August 24, 2020

2020 has been an unprecedented year filled with many challenges. We’ve engaged in social distancing practices like we have never done before. We are wearing protective face masks, both at work and in public, in an effort to protect ourselves, each other, and prevent the further spread of the coronavirus.

But despite the uncertainty and daily disruptions caused by the COVID-19 pandemic, this health crisis has prompted our physicians, nurses and other patient care staff to explore innovative, non-traditional approaches to patient care processes – like e-rounding – to enhance the provider/patient experience.

Daily patient rounding has been around for centuries, and is an important part of the patient care process. Before COVID-19, a group of multidisciplinary staff would gather in or outside a patient room to discuss the patient’s condition and plan of care with the patient’s family, taking into account the experience, concerns, questions and needs of the patient. Through this multidisciplinary, family-centered approach, each team member would then contribute their expertise to support the best possible care/outcomes for the patient.

To adapt to COVID-19 and to ensure social distancing practices are followed, our critical care teams began conducting patient e-rounding in April, which has been a beneficial change from the norm.

“E-rounding has been a big change for us,” said Dr. Jordana Goldman, attending physician in Critical Care. “Rounds are as old as time in medicine and so it takes a little bit of practice to get use to it. But once you get the flow of it, it really works well. Our physician and nursing leaders, and the e-Health and IS teams have been very supportive in helping us leverage new technology to make e-rounding possible.”

Through the VidyoConnect platform, virtual “rooms” are created that are then available for all rounding team members to join. During e-rounding, an attending physician, bedside nurse and family member, can be outside the patient’s room in front of a computer screen while maintaining social distancing, and can communicate virtually with remote team members including our consultants, the provider team (consisting of APPs, fellows and residents) dietitian, pharmacy, Respiratory Therapy support and other members.

“We facilitated the implementation of e-rounding by working with Dr. Goldman and Dr. Aarti Bavare to integrate their ideal workflow using the software and hardware that we already had available,” said Dr. Robert Ball, medical director of e-Health. “It was the team work of Information Services, e-Health and the physician champions that made it a reality. When you have amazing innovators in every corner of our organization working together to enhance this process, there are no obstacles that cannot be overcome.”

Since e-rounding was first introduced in the PICU and CICU in April, e-rounding has expanded to other parts of the hospital including the acute care cardiology floor. PHM has been working on the acute care side on a version of e-rounds to help with the education of the residents and medical students. Plans are underway to expand e-rounding capabilities to the Pavilion for Women and NICUs with the option of e-rounding being made available to all inpatient areas at our three hospital campuses in the coming weeks.

Our e-Health teams are also working on the ability to leverage VidyoConnect to communicate with families in a HIPAA compliant way so they can join rounds when they are not able to be at the bedside.

“The disruption of COVID-19 has allowed us to take a closer look at our rounding practices and see how we can improve them for our patients, team, learners and consultants,” Goldman said. “This is a very new process for us, but our team’s willingness to engage in this novel approach has been pretty phenomenal.”

May 12, 2020

Chief of Critical Care Dr. Lara Shekerdemian is the lead author on multicenter research that came out this week in JAMA Pediatrics. The research describes characteristics and outcomes of children with COVID-19 admitted to U.S. and Canadian Pediatric Intensive Care Units.

The study looked at 48 cases from 14 hospitals, infants up to age 21, during late March and early April. Two of the children died. Eighteen were placed on ventilators and two of them remain on the breathing machines more than a month later. None of the children in the study were stricken by the new mysterious inflammatory syndrome linked to the coronavirus that can cause life-threatening cardiac issues in children. They suffered from the virus’s primary line of attack: the severe respiratory problems that have afflicted tens of thousands of American adults.

Over all, the research both reinforces the evidence that only a small percentage of children will be severely affected by the virus and confirms that some can become devastatingly ill. Shekerdemian has conducted several interviews with national media about her findings. To learn more, click here to read the story published in JAMA and click here to read a story about the study in the New York Times.

October 15, 2019

The Pavilion for Women recently held a two-day conference focused on obstetric critical care. With increasing focus on maternal morbidity and mortality the need to expand and elevate the care provided by physicians and nurses is paramount. This unique conference affords the opportunity to participate in skill simulation and expert presentations. Additionally, CMEs and CNEs were awarded upon receiving a successful pass rate of the post-test administered.

Attended by more than 100 people across Texas, and 12 midwives visiting the Pavilion for Women from Hong Kong, the conference covered physiologic changes during pregnancy, specific obstetric medical conditions and appropriate treatment; maternal cardiovascular resuscitation and airway management of critically ill pregnant patients; as well as appropriate steps in fetal assessment, delivery, and neonatal management.

