August 20, 2019

Texas Children’s Hospital recently celebrated a well-deserved milestone after being named No. 2 in the nation for Gastroenterology and GI surgery by U.S. News & World Report.

“Our team was delighted by this year’s ranking of No. 2 nationally,” said Dr. Benjamin Shneider, Chief of Gastroenterology, Hepatology and Nutrition. “I am particularly proud of the achievements our team has made in improving outcomes for the children and families who entrust us with their care.”

The U.S. News rankings uses a methodology that weighs a combination of factors including patient outcomes, quality of health, available clinical resources like specialized clinics and external accreditations, and compliance with best practices. Improved rankings show a health care organization’s commitment to providing high-quality care and identifying gaps where improvements are needed.

Big wins for patients and families

Building on the successes of previously existing programs, the Gastroenterology, Hepatology and Nutrition team, in collaboration with Pediatric Surgery and Liver Transplantation, continues to make great strides in patient care and outcomes which were recently noted in the U.S. News rankings:

  • Achieved successful Kasai procedures in infants with biliary atresia. The most common reason for pediatric liver transplantation is biliary atresia (BA), which occurs in infancy. Within weeks, the liver suffers from extensive scarring that eventually leads to end-stage liver disease. One way to slow disease progression is with an operation called the Kasai procedure. Kasai procedures performed earlier have the best chances of delaying or preventing the need for a liver transplant.

In the U.S. News rankings, Texas Children’s scored the highest score for success after the Kasai operation. The score reflects the world-class care given to patients with biliary atresia cared for at Texas Children’s Hospital. Texas Children’s provides comprehensive care to infants with BA and their families, including aggressive nutritional support, social work services, nursing expertise, and attention by leading pediatric surgeons, hepatologists and transplant surgeons.

BA research at Texas Children’s Hospital, led by Dr. Sanjiv Harpavat, is laying the foundation for a uniform way to detect infants with biliary atresia earlier, to ensure they receive the Kasai procedure at a young age. Texas Children’s researchers have developed a newborn screening tool, which they have implemented in nurseries around the city. This has led to earlier referrals and helped fuel the improved outcomes with the Kasai procedure. Texas Children’s researchers are now working to implement this early screening program across Texas and nationwide, to ensure that all infants with biliary atresia can receive an early Kasai procedure, delaying liver transplantation and potentially avoiding the need for liver transplantation.

  • Improved three-year survival for children undergoing liver transplantation. Texas Children’s has one of the largest and most successful pediatric liver transplant programs in the country. “Our team’s multi-disciplinary approach to pre and post-transplant care, further development of our Liver ICU, surgical innovations, and the incredible teamwork and dedication of our entire liver transplant teams, including our inpatient and outpatient nursing and support staff, have only enhanced our outcomes year after year,” said Dr. Daniel Leung, Director of Hepatology and Liver Transplant Medicine. Texas Children’s three-year liver transplant survival exceeds 92 percent and post-liver transplant length of stay is four days shorter than other high volume peer programs. Additionally, our one-year liver transplant survival exceeds 95 percent.
  • Improved prednisone-free remission rates in children with Inflammatory Bowel Disease (IBD). Since steroids carry significant side effects for children, steroid-free remission is a commonly used outcome measure of clinical care quality in Inflammatory Bowel Disease. To meet this metric, an automated mechanism was implemented in the electronic medical record (EMR) system, which alerts physicians about their patients’ steroid use, thereby focusing attention on the on-going need and appropriateness of steroid use for each patient in a real-time fashion. As part of a hospital supported effort, Texas Children’s also is part of the International Improve Care Now (ICN) registry of pediatric IBD patients, which allows GI physicians to closely monitor the hospital’s active patient cohort and improve their clinical care. Steroid free remission indicates optimal medical management and decreased potential for IBD-related complications in children suffering from these disorders. It is a big win towards improved quality of life for our patients.
  • Implemented successful community support groups

Our community hospital system at Texas Children’s has provided tremendous support to engage our children and families contending with IBD in the form of monthly Family Support Group meetings. These meetings create an outstanding venue for patient and family education, and enables parents to actively influence the care of their child. These interactions have helped to improve patient satisfaction and quality of life in children with IBD. Texas Children’s offers similar support programs for liver transplantation and intestinal failure.

Click here to learn more about our Gastroenterology, Hepatology and Nutrition Service at Texas Children’s Hospital.

There’s no greater responsibility than raising a child. Who should do that alone?

If you asked Adrian McKinney, manager of Texas Children’s Nurse Family Partnership (NFP), she’d say no one. Thanks to McKinney and her team, more than 625 first-time mothers and 487 children have benefited from personalized nursing support since 2009.

