August 23, 2016

82416thorasicsurgeryinside640Texas Children’s Hospital’s congenital heart surgery program recently earned a three star rating from the Society of Thoracic Surgeons (STS), the highest possible distinction.

Star ratings are based on the STS Congenital Heart Surgery Database (CHSD) mortality risk model. One hundred and seventeen congenital heart surgery programs nationwide participated in the Spring 2016 STS CHSD Feedback Report. Texas Children’s is among only eight hospitals in the U.S. to earn a three star rating.

“We are honored to be recognized for our outcomes, which are among the best in the nation,” said Dr. Charles D. Fraser Jr., surgeon-in-chief and chief of congenital heart surgery. “Since 1995, our congenital heart surgery program has carefully tracked patient outcomes and continues to be committed to transparency. Information about our performance is a driver of innovation and critical to elevating the quality of care we provide to our patients every day.”

Texas Children’s Heart Center is comprised of an expert team of congenital heart surgeons, pediatric cardiologists, pediatric cardiovascular anesthesiologists and pediatric critical care physicians, among others. In 2015, Texas Children’s congenital heart surgery program’s overall risk-adjusted mortality rate was 1.6 percent, well below the STS national benchmark of 2.9 percent. Outcomes for atrial septal defect repairs, ventricular septal defect repairs, atrioventricular canal repairs, tetralogy of Fallot repairs and arterial switch operations were also below STS national benchmarks last year.

Texas Children’s is ranked No. 2 nationally in cardiology and heart surgery by U.S. News & World Report. To learn more about Texas Children’s Heart Center outcomes visit the website. For more information about STS Congenital Heart Surgery Public Reporting click here.

August 9, 2016

81016ChronicleAdUrology250.pgTexas Children’s is the honored sponsor for every Tuesday’s “Houston Legends” series. We will showcase the legendary care Texas Children’s has provided since 1954, and focus on milestone moments in our unique history. Also, a complementary website offers a more detailed look at our past, our story and our breakthroughs.

On the right is the Texas Children’s ad that is featured in this week’s Chronicle. Click the ad to visit our companion website at texaschildrens.org/legendarycare. The website will change weekly to complement the newspaper ad, which will be published in section A of the Chronicle on Tuesdays for the next several weeks. We also will spotlight this special feature weekly on Connect, so stay tuned to learn and share our rich history.

81016smithvisit640On July 11, Executive Commissioner Charles Smith of the Texas Health and Human Services Commission (THHSC) met with executive leaders at Texas Children’s Hospital and toured several areas of the hospital’s medical center campus to learn more about how we strive to provide the best care to women and children in the Greater Houston community and throughout Texas.

In his new role as THHSC executive commissioner, Smith will oversee the operation of the state’s 58,000 employees across four health care agencies, including the Medicaid/CHIP division and many health care services that impact the care that children and women receive at Texas Children’s.

Dr. Mark Shen, who serves as the chairman of the Children’s Hospital Association of Texas board and is president of Dell Children’s Medical Center, along with Stacy Wilson, president of the Children’s Hospital Association of Texas, also joined the visit and highlighted the collaboration that occurs among all freestanding children’s hospitals in Texas.

Chief of Neonatology Dr. Gautham Suresh, Vice President of Nursing Judy Swanson and NICU Nursing Director Heather Cherry toured the group through the Level IV NICU where they met with several patient families and heard their touching stories. As the state of Texas undergoes its process to designate NICU levels of care, the tour allowed our subject matter experts to educate the commissioner regarding the extensive differences between a Level 1 and Level 4 NICU.

The group also met with Dr. Christian Niedzwecki, medical director of the inpatient rehabilitation unit, and Shelley Ellison, director of the Physical Medicine and Rehabilitation. During their tour of Texas Children’s Physical Medicine and Rehabilitation, the group discussed the concerns shared by physicians and patient families regarding Medicaid therapy rate cuts, which will impact this service line and the care provided to Texas Children’s patients with rehabilitation needs following a physical injury or medical condition.