The conference was held October 4 and 5, and was formatted as a series of presentations and skill stations to provide knowledge and guidance for decision-making, and limited practice in some clinical procedures and scenarios. Positively received by attendees, the conference enables the Pavilion for Women as a Level IV Maternal Care Designated facility to determine what educational needs exist across the state and provide additional education to help improve quality outcomes for women.

June 10, 2019

The Department of Critical Care celebrated the remarkable legacy of Dr. Thomas Vargo during Pediatric Ground Rounds on May 24.

Texas Children’s founded the Thomas A. Vargo Visiting Professorship in honor of Vargo’s service as the first chief of Pediatric Critical Care Medicine and the first full-time medical director of Texas Children’s pediatric intensive care unit (PICU), a position he accepted in 1979 at the personal request of legendary Physician-in-Chief, Dr. Ralph D. Feigin.

“The Visiting Professorship is a wonderful opportunity for us to honor Dr. Vargo and his great contributions to Critical Care and Cardiology at Texas Children’s and at the same time learn from and interact with the top experts in the field of pediatric critical care,” said Texas Children’s Chief of Critical Care Dr. Lara Shekerdemian. “I can only imagine what an undertaking it was to build a program at a time when pediatric intensive care was in its infancy and none of the resources we have today – human, technology or equipment – were available. Despite these challenges, Dr. Vargo persevered and laid the foundation for the wonderful service we are part of today.”

This year’s Visiting Professor was Dr. Peter Laussen, Chief of the Department of Critical Care Medicine at the Hospital for Sick Children (SickKids) in Toronto, Professor of Anaesthesia at the University of Toronto, the David and Stacey Cynamon Chair in Critical Medicine, and a globally recognized authority on cardiac critical care.

Over the past decade, Laussen has focused on systems and human engineering applied to critical care, and is the lead developer of a web-based data visualization platform that stores ICU data collected in real time from multiple sources, such as patient monitors, ventilators and lab systems. That data is then seamlessly synthesized in a manner that reduces the impact of human error in ICU decision-making processes.

In his presentation, “Boosting Signals and Seeing Patterns: Artificial Intelligence and Critical Care,” Laussen described the changing landscape of critical care medicine over the past 40 years. He also discussed the increasingly important relationship between critical care and technology, and specifically addressed the potential advantages of artificial intelligence and data science in critical care.

Technology and data utilization are already crucial aspects of care at Texas Children’s. Ultimately, we hope to have the ability to use sophisticated data platforms as decision support tools to enhance patient care and even to predict imminent deterioration.

Another example of how we’re using data is in Texas Children’s Mission Control, where we have real-time tracking of our transport ambulances and plane. That simple ability lets us better estimate ETAs and redirect teams for emergencies. Our teams also have access to real-time census data that allows them to know our bed capacity and how best to direct patients to the closest ICU.

A recent scenario when this technology made a lifesaving difference happened in August 2018. Mission Control received a call from a surgery center north of Houston, where a child suffered a lacerated carotid artery during a routine outpatient procedure. The Kangaroo Crew team at Texas Children’s Hospital The Woodlands was dispatched to the patient, while a second team was sent from the Texas Medical Center with emergency blood. Mission Control coordinated a precise meeting between the two teams to hand off the blood and was in constant communication with our emergency center, ENT surgeons and others to meet the child on arrival. Prior to launching Mission Control, with its sophisticated technology and communication tools, this would not have been possible.

About Dr. Thomas A. Vargo

Dr. Tom Vargo was born and grew up in Los Angeles, California. He received his bachelor’s degree from George Pepperdine College and his medical degree from UCLA. He trained in pediatrics in Madison, Wisconsin, where he met his wife, Connie. The two have been married since 1964 and have three children.

After spending two years in the United States Air Force in Florida, Vargo joined Baylor College of Medicine and Texas Children’s in 1968 to train in Cardiology with Drs. Dan McNamara and Denton Cooley. Vargo has remained in Houston since, serving as a professor of Pediatrics at Baylor. In that time, he laid the foundation for Texas Children’s world-class Critical Care service, which now has 80 attending physicians, 40 advanced practice providers, 10 physician instructors and 20 fellows, admitting more than 7,000 patients annually to the critical care units at our Texas Medical Center campus, West Campus and Texas Children’s Hospital The Woodlands.

