the fact that when Aiden undergoes his final surgery, it will be in the new Heart Center in Legacy Tower. The Heart Center will occupy eight floors and will feature four cardiac catheterization labs including integrated MRI scanner, four cardiovascular operating rooms, three cardiovascular ICU floors with 48 private rooms, two cardiac acute care floors with 42 private patient rooms, and a dedicated space for families.

“I’m thrilled that we’ll have access to this awesome new facility,” Jenny said. “It’s huge to know that because of the layout of the new CVICU rooms, I don’t have to leave to sleep or shower. I can be right where I’m supposed to be – with Aiden.”

The road has been long and their journey isn’t over, but the Rodgers family is grateful for Texas Children’s and the care they’ve received. In honor of their experience, and their continued involvement in the pediatric heart community, the family decided to name their company’s first ever subdivision Heartwood Acres. When residents and visitors pass into the neighborhood, they’ll pass a plaque that tells Aiden’s story and how this place and its streets got their names. The first three streets are appropriately named Fannin, after the street where Texas Children’s stands, Ayres Circle and Heinle Way.

On September 6, the Rodgers family presented Drs. Ayres and Heinle with their own street signs, each with a personal inscription to the people who Jenny said held Aiden’s life – and his heart – in their hands.

The inscription reads:
Your care lit the path for our son Aiden’s life and we are honored to pave the streets in your name for others to live theirs.

“We wouldn’t have Aiden without them,” Jenny said. “They mean so much to us and we love them.”

Learn more of the Rodgers family’s story.

What happens when 32 specialties at Wallace Tower, 16 specialties at Texas Children’s Hospital The Woodlands, and 51 Texas Children’s Pediatrics practices take part in their own “Shoot for the Stars” MyChart challenge? It means more patients and their families are signing up for My Chart, the hospital’s online patient portal.

Due to the tremendous success of the 5-week MyChart Madness Challenge in March – which generated close to 2,000 same-day MyChart activations across the hospital system – clinical staff launched a second competition to add to these successes, while engaging their teams around Texas Children’s Patient Access Initiative.

MyChart Instant Activation is one component of the Patient Access Initiative, which essentially pushes a text or email notification to patient families that allows them to sign up for a MyChart account via phone instead of having to use a computer to sign up. Patients are then able to access their personal health information, communicate directly with their care team at any time, and schedule their clinic appointments online.

The Shoot for the Stars My Chart Challenge began on July 23 and ended on August 31. The competition generated impressive results across the organization which has helped to improve access for our patients and their families.

Wallace Tower and The Woodlands

Over the course of five weeks, Wallace Tower generated a total of 979 same-day MyChart activations. Of the 32 participating clinics at Wallace Tower, the neurology team won with 204 same-day activations. Over the course of four weeks, The Woodlands campus generated 100 same-day activations with Dermatology winning the challenge.

Texas Children’s Pediatrics

Texas Children’s Pediatrics (TCP) conducted their own competition which began on July 23 and ended on September 2. TCP generated a total of 11,206 My Chart activations. Several practices won weekly and overall raffles including TCP Baytown, Cy-Fair, Lakewood, Pasadena, PMG and Sterling Ridge.

Texas Children’s Pediatrics also conducted a creative competition where each TCP practice designed a creative campaign to display the benefits of MyChart and encourage MyChart activation.

Here are the top three creative campaign winners:

  • TCP Pasadena – “MyChart is Out of this World”
  • TCP Heights – “Be Incredible…Sign Up for MyChart
  • TCP Rayford – “MyChart-Land”

Click here to view all of the MyChart campaign posters.

Patient access: Opening the door at Texas Children’s

Since launching this initiative in March, Texas Children’s has seen significant improvements in patient access across the hospital system. Several enhancements were implemented in waves across specialties which included:

  • Standard clinic sessions: After evaluating 944 provider templates, extra slots were found where physicians could see patients for a duration of four hours. By standardizing clinic sessions for all specialties across Texas Children’s, over 53,000 new appointments have been added to the system.
  • MyChart activation: In October 2017, the organization had less than 8,000 monthly MyChart activations. To date, we have now exceeded over 60 percent activation for MyChart throughout the system.
  • Direct scheduling: More than 100 patients have used this online feature that allows current patients to quickly and easily schedule appointments online on MyChart.
  • Electronic waitlist: This MyChart feature automatically offers up available appointments to patients desiring a sooner appointment. Since its implementation, over 300 patients have accepted an appointment on average 52 days earlier than their prior appointment.

Click here to watch this video that highlights our patient access journey and our recent accomplishments.

Texas Children’s Physical Medicine and Rehabilitation Electrodiagnostic Laboratory has received Laboratory Accreditation with Exemplary status from the American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM). Dr. Suzanne Woodbury is the laboratory’s medical director and said she is very excited to receive AANEM Laboratory Accreditation status.

The AANEM established laboratory accreditation criteria for electrodiagnostic (EDX) laboratories to ensure patients receive quality medical care in a safe environment. Laboratory accreditation provides patients, referral sources, and payers with a credible measure to differentiate the laboratory’s quality of care. The accreditation standards evaluate the diagnostic services and clinical operations essential to providing quality patient care, which include:

  • Clinical staff qualifications and continuing education
  • Physical facilities
  • EDX equipment
  • Protocols for performing EDX studies
  • Patient reports
  • Policies for ensuring the health and safety of every patient

Exemplary Status is the highest level of accreditation an EDX laboratory can achieve under the AANEM Accreditation Program. To be awarded Accreditation with Exemplary Status, physicians performing studies in the laboratory must:

  • Have completed a neurology or physical medicine and rehabilitation residency program; and
  • Have completed a minimum of three months of training in EDX medicine as part of a residency or fellowship program; and
  • Be certified by the American Board of Electrodiagnostic Medicine (ABEM), or by the American Board of Psychiatry and Neurology (ABPN) in clinical neurophysiology, or by the ABPN/American Board of Physical Medicine and Rehabilitation in neuromuscular disease.

AANEM is a nonprofit membership association dedicated to the advancement of neuromuscular, musculoskeletal, and electrodiagnostic medicine. For more information about AANEM, or to learn more about laboratory accreditation, visit www.aanem.org.