June 28, 2016

62916usnews640It’s one of parents’ worst fears – their child has a complex or life-threatening illness. How do they decide where to go for the comprehensive care their child needs?

Over the years, the U.S. News & World Report Best Children’s Hospitals rankings have helped thousands of parents identify top sources of care for children with the most difficult medical problems. And Texas Children’s Hospital has consistently been among them.

On the 2015–16 Best Children’s Hospitals Honor Roll, which recognizes pediatric centers that are highly ranked in multiple specialties, Texas Children’s, working closely with academic partner Baylor College of Medicine, ranked no. 4 in the nation for the fifth consecutive year. It is the only children’s hospital in Texas on the Honor Roll.

“We’re rightfully proud of the great work that Texas Children’s does day in and day out on behalf of sick children and their families, but we know we have room for improvement,” said Texas Children’s Physician-in-Chief Dr. Mark W. Kline. “To the degree that the U.S. News survey can help us develop a blueprint for being the world’s best and highest quality pediatric health care institution, we are pursuing that.”

In a process that has become increasingly rigorous and data driven, the U.S. News rankings enable hospitals to look in the mirror and scrutinize themselves.

“Do we like the reflection? Are we as good as we think we are?” asked Dr. Angelo P. Giardino, senior vice president and chief quality officer at Texas Children’s. “In many cases, we are, and we’re thrilled because we are a really great children’s hospital. But there are opportunities where we look in the mirror and we say, ‘We could really do that better.’”

Rankings evolve

Beginning in 1990, as part of the Best Hospitals list, the pediatric rankings were 100 percent reputational for more than 15 years, based entirely on a survey of pediatricians and pediatric specialists across the country, asking them to identify the best children’s hospitals.

When U.S. News decided to rank pediatric hospitals separately from adult hospitals, the publication faced a challenging absence of data. While adult hospital rankings were drawn from Medicare data, no comparable source of information about children’s hospitals was available. As a result, U.S. News enlisted RTI International, a nonprofit research and consulting firm that was already the contractor for the Best Hospitals rankings, to develop a methodology for obtaining data directly from the hospitals and to analyze the results.

The first rankings incorporating such data were published in 2007 as General Pediatrics. Texas Children’s Hospital was listed among the top 30 children’s centers.

In 2008, rankings in six specialties, including cancer and neonatal care, were added to the children’s hospital rankings. In 2009, a newly created Honor Roll listed the 10 children’s hospitals out of 160 surveyed that were ranked in all the specialties, which had been increased from six to 10.

The 2015-16 Honor Roll required a hospital to rank in the top 10 percent in three or more specialties. Only 12 pediatric hospitals qualified among 184 surveyed nationwide. Texas Children’s has appeared on every Honor Roll.

In 2015, Texas Children’s ranked no. 2 in three specialties: cardiology/heart surgery, neurology/neurosurgery and pulmonology. Texas Children’s ranked among the top five hospitals in six specialties and in the top 30 hospitals in all 10 specialties.

“The original purpose of the Best Hospitals rankings was to inform patients and families and help them make decisions,” said Health Rankings Editor Avery Comarow, who has directed the Best Hospitals projects since their beginnings. “I now recognize that we don’t necessarily have to just reflect performance. We can also drive it by incorporating metrics that reflect that goal. Every year, our contractor, RTI International, meets with medical experts to evolve the methodology in ways that not only reflect what children’s hospitals are doing, but ways in which they could and should be doing better.”

Quality framework

Today, the U.S. News Best Children’s Hospitals rankings use a well-accepted framework for evaluating the quality of health care:

Structure: hospital resources related to patient care, such as the ratio of nurses to patients, specialized clinics and programs, and certification by external organizations.

