September 4, 2018

In 2002, Dr. George Mallory helped establish Texas Children’s Lung Transplant Program and has built it into one of the world’s preeminent pediatric programs, with a reputation for collaborative, patient-centered care. This year, Mallory is passing the torch of medical leadership to Dr. Tina Melicoff, who will lead the program in partnership with surgical director Dr. Jeffrey Heinle.

“We all share Texas Children’s vision of taking care of children with complex lung conditions,” said Melicoff. “Cases that would be too complex to treat elsewhere are common at Texas Children’s. With our amazing team, and our focus on clinical and basic research, we can continue to build on Dr. Mallory’s incredible legacy of compassionate care and clinical excellence.”

Under Mallory’s distinguished leadership, the program has reached some extraordinary milestones. It is one of the largest lung transplant programs in the world – and the most active, with the highest clinical volume of any program over the past five years. Experts at Texas Children’s have performed more than 200 lung transplants, completing more in the past five years than any other pediatric program. Over the past ten years, the program has been one of only three that consistently performs transplants in infants and young children. It is also one of only two programs performing 10 or more pediatric transplants per year. And even with high volume, the program has a pristine record of below-average wait list times, with a median wait time of less than four months, shorter than most other programs.

Mallory, who is transitioning to the role of Medical Director Emeritus, attributes the program’s success to the collaborative and comprehensive approach to care, which includes surgery, pulmonary medicine and immunology services, infectious disease expertise, social work, nutrition, psychological care, basic and clinical research, and more.

“One of the things I’m most proud of that we’ve achieved is a fabulous multidisciplinary team,” he said. “That’s common language in modern medicine, but we really have a great team”

As the program moves forward under new leadership, that team will continue to work together for the same shared goals: improving outcomes, delaying chronic rejection and keeping children where they should be – with their families.

“Easily, the single best thing is to have engaged honestly and deeply with patients and families and see the majority of them capture years of quality of life,” Mallory said. “What we do here is much more than a dry scientific pursuit; it’s an amazing opportunity to see miracles happen.”

To learn more, watch the video.

August 13, 2018

Dr. Ameeben Patel, January – June 2018 Physician

Your name, title and department. How long have you worked here?
Amee A Patel, DO, assistant professor of Pediatrics, board certified in general pediatrics, pediatric pulmonary, and sleep medicine – I started out as a sleep medicine fellow in 2014 and then joined as faculty.

Tell us how you found out you won a super star award.
I found out about the super star award during our monthly faculty meeting. The section chief and practice administrator announced that I had received this award with several bright shiny balloons.

What does it mean to be recognized for the hard work you do? How has the organization helped you achieve your personal and professional goals?
Being recognized for this honor, is empowering. I feel incredibly grateful to be part of such an institution that encompasses the value of patient care. Texas Children’s Hospital has provided several opportunities for my personal and professional goals including medical education and research. The balance of working with patients, identifying gaps in knowledge/research as well as teaching students, residents, and fellows is quite rewarding and is amazing that I am able to participate in all three areas while working at Texas Children’s.

What do you think makes someone at Texas Children’s a super star?
At Texas Children’s, everyone is a super star. We are all dedicated to our patients and their families. We strive to deliver the best possible care as a team. Therefore, being recognized for the hard work and dedication to our patients is a team effort and the entire team should be recognized.

What is your motivation for going above and beyond every day at work?
After working as hard as we all do and with the challenges of health care that we face every day, I still have a sense of gratification that I helped several children in a single day – it is this feeling that motivates me to keep pushing through the various barriers and challenges of practicing in health care.

What is the best thing about working at Texas Children’s?
Texas Children’s is recognized nationwide for the specialists as well as the research. It is an honor to be part of such a great organization/team.

What does it mean to you that everyone at Texas Children’s is considered a leader? What is your leadership definition?
A leader at Texas Children’s is someone that puts the child and their family first and motivates and inspires others to continue to value this practice.

Dr. Nidhy Varghese has been named the new director of our Pulmonary Hypertension Program. Varghese took over for Dr. George Mallory who helped lead the program to national prominence.

“I am honored to be named to this prestigious leadership position,” Varghese said. “We are one of the few pulmonary hypertension programs in the United States dedicated to treating children. I am excited to expand our groundbreaking pulmonary programs and medical advances.”

In 2018, U.S. News & World Report ranked Texas Children’s Pulmonology as the best program in the country for children with lung diseases. Established in 2001, the pulmonary hypertension program is one of only a handful of pediatric hospitals nationally – and the only one in the southwest – to be named an accredited care center by the Pulmonary Hypertension Association. The program has extensive experience in the diagnosis and treatment of infants, children and teens with this rare condition.