The highlight of Vargo’s career has been the education and training of students and residents. He has been a long-time member and chair of various medical school student and resident physician advisory committees. His lectures were always popular with the medical students and he has mentored numerous fellows and faculty. For more than 40 years, he has been the training program director of four different residency programs at Baylor – in pediatrics, pediatric cardiology, critical care medicine and the post-graduate year 1 residency. Vargo was a founding member and president of the Society of Pediatric Cardiology Training Program Directors. He has received multiple teaching awards from medical students and residents at Baylor, including the Pediatrics Department’s lifetime teaching award.

September 26, 2017

On September 22, Dr. Martha Curley, the 2017 recipient of the Thomas Vargo Visiting Professorship in Pediatric Critical Care Medicine, presented two lectures to residents, fellows, APP’s, physicians and nurses during her visit to Texas Children’s including Pediatric Grand Rounds  titled “Team Science – Answering Complex Clinical Questions Together.”

Curley is the Ellen and Robert Kapito Professor in Nursing Science at the University of Pennsylvania School of Nursing. She also holds a joint appointment in Anesthesia and Critical Care Medicine at the University’s Perelman School of Medicine and is a nurse scientist at Boston Children’s Hospital.

Through several decades of outstanding high quality nurse-led research that engages all members of the clinical team, Curley has transformed the ICU experiences and outcomes of countless critically ill children and their families all over the world.

January 31, 2017

2117crititicalcare640The Society of Critical Care Medicine (SCCM) held its 46th Annual Congress on January 21 to 25 in Honolulu, Hawaii. The SCCM is the largest and best attended annual meeting of the specialty of critical care.

This year, the Baylor College of Medicine and Texas Children’s Hospital’s section of Critical Care Medicine had an outstanding presence at the meeting with 28 presentations from our faculty and fellows. Highlights from our section included Junior Faculty members Barbara-Jo Achuff and Tessy Thomas, who received Star Research awards. Other highlights included research snapshot presentations from Intensive Care Unit (ICU) fellows Dalia Bashir, Nirica Borges, Melanie Kitagawa, Erin Kritz, Sonia Labarinas, Andrea Ontaneda and Chinu Onyearugbulem, and Pediatric Intensive Care Unit nurse Jenny Tcharmtchi.

“This has been a fantastic year for us at the SCCM,” said Texas Children’s Chief of Critical Care Dr. Lara Shekerdemian. “We are so proud of our ICU team for representing our section and Texas Children’s Hospital and for all that they are doing to advance the field.”

April 8, 2014

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Intense study focuses on critical needs of main campus core areas

At the beginning of this year, some pretty exciting things happened at Texas Children’s: a new system-wide mission statement announcement, celebration of the organization’s 60th birthday and the groundbreaking of the new Texas Children’s Hospital The Woodlands. But something even bigger and more imperative was going on behind the scenes: CareFirst.

In January, Texas Children’s launched CareFirst, an intense study of the core areas throughout the main campus. It involves a rigorous, eight-month planning process to help evaluate the hospital’s critical needs and set the right course for the future.

CareFirst initially will center around the needs of three areas:

  • the Emergency Center
  • Critical Care
  • Operating Rooms/PACU.

View this video to see why these areas need our attention.

“In the past several years, we’ve grown our programs and our physical footprint in the community to provide care where there was growing need,” said President and CEO Mark A. Wallace. “CareFirst is about focusing on the pressing needs at our main campus and reinvesting in the core clinical areas.”

In a video Wallace distributed last week, he documented a recent visit to the three core areas. In the videos, Dr. Paul Sirbaugh takes Wallace through the Emergency Center, which receives 50 percent of all 911 and EMS transports in Houston. In the Operating Rooms/PACU, Dr. David Wesson and Judy Swanson explain how some rooms barely accommodate the advanced technology required to take care of our patients. And in Critical Care, Dr. Lara Shekerdemian and Dr. Paul Checchia describe the balancing act involved in taking care of patients who now are surviving because of the care we provide and subsequently requiring longer hospital stays in our over-crowded ICUs.

CareFirst is such a high priority that Texas Children’s Board of Trustees, administrative leaders at all levels, physicians and many Texas Children’s employees have been engaged in the effort. The work teams are dedicating considerable time to CareFirst to move thoughtfully, but swiftly, and Wallace plans to unveil the findings and plans for the next stage of CareFirst at the beginning of fiscal year 2015.

“This will be one of the most difficult initiatives we have ever undertaken,” Wallace said. “Many areas will be impacted, and at times, this is going to challenge us. But I know it is the right thing to do for our patients and their families. It’s about ensuring that exceptional care continues to be first and foremost at Texas Children’s.