Process: compliance with best practices in diagnosis, treatment, prevention and patient education. As a part of the process, reputation now counts as 16.7 percent of the overall score, down from the original 100 percent.

Outcomes: factors such as rates of survival, infection, mobility and cure.

The increasing emphasis on quality measures had strong support from the late Dr. Bernadine Healy, a former director of the National Institutes of Health, who was health editor of U.S. News before her death in 2011.

“Her expertise and perspective were invaluable,” Comarow said. “She had such a strong sense of the things that were important to patients and families. She brought that same perspective to some of the choices that we made in trying to decide which measures to highlight, what sort of weight to give them, how many hospitals we should assign rankings to, and where we would run out of meaningful data as opposed to numbers that looked OK but were not terribly reliable statistically.”

As U.S. News shifted the emphasis toward quality measures, Texas Children’s shifted coordination of the survey response from its Marketing/PR Department to its Quality and Safety Department.

Team effort

The evolution into quality led us to bring all the chiefs of medical and surgical services to the table,” said Mary Jo Andre, senior vice president and chief nursing officer and former senior vice president of Quality and Safety. “The more that quality and best practices were built into the survey, the more accountability of the survey shifted from an administrative standpoint to the medical staff.”

To help build physician engagement, Giardino and Thomas Luerssen, chief quality officer – surgery, were appointed quality officers for Pediatrics and Surgery, respectively, in 2013. The next year, Giardino was named to his present position as chief quality officer of Texas Children’s, and Eric Williams, succeeded him as quality officer for Pediatrics. They work closely with teams of physician section chiefs, practice administrators and data specialists.

Although only 10 clinical areas are ranked, a total of about 20 different services contribute to the survey, such as Radiology, Emergency Services, Intensive Care, Social Work and Nutrition. For example, nursing certification, attention to safe practices and increasing specialty roles of nurses appear in each section of the survey. Texas Children’s receives points for safety because of the hospital’s Magnet certification by the American Nurses Credentialing Center.

“Any outcome is a partnership of nursing and physicians,” Andre said. “The question directly related to nursing is about staffing. Seeing how we compared to the rest of the country has been a good thing for nursing, because it’s driven us to have higher standards as well.”

More than 100 people at Texas Children’s contribute to the survey each year, submitting more than 1,500 survey elements in all. Texas Children’s also is represented in four of the working groups that RTI consults each year in continuing to refine the methodology. Involvement in quality improvement at Texas Children’s is even more far-reaching. More than 400 staff members have been trained in Advanced Quality Improvement.

“Quality improvement, which Texas Children’s is passionate about, extends everywhere,” said Dr. Charles D. Fraser, Jr., chief of Congenital Heart Surgery and surgeon-in-chief at Texas Children’s. “Quality starts immediately when the patient or family arrives here. Everyone is important, whether you’re in housekeeping or food services, the cardiac intensive care unit or are an administrative executive. Everyone is responsible for quality.”

Gap analysis

Texas Children’s analytics team provides data to each section chief with a detailed analysis of the gaps between the section and comparable data from top-ranked peer institutions in the Best Children’s Hospitals rankings. The service chiefs and their clinical and administrative teams review the data closely and objectively, identifying gaps and opportunities to improve quality, access or outcomes.

For example, in Texas Children’s Diabetes and Endocrinology section, gap analysis revealed several opportunities for improvement that are being addressed. To help deal with limited patient access, four new pediatric endocrinologists have been hired. To reduce disease complications, timely alerts now appear on physicians’ computers, reminding them to schedule their patients for tests for thyroid problems, kidney complications and early signs of diabetic retinopathy, which is associated with blindness.

“The U.S. News rankings are a wonderful opportunity to shine a light on potential problem areas and to allow us to make the care that we deliver better, more effective and more patient centered,” said Dr. Jake Kushner, chief of Diabetes and Endocrinology at Texas Children’s.

The rankings not only help identify gaps where improvements are needed, but also provide data to build the case for needed changes.