The Pulmonary Medicine team specializes in the evaluation and treatment of complex, chronic and rare pulmonary disorders and offers services to treat children dealing with a variety of pulmonary issues. As part of its accreditation, Texas Children’s will also contribute to a national patient registry which will track diagnostic and treatment patterns and patient outcomes to help establish best practices in patient care.

Varghese will succeed Mallory in leading Texas Children’s program. During his tenure, Mallory helped the program earn national accreditation. He also served on the editorial Board of Pediatric Pulmonology for over 25 years. Mallory will continue to dedicate his time and expertise to the programs and the Pulmonology Section at Texas Children’s.

Click here to learn more about the Pulmonary Hypertension Program at Texas Children’s.

February 28, 2017

Texas Children’s Pulmonary Hypertension (PH) Program recently earned national accreditation from the Pulmonary Hypertension Association (PHA). Texas Children’s is among only six pediatric programs nationwide, and the only one in the southwest, to be awarded this high level of distinction.

“This accreditation is a recognition of the care that our program provides for children who suffer from PH,” said Texas Children’s pulmonologist Dr. Nidhy Varghese. “It is an honor to collaborate with other PH specialists across the country to advance the understanding and treatment of this lung condition that can affect heart function.”

The PHA designation means a lot for patient families like Jessica Johnson, whose 11-year-old daughter Kayleigh, was diagnosed with PH two and a half years ago.

Prior to her daughter’s diagnosis, Kayleigh experienced multiple fainting episodes with exercise. After seeing several pediatric cardiologists in their home state of Louisiana, Kayleigh finally received a diagnosis of PH, but her condition was so far advanced that she was in severe right heart failure. Since their local hospital did not have the resources to treat her condition, the family came to Texas Children’s Hospital for treatment.

“To know that my child is receiving state-of-the-art treatment reassures our decision in choosing the PH team at Texas Children’s as Kayleigh’s care facility,” Johnson said. “My husband and I are extremely happy to hear that Texas Children’s received accreditation from PHA.”

In order to be designated an accredited PH Care Center, a program must demonstrate dedication to making a proper diagnosis and have the capacity to appropriately and comprehensively manage PH patients through a set of criteria established by the PHA’s Scientific Leadership Council and PHCC Oversight Committee.

“PH is a rare disease which requires care from highly trained specialists,” said Dr. George Mallory, director of the PH Program and medical director of the Lung Transplant Program at Texas Children’s. “PHA-designated comprehensive care centers are committed to providing state-of-the-art care and therefore achieving the best possible outcomes.”

Since Kayleigh’s treatment at Texas Children’s through the PH Program, Johnson says her daughter has made great progress.

“She runs, plays, rides her bike and has gone back to taking dance lessons,” Johnson said. “Kayleigh has not had another episode since her diagnosis and she is doing many of the things she enjoyed prior to her diagnosis. I truly believe the doctors and staff at Texas Children’s saved my daughter’s life. For that, I am forever grateful.”

Texas Children’s Pulmonary Medicine is ranked No. 1 nationally by U.S. News & World Report. For more information on the PH Program, click here.

December 6, 2016

12716transplantinside350Seventeen-year-old Shelby Standridge came down with common colds early in her childhood, but nothing out of the ordinary. A severe nose bleed at age 9, however, landed her in the hospital and prompted questions from her parents about the cause of her unexpected illness.

Doctors in her hometown in Alabama thankfully ruled out leukemia, but did a test for cystic fibrosis, which came back positive. Cystic fibrosis is a genetic disorder that affects mostly the lungs, but also the pancreas, liver, kidneys and intestine.

At the time doctors tested Shelby for the disease, they determined her liver was already fully involved, almost to the point of end-stage liver failure. She wasn’t yet a candidate for transplant, however, so she continued battling the disease over the next five years. Throughout the past couple of years, though, Shelby’s parents and older sister noticed her lung function was declining.

“Her life had become narrow,” Shelby’s mom, Teresa Standridge, recalled.

As a result, Shelby and her family were referred to Texas Children’s, home to one of the largest pediatric transplantation programs in the nation. The team performed 86 solid organ transplants in 2015, making the program the most active pediatric transplant program in the U.S. last year.

Shelby, her mom, and older sister, Olivia, moved to Houston in October so she could be listed for a double lung and a liver transplant