That’s 10 years of taking pre-natal and post-partum care directly into the home of Texas Children’s Health Plan members. Certainly something worth celebrating.

“We couldn’t be more pleased about the success we’ve had as a team,” McKinney said. “Our mothers are all entering one of the most challenging times in life and if we can help make preventative health care a priority before their children are born then we’ve already won.”

And that is ultimately the focus of the program. Much like a strong pre-school experience is important to the educational life of a child, so is a good prenatal experience. If the seeds for success are planted early there is time to yield an incredible result.

Rachael Mumbach knows this personally. Mumbach is currently enrolled in the NFP program and calls it an answered prayer. She is mom to little Alaina, who will be two-years-old in December.

“As a first-time mom you get so much inconsistent information about how to handle your pregnancy and raise your children. Your mom and grandmother will tell you one thing. Your boss and your friends will tell you something different,” she said. “They all mean well, but you don’t really know what’s right and what’s wrong.”

Mumbach’s nursing partner, Savanah Ryan, has been an NFP nurse for six years and thoroughly enjoys her work. “Every day looks completely different,” she said. “We are on the road, in homes and providing that hands-on support that our moms need. It’s a joy.”

More than mom
Although moms are the primary focus of the program’s coaching model, McKinney says other family members can also be involved in the sessions. “Dads, grandparents, friends and others who will be part of the child’s support system can absolutely take part in the sessions. We want to make sure that as many people as possible are informed and prepared for the baby’s arrival.”

Who teaches what?
McKinney’s team of nurses conduct weekly and semi-monthly sessions. They teach on topics such as maternal health, sexual health, depression, anxiety, drug use, general child development, parenting and more. Nurses on the team are:

  • Savannah Ryan
  • Galynn Jackson
  • Natalie Nichols
  • Jeanette De Leon
  • Erika Dunn

A big congratulations to the entire team on their 10-year anniversary and successful outcomes for moms.

*****

The Bottom Line
  • Any first-time mother who is a member of Texas Children’s Health Plan and no more than 25 weeks pregnant may be eligible for NFP Services.
  • Anyone who is interested and thinks they may be eligible can contact Mary Perez at 832-828-1274, mmperez1@texaschildrens.org
  • Want more information about NFP? Visit nursefamilypartnership.org

Back-to-school is a time full of anticipation as students get ready to learn new things and make new friends. However, it can also be a time of stress and anxiety for families who can’t afford back-to-school supplies.

To help ensure Houston-area students have the materials they need to start the year successfully, advanced practice providers (APPs) in the Department of Surgery APP Community Outreach Committee collected more than 50 backpacks filled with school supplies from across the three Texas Children’s Hospital campuses. The backpacks were donated at YMCA of Greater Houston locations and The Woodlands Family YMCA at Branch Crossing as part of YMCA Operation Backpack.

This was the fourth year APPs participated in the backpack drive, one of two major charitable initiatives held by the committee each year in which APPs from all Texas Children’s Hospital locations join forces for a common cause – to give back to the community. The other larger annual initiative is a food collection drive in January that benefits Houston Food Bank and Montgomery County Food Bank.

“Each campus participates in numerous events throughout the year, but we wanted to find a couple of opportunities to give back during the year when everyone can be involved,” said Jackie Broda, PA-C in Pediatric Urology and Clinical Lead of the Community Outreach Committee. “Going back to school is obviously a big thing for all our patients. So the backpack drive allows us to help kids get started back to school on the right foot.”

Supplies for each donation included:

  • 1 new backpack
  • 1 package of pens
  • 1 package of #2 pencils
  • 1 pencil sharpener
  • 1 eraser
  • 1 24-pack of crayons or 8-pack of markers or colored pencils
  • 1 package ruled loose leaf 8.5 x 11 paper (wide ruled)
  • 1 12” ruler
  • 1 pair of child safety scissors
  • 2 pocket folders
  • 2 spiral notebooks (100 sheets each)
  • 1 glue bottle or glue stick
  • 1 composition notebook

The backpack drive and food drive are just a part of the busy annual calendar of charitable initiatives and community events that APPs take part in every year at each Texas Children’s Hospital campus. Committee members take an active role in organizing and also volunteer at these events, which include the annual Family Fun Runs, Camp For All 2 U, Teddy Bear Clinics and many, many more – and all in addition to the amazing care and support they provide for patients and families every day.

“It’s a source of pride that everyone comes together for these incredible causes, but it’s awe-inspiring how much everyone is willing to give back on top of all the amazing work they do helping our patients,” Broda said.