“Many of the service chiefs and practitioners have said, ‘We’ve been wanting this – this process, this equipment, this type of clinic – for years, and here it is in the survey,’” said Terri Brown, assistant director of Clinical Outcomes and Data. “So they are able to leverage the survey to help achieve what they already know to be good ideas.”

As the Best Children’s Hospitals survey focuses more and more on ways to improve outcomes, the transparency and accountability of the published rankings are helping to improve children’s health care nationally.

“If you look at the hospitals on the Honor Roll, we’re all delivering great care to children and families,” Giardino said. “Everybody’s working hard to get better. So the bar keeps moving higher. And that’s the whole point.”

June 21, 2016

62216journal640The third issue of The Journal of Texas Children’s Hospital was recently released along with its companion website for online readers. Visit the site here to get a look at the third issue, which features a special section on the separation of conjoined twins Knatalye Hope and Adeline Faith Mata.

The special section is organized into three main parts: pre-surgery, surgery and post-surgery, all of which demonstrate the expertise, talent and comprehensive care available at Texas Children’s. The section lays out the extent to which our team nurtured a trusting rapport with the family, and skillfully cared for and thoughtfully treated the Mata babies from the time they were born until a little more than a year later when they were discharged to their home in west Texas.

Additional features of this edition’s The Journal include:

  • A column from Texas Children’s President and CEO Mark A. Wallace detailing how we have grown as an organization in size, staff and programming in order to continue to meet our ever increasing demand and to be the court of last resort for so many in need.
  • An in-depth look at the U.S. News and World Report rankings, what they mean, how they are formed and whether they have made Texas Children’s, which is ranked the 4th best children’s hospital in the nation, a better, stronger health care institution.
  • A story about the opening of the Special Isolation Unit at Children’s Hospital West Campus and how it demonstrates how Texas Children’s runs toward problems instead of away from them when it comes to the wellbeing of children and their families.
  • An intriguing piece about the research Texas Children’s is doing on a promising treatment using fecal bacteriotherapy to treat inflammatory bowel disease in children.
  • A spotlight on the successful care of morbidly adherent placenta, a potentially fatal condition, in pregnant women.
  • A column from Dr. Stanley Spinner, the chief medical officer of Texas Children’s Pediatrics, about retail-based after-hours care and Texas Children’s efforts to fill that gap by opening quality pediatric urgent care center across the Houston area.

The Journal launched in January 2013, replacing Shine magazine as the organization’s flagship publication. The magazine shares Texas Children’s advancements with intelligent, compelling stories featuring our people, our patients and timely, broadly relevant topics. Along with a philanthropic audience of about 30,000 recipients, the twice-yearly Journal is distributed to another 20,000 recipients, including:

  • CEOs and clinical leaders at all U.S. children’s hospitals and women’s hospitals
  • All U.S. medical school deans and chairs of pediatrics, pediatric surgery, OB/GYN and genetics
  • Physicians in pediatrics, 25 pediatric sub-specialties and women’s health services in Texas and four contiguous states

62116USNEWS640The 2016-17 edition of Best Children’s Hospitals by U.S. News & World Report ranked Texas Children’s Hospital fourth in the country out of nearly 200 pediatric institutions. For the eighth straight year, Texas Children’s Hospital was placed on the Best Children’s Hospital Honor Roll, and for the first time Texas Children’s has a no. 1 ranked service – Pulmonology.

Texas Children’s national rankings for each subspecialty area are:

#1     Pulmonology
#2     Cancer

#2     Cardiology and Heart Surgery
#2     Neurology and Neurosurgery
#3     Nephrology (kidney disorders)
#5     Urology
#6     Gastroenterology & GI Surgery
#11   Diabetes and Endocrinology
#14   Neonatology
#21   Orthopedics

Five services are ranked in the top 5 percent, and two services are in the top 10 percent. Also, based on last year’s rankings, eight services made gains or maintained their current top rankings.

