September 4, 2019

Every year, more than 25,000 patients come to Texas Children’s for the expert care we provide in neurology, neurosurgery, neurophysiology and genetics. They come from across the nation and around the world with neurologic conditions ranging from common to rare to unknown because few places offer the full continuum of care that Texas Children’s provides.

It was fitting, then, that Texas Children’s was recently recognized for its commitment to excellence and comprehensive, high-quality care, once again being named No. 3 in the nation for pediatric neurology and neurosurgery by U.S. News & World Report.

“We are incredibly proud to be ranked once again among the best locations in the nation for pediatric neurology and neurosurgery,” said Texas Children’s Chief of Neurology and Development Neuroscience Dr. Gary Clark. “Our desire is always to provide the very best care for our patients. That is what drives everything we do and what has gotten us where we are today. We’re committed to providing outstanding neurological and neurosurgical care, to conducting groundbreaking research, and to becoming the best program in the nation.”

The U.S. News rankings use an approach that analyzes quality of health care and patient outcomes data from thousands of medical institutions across the country. This includes measuring specialized clinics and programs, external accreditations, and compliance with best practices. A ranking among the top hospitals in a specialty area indicates a commitment to not only providing high-quality care, but also to identifying gaps where improvements are needed.

One recent example was when survey data revealed gaps specific to neurosurgical shunts. Teams were able to review and analyze the data and swiftly close the gaps.

“We are always striving for excellence, so we take the U.S. News rankings very seriously,” said Chief of Neurosurgery Dr. Howard Weiner. “The rankings are just one measure of the trajectory of the Neuroscience Center as a whole. When I first arrived three years ago, the goals were to be the destination for high-quality, innovative and attentive care; to train the leaders in the field; and to lead in the investigation of neurologic conditions. We’re meeting those goals, but what’s key to our success is the ability for everyone – in Neurosurgery and our amazing colleagues in Neurology – to work together for our patients. That’s the driving principle behind Neuroscience at Texas Children’s.”

Big wins for patients and families

This year, Neurology and Neurosurgery built on successful existing programs and also implemented new initiatives to improve monitoring capabilities, reduce occurrences of infection and improve the overall quality of care.

  • Saw significant decreases in unplanned returns to OR for craniotomy and in readmissions for Chiari decompression

The surgical advanced practice provider team implemented a post-discharge call system to assess patients for signs of infection, increases in pain or other possible complications. This system allowed the surgical team to determine if a clinic visit was appropriate, and it helped decrease the number of 30-day unplanned returns to the OR for craniotomy patients and the number of Chiari decompressions patients readmitted within 30 days of surgery.

  • Increased monitoring for epilepsy patients who received surgical resection or laser ablation

To ensure patients always receive the highest possible level of care, Texas Children’s has always been committed to recruiting and retaining the best and brightest. The addition of six new epileptologists helped greatly improve monitoring capabilities. This past year, at least 50 percent of epilepsy patients who received surgical resection or laser ablation surgery received intraoperative electrocorticography and/or extra-operative monitoring.

  • Significantly decreased percentage of surgical site infections (SSIs) for ventricular shunt surgeries

Dr. William Whitehead has been leading efforts to identify opportunities to reduce SSIs for shunt-related procedures. One key strategy was improved compliance with a bundle of evidence-based surgical protocols, which include the administration of pre-operative antibiotics, appropriate hair removal and proper scrubbing of the surgical site. Adherence to these protocols contributed to a significant decrease in the percentage of SSIs for ventricular shunt surgeries.

  • Decreased the complication rate for epilepsy surgical procedures

An expansion in Texas Children’s Epilepsy program has led to an increase in neuro-diagnostic monitoring volumes that eclipses other institutions. With the addition of new team members (i.e., six new epileptologists) and the opening of a dedicated neuro-intensive care unit this past year – one of the first of its kind in the country – Texas Children’s provides the safest and most effective environment for the care of children with seizure activity.

Learn more about Texas Children’s Neuroscience Center.