Department of Surgery APP Community Outreach Committee 2019 Backpack Drive

Clinical Lead: Jackie Guarino Broda, PA-C

Texas Children’s Hospital – Texas Medical Center campus
Lead: Marielle Faraone, PA-C
Co-project Leaders: Marielle Faraone, PA-C and Madison Fitzgerald, PA-C
Donated: 14 backpacks

Texas Children’s Hospital West Campus
Lead and Project Leader: Anna Shafer, PA-C
Donated: 12 backpacks

Texas Children’s Hospital The Woodlands
Lead: Stephanie McGee, PA-C
Co-project Leaders: Alaina Dozar, NP and Jill Goeltz, PA-C
Donated: 28 backpacks

Fetal growth restriction is a major public health concern that can lead to short-term complications for the newborn and possibly the development of health problems later in life. Researchers at Texas Children’s Hospital and Baylor College of Medicine were recently awarded $3.2 million by the National Institutes of Health to develop an improved way to assess umbilical venous blood flow using 3D and Doppler ultrasound techniques. They aim to improve the detection and monitoring of small fetuses.

Fetal growth restriction increases the risk of stillbirth, problems during the newborn period, and neonatal death. Affected fetuses also are predisposed to developmental delay as well as the occurrence of adult diseases such as obesity, type 2 diabetes mellitus, coronary artery disease, and stroke.

“Our research team will initially validate the accuracy and reproducibility of new 3D volume flow measurements and then develop corresponding reference ranges in normal pregnancies,” said Dr. Wesley Lee, co-director of Texas Children’s Fetal Center and professor of obstetrics and gynecology at Baylor. “Detailed observations of fetal growth, heart function, and circulatory changes will be made in over 1,000 small fetuses with estimated weights below the tenth percentile. The results will be correlated with pregnancy outcomes to identify prenatal predictors of clinical problems in newborns.”

According to Lee, identifying the most vulnerable, small fetuses may not only influence their neonatal course, but could also have lasting impact on long-term health consequences during adult life. Researchers hope to develop 3D umbilical venous flow as a reproducible circulatory measurement that is accurate and clinically applicable, even during early pregnancy.

The five-year investigation is a collaboration between Texas Children’s Hospital, Baylor College of Medicine, University of Michigan, Perinatology Research Branch of the Eunice Kennedy Shriver National Institute of Child Health and Human Development and GE Healthcare.

August 13, 2019

Texas Children’s Pulmonology recently celebrated a well-deserved milestone after learning they were ranked No. 1 by U.S. News & World Report for the second straight year in a row.

On June 19, the Pulmonology team gathered in a conference room on the 10th floor of Wallace Tower to celebrate this impressive accomplishment. Pulmonology, which first debuted in the top spot in the 2016 rankings, was once again recognized as the best in the nation for children in need of pulmonary care.

“At Texas Children’s, we built our program to serve the needs of children with all types of lung disease, from common ailments to the most complex cases,” said Chief of Pulmonary Medicine Dr. Peter Hiatt. “Our unrelenting commitment to providing life-changing and life-saving treatments to children is what motivates us every day to do better and ultimately achieve the best possible patient outcomes.”

The U.S. News rankings uses a methodology that weighs a combination of patient outcomes, quality of health care, available clinical resources, such as specialized clinics, external accreditations and compliance with best practices. Improved rankings show a healthcare organization’s commitment to providing high-quality care and identifying gaps where improvements are needed.

Big wins for patients and families

Building on the successes of previously existing programs, the Pulmonology team continues to make great strides in patient care and outcomes which were recently noted in the U.S. News rankings:

  • Improved one year survival for lung transplant patients.
    Texas Children’s has one of the largest and most successful pediatric lung transplant programs in the country. The one-year lung transplant survival metric is based on data collected from the United Network for Organ Sharing (UNOS) in the Scientific Registry of Transplant Recipients (SRTR) database. Based on this metric and when comparing the volume of our lung transplant patients across the country, the team has seen measurable improvements in our one-year lung transplant survival rate.
  • Improved growth percentile for cystic fibrosis patients 0 – 24 months of age.
    Along with respiratory lung problems, cystic fibrosis patients may encounter digestive problems that can lead to nutritional concerns (malnutrition) and poor growth. Attention to nutritional status and lung function in the first years of life is crucial to promoting the most favorable outcomes. Our pulmonology team improved the median weight-for-length (WFL) growth percentile in CF patients (0-24 months of age) by focusing efforts on early intervention. This included working with our CF dietitians to manage nutrition and avoid calorie and nutrient deficiencies in this patient population. Also, the team collaborated with our CF Family Advocacy group to help under-insured or uninsured families obtain supplements.
  • Reduced hospital re-admissions for patients with asthma-related symptoms
    Pulmonology develops the protocols that guide the organization on how asthma care is delivered to patients across the system. Multidisciplinary collaborations helped the organization decrease hospital re-admissions for exacerbated asthma-related symptoms. Our team collaborated with our partners at the Emergency Center and Texas Children’s Pediatric practices to manage care for chronic to high-risk asthma patients. Other efforts included educating patients about follow up care and the importance of asthma medication adherence to reduce unnecessary re-admissions.
  • Achieved below target threshold for hospital length of stay (LOS) for asthma patients
    Texas Children’s stayed under the 2-day threshold for asthma length of stay on average. Prompt administration of systemic corticosteroid in the Emergency Department (ED) setting and having a focused unit for asthma inpatient care allowed for close monitoring and weaning of therapy to allow for a timely discharge. This was a partnership with the ED and hospitalist clinicians.

Click here to learn more about Texas Children’s Pulmonary Medicine and our services.

July 29, 2019

Texas Children’s Cancer and Hematology Centers recently honored three team members with the Bravo Award for going above and beyond to ensure our patients and families receive the best possible care.

The award is handed out quarterly and recognizes nurses and other professional staff in the Cancer and Hematology Centers for outstanding performance. Anyone within the Texas Children’s system may nominate a member of the cancer and hematology teams for this award. The team’s clinic leadership will select the winners.

Last quarter’s winners of the Bravo Award were:

Suzy Gaius is a Financial Counselor with the Cancer and Hematology Center at Main Campus. Gaius was honored for spending countless hours explaining insurance plans and options to families and staff. She is always available to help us ensure patients receive ongoing care. Gaius is patient and never rushes families if they have questions or need more information.

Yadhira Huerta is a Social Worker with the Vannie Cook Vannie Cook Children’s Clinic in McAllen. Yadhira is a team player who always finds time to lend a hand and give accurate and compassionate advice. She is caring, respectful, and goes out of her way to find answers for patients’ needs. She is equally passionate about helping care for members of the care team at the Vannie Cook clinic.

Teresa Nafegar is a Medical Assistant in the Texas Children’s Cancer and Hematology Clinic Main Campus. Teresa is excellent at keeping patients moving through her pod in clinic. She is a great communicator to the medical team promptly updating them on patient needs and offering ways to increase efficiency. Nafegar also is able to find creative ways to communicate with patients with whom she may not share a common language.

July 15, 2019

There are many types of supervisors in various work environments; those who enforce rules, and those like Ashly Swaty, who elevates them. As a Patient Care Manger in the Legacy Tower pediatric intensive care unit (PICU), Swaty makes sure that all the nurses are taken care of and have all materials and any assistance they need.

With the PICU being so unpredictable on a daily basis, in addition to payroll paper work and nursing rounding, she ensures that nurses take lunch breaks on time. Due to the busy and fast-paced environment at times nurses often cannot leave the bedside without someone covering their assignment. Swaty is known for not hesitating to step in and make sure both the patient and nurse are taken care of daily.

“Her heart is to serve our patients, families, and staff. She consistently goes above and beyond to ensure those around her have the best experience possible,” Director of Nursing, Shannon Holland said. “In all my years of leadership, I have rarely met someone with Ashly’s dedication and compassion.”

Holland recalled a time on a busy day when a nurse skipped lunch because she was extremely busy managing her very sick patient.

“Ashly jumped in feet first, took over care, and insisted the nurse take a break,” she added. “She did all of this with a smile and supportive and caring attitude. She is truly a servant leader who is caring, genuine, and the embodiment of Caught You Caring!”

Another part of Ashly’s job is to sit down with patients’ parents to understand the motivation behind certain behavior and how they can move forward with better outcomes.

“I truly love being with the families!” Swaty said. I know these days may be the worst of many in their lives, but it means the world to me knowing I can bring just a little bit of comfort or knowledge, when they’re questioning something.”

The appreciation and compassion she has for her patients and nurses goes hand in hand. Her selfless personality is why she believes there are others that deserve this award as well, nonetheless, she is grateful for the honor and the opportunity to work for such a prestigious organization.

“I was so shocked when I found out. I was mostly surprised because, honestly, there are so many people who do great things here in the PICU, so anybody in this whole place could have won,” Swaty said. “It’s such a great honor to be recognized, and an even greater honor to work for Texas Children’s.”