“These rankings continue to reflect the steadfast commitment Texas Children’s has to providing the highest-quality patient care and outcomes possible for the families we serve,” said President and CEO Mark A. Wallace. “The diligent efforts and enthusiasm our staff and employees display every day for Texas Children’s mission, along with our outstanding results in this survey, proves we are unquestionably the best in Texas.”

To be considered for the honor roll distinction, a hospital must have high rankings in at least three specialties. Texas Children’s Hospital is 1 of only 11 hospitals on the Honor Roll this year. We are also the only pediatric hospital in Texas – and the Southwest region – to make the Honor Roll all eight times since the specialty-specific rankings began in the 2009 – 2010 survey year.

In addition to ranking children’s hospitals overall, U.S. News & World Report also ranks the top 50 pediatric hospitals in 10 major subspecialty areas.

“From a measurement perspective, our survey results demonstrate how hard we’re working as an organization to deliver high quality care to our patients,” Wallace said. “The more consistently we deliver high quality care and the safer we deliver that care to our patients, the better their outcomes are, and the better our overall numbers are.”

The results also reflect the diligent efforts of a solid structure focused on the U.S. News survey. The process of compiling and refining our data is an ongoing challenge, which will continue to improve under the leadership of Texas Children’s USNWR Operations team, including Dr. Angelo Giardino, Trudy Leidich, Paola Alvarez-Malo, Elizabeth Pham, Roula Smith.

“These rankings continue to reflect what we all already know, that the trajectory of Texas Children’s is absolutely incredible,” Wallace said.

For more information about the U.S. News rankings, visit:

U.S. News & World Report Best Children’s Hospitals Honor Roll 2016-2017
Rank Hospital
1 Boston Children’s Hospital
2 Children’s Hospital of Philadelphia
3 Cincinnati Children’s Hospital Medical Center
4 Texas Children’s Hospital, Houston
5 Seattle Children’s Hospital
6 Ann and Robert H. Lurie Children’s Hospital of Chicago
7** Children’s Hospital Los Angeles
7** Children’s Hospital of Pittsburgh of UPMC
9 Children’s Hospital Colorado, Aurora
10** Lucile Packard Children’s Hospital at Stanford, Palo Alto, Calif.
10** Nationwide Children’s Hospital, Columbus, Ohio

*2 points per specialty for ranking in highest 5 percent of hospitals; 1 point if in next 5 percent.

**Tie.

May 24, 2016

52516transplant640Transplant teams with Texas Children’s Hospital performed 86 solid organ transplants in 2015, making it the most active pediatric transplant program in the nation.

The liver and the kidney transplant programs were the busiest with 30 liver transplants and 27 kidney transplants completed last year. Of the 27 kidney transplants, nine were living donors and 18 were deceased donors. The heart program completed 21 transplants in 2015 and the lung program finalized eight, making it one of the largest lung transplant programs in the country.

“I would like to commend our transplant teams for the exceptional work they do every day,” said Surgeon-In-Chief Dr. Charles D. Fraser, Jr. “Their great commitment to our transplant patients is inspiring and results in changed lives.”

Dr. John Goss, medical director of Transplant Services, said Texas Children’s Transplant Services continues to earn its reputation as one of the best pediatric transplant programs in the country.

“I believe our success is a testimony to the skill and commitment of our multidisciplinary team, which offers an interdisciplinary approach to all aspects of the transplant process, from initial referral to hospitalization and outpatient management,” Goss said. “We also work closely with patients, families and referring physicians to help make the evaluation process as convenient and efficient as possible.”

Goss added that the success of Texas Children’s transplant program would not be possible without the gifts from our selfless donors and their families.

“They are the ones responsible for providing our patients with a second chance at life,” he said. “We are forever grateful for their unwavering kindness.”

To learn more about Texas Children’s Transplant Services, click here.