August 26, 2019

When the results of the 2019 U.S. News & World Report survey of Best Children’s Hospitals poured in on June 18, Nephrology patiently waited to find out if they would again be named among the best in the nation.

For the first time, Texas Children’s is ranked in the top 10 in each of the U.S. News & World Report-recognized pediatric sub-specialties. Nephrology, moved up a spot from last year, ranking No. 2.

“We were all very pleased,” Chief of Renal Services Dr. Michael Braun said. “The entire multidisciplinary team has a tremendous focus on making sure we deliver the best and safest care possible, and so seeing that reflected in our U.S. News & World Report rankings is wonderful.”

The U.S. News rankings uses an approach that analyzes quality of health care and patient outcomes data from thousands of medical institutions across the country. This includes measuring specialized clinics and programs, external accreditations and compliance with best practices. Improved rankings determine a health care organization’s commitment to not only providing high-quality care, but also to identifying gaps where improvements are needed.

“We are excited because it validates what we already know about the program,” Renal Programs Manager Helen Currier said. “Our goals haven’t changed, and we are going to continue to provide outstanding care to patients with kidney disease in a safe and family-centered context.”

Big wins for patients and families

This past year, Nephrology exceeded their yearly goals and executed additional initiatives to increase transparency, reduce risk of infection, and improve the quality of care.

  • Significant decrease in hemodialysis catheter associated blood stream infections (BSI)

Hemodialysis catheter associated BSIs are complications that can result in hospitalization and possibly death. Minimum standards are set by the federal government, as a result metrics are analyzed monthly to identify improvements at a system level. Minimizing these infections is an example of our commitment to providing the best possible care for our hemodialysis patients.

The Standardized Care to Improve Outcomes in Pediatric End-stage Renal Disease (SCOPE) collaborative focuses on infections prevention in pediatric peritoneal dialysis and hemodialysis patients using large-scale collaboration to identify and spread effective interventions across pediatric care settings. Adopting and following SCOPE played a large role in this big win as well.

  • Increased number of full-time equivalents (FTEs) Psychologist/Psychiatrist dedicated to the care of pediatric maintenance dialysis patients in Pediatric Nephrology Program

FTEs are licensed, doctoral psychologists or psychiatrists who work more than 30 hours per week. The burden of illness is the highest among all pediatric chronic illnesses, Texas Children’s Hospital has led the nation as a proponent of integrated mental health support to patients, and families with end-stage renal disease (ESRD).

  • GRAFT Survival rate of 1 year kidney transplant

Graft survival is an estimate of the probability of the transplant functioning at a finite time after transplantation. According to the National Center for Biotechnology Information, outcomes after pediatric kidney transplantation in the United States have improved over time, independent of changes in recipient, donor, and transplant characteristics.

Not only is the first year that Texas Children’s Hospital leads the nation in the number of pediatric kidney transplants, but we also celebrated the 500th kidney transplant done at Texas Children’s Hospital. This is not only reflected in our U.S. News ranking, but has been a major impact on the well-being of our patients. Texas Children’s transplant team as a whole goes above and beyond to provide high quality care to our patients. Last year, they received a glowing review from the Centers for Medicare and Medicaid Services recertification evaluation team. More specifically, the fantastic work that the kidney transplant team has done is reflected in this esteemed honor in the U.S. News & World Report survey.

  • Improvement in Children under 5 years of age receiving hemodialysis

Dr. Braun attributes this improvement in outcomes in large part to the impressive work of Dr. Michael Belfort and the Fetal Center in developing an outstanding maternal fetal medicine program. Texas Children’s Fetal Center is one of the nation’s leaders in the diagnosis and treatment of abnormalities in unborn and newborn infants, allowing us the ability to care for a child even before birth which directly impacts their quality of care later in life.

Click here to learn more about our Kidney (Renal) department at Texas Children’s Hospital.

A group of 25 Texas Children’s ventricular assist device (VAD) patients of all ages and more than 100 other guests, including families, caregivers and guest speakers, recently attended the second annual VAD celebration – “A Night with VAD Superstars.”

There was plenty of food, a visit from Child Life Specialist Adair Galanski with Bailey – the dedicated therapy dog for Lester and Sue Smith Legacy Tower – and games and activities provided by Physical Therapy, Occupational Therapy and Child Life.

The evening was emceed by Barbara Elias, VAD coordinator and the event’s founder, who started the celebration as a way to honor patients currently on heart pump or circulatory support, or those patients who have previously been on support but have had their pump removed or received a transplant. The VAD celebration also honors families and caregivers and has quickly become an outlet for information exchange and networking.

“Device patients are a special group that lead challenging lives, and their families and caregivers are with them every step of the way for what is sometimes a very long journey,” said Elias. “This event serves many purposes: It provides a forum for families to meet one another, share their experiences and build a community. It allows parents of children with VADs to meet other children or adults who have lived through the experience and persevered. And it gives caregivers – especially those from the ICU, who have seen these patients at their worst – an opportunity to see these patients living their lives and doing well.”

The evening’s speakers included Dr. William Dreyer, Texas Children’s medical director of Heart Failure, Cardiomyopathy and Cardiac Transplant; Dr. Lara Shekerdemian, chief of Critical Care; and Texas Children’s heart surgeon Dr. Iki Adachi. Attendees also heard from special guest speaker Dr. Richard Wampler, the inventor of Medtronic’s HeartWare® HVAD pump, a device frequently used in Texas Children’s patients. In turn, the event gave Wampler an opportunity to see firsthand how his invention has positively affected the lives of so many children at Texas Children’s.

“This event was testimony to what our VAD program has accomplished over the last decade,” said Adachi. “There is no doubt that VAD support has provided our patients with a chance for life. It was a pleasure seeing and sharing the happiness generated by such life-saving therapies with patients, families and medical colleagues.”

The VAD program’s expertise was on display in the evening’s two special patient honorees, Eugene Carrette and Jameson Finney. Eugene, who is from Belgium, was the smallest and youngest patient to receive a VAD since the beginning of the program. Thanks to the expert care he received at Texas Children’s, he has been able to travel with his family to Europe recently, a phenomenal feat for a young VAD patient. Jameson Finney earned the nickname “Daredevil” for living life to the fullest while on a device, running, golfing and riding bikes until receiving a heart transplant in 2018. Both the VAD implantation and the transplant were performed by Adachi. Jameson has been doing well since his transplant and continues to lead an active life.

The event concluded with a special moment of sharing and reflection. During this emotional and cathartic time of testimony, patients, families and caregivers who wished had the opportunity to share their stories and to speak frankly about living with a VAD. Many also thanked the experts at Texas Children’s for the care they received and how it has empowered them to live their lives.

“The event was extremely well received and was powerful for everyone in attendance,” said Elias. “I would like to thank Dr. Adachi, Dr. Hari Tunuguntla, my partner, VAD coordinator Jason McMullen, RN, the Heart Center Social Committee, and therapies including Physical and Occupational Therapy and Child Life, whose efforts allowed the event to occur.”

Texas Children’s Heart Center® was recently named the No. 1 pediatric heart center in the country for a third straight year by U.S. News & World Report. The VAD program is part of the Heart Failure Program and is one of the busiest pediatric programs in the country. There are currently 15 VAD patients in the program. Seven of those are full-time students.

Learn more about the Heart Center and its recent U.S. News ranking.

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.

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.

August 6, 2019

On his blog this week, Mark Wallace shares his excitement about Texas Children’s once again being named among the top children’s hospitals in the nation according to the most recent U.S. News & World Report rankings. He also announces a new Connect series that will feature each of the 10 subspecialty areas ranked in the U.S. News survey and highlight the programs, improvements and advancements that helped earn this year’s outstanding rankings. Read more

Early on the morning of June 18, Texas Children’s Heart Center staff filed into Taussig auditorium on the 16th floor of Lester and Sue Smith Legacy Tower. Details about the meeting’s purpose had been scarce. Little did everyone know that they’d been called in for a big reveal.

Texas Children’s Heart Center had once again been named the best place in the country for pediatric cardiology and heart surgery in the U.S. News and World Report 2019-2020 Best Children’s Hospitals rankings – the center’s third straight year at No. 1.

“It’s thrilling for our team to be recognized for the care we provide to our patients every day,” said Chief of Pediatric Cardiology Dr. Daniel Penny. “Even though we received the top honor, we know there is always room for improvement. We are continuing to evolve as a true multidisciplinary team that is dedicated to setting a new standard for the treatment of children and adults with congenital heart disease.”

The U.S. News rankings use a well-accepted framework for evaluating quality of health care, which factors in patient outcomes, such as mortality and infection rates; available clinical resources, such as specialized clinics and programs and external accreditations; and compliance with best practices. Improved rankings demonstrate a health care organization’s commitment to not only providing high-quality care, but also to identifying gaps where improvements are needed.

But where do you go when you’re No. 1?

“Our goal is to be so far ahead that no one can catch us,” said Dr. Christopher Caldarone, Texas Children’s chief of Congenital Heart Surgery. “Being No. 1 is a state of mind, where commitment to excellence is inherent in everything a program does. Our team has a No. 1 mindset. We work hard, we constantly measure our performance, and we drive ourselves to improve in every aspect of providing care.”

Big wins for patients and families

This past year, the Heart Center built on the successes of previously existing programs and also implemented new initiatives to increase transparency, reduce risk of infection and improve the quality of care.

  • Participated in STS National Database public reporting
    The Society of Thoracic Surgeons (STS) is a national leader in health care transparency and accountability. Participation in STS public reporting demonstrates a commitment to quality improvement in health care delivery and helps provide patients and families with access to information that can help them make more informed health care decisions.

Texas Children’s holds a three-star rating in the STS Congenital Heart Surgery Database (CHSD), which is calculated based on overall risk-adjusted operative mortality for all patients undergoing pediatric and/or congenital heart surgery. The rating is the highest category of quality and places Texas Children’s among the elite congenital heart surgery programs in the U.S. and Canada. Additionally, STS recognized Texas Children’s for having operative and adjusted operative mortality rates that were consistently below expected rates over a 4-year period.

  • Implemented a program to routinely track and submit IMPACT data
    In partnership with clinical and physician leadership, the Heart Center’s Cardiac Catheterization Labs implemented processes to submit metrics on all catheterization procedures included in the American College of Cardiology’s IMPACT Registry®. This national register collects quality-focused data on the management and outcomes of pediatric and adult congenital heart disease (ACHD) patients who undergo diagnostic and interventional cardiac catheterization procedures. The registry also allows Heart Center leadership to compare performance against a national aggregate for quality improvement initiatives.
  • Increased the number of cardiac intensive care unit (CICU) RNs with greater than 2 years’ experience
    CICU care requires a multidisciplinary team effort. Success is due, in part, to the team’s being able to rely on experience. In the months leading up to the Heart Center’s move into Lester and Sue Smith Legacy Tower, CICU leadership worked tirelessly to not only recruit the very best nurses, but also to retain them. This enables the nurses to gain valuable experience and mature as caregivers, and also helps improve the overall quality of the CICU team. The response has been extremely positive, with low turnover.
  • Implemented a universal methicillin-resistant Staphylococcus aureus (MRSA) decolonization treatment protocol
    To reduce the risk of infection faced by all surgical patients during the perioperative period, the Congenital Heart Surgery team partnered with experts from Infectious Disease to implement a universal decolonization protocol for MRSA, which causes infections that are more difficult to treat than methicillin-susceptible staph. The protocol, which involves five days of antibiotic ointment in the nose and five days of special wipes, has the added benefit of decreasing MRSA wound infections, and incidence of methicillin-susceptible staph ventilated-associated pneumonia and central line infections.

Learn more about the Heart Center, its services, and volume and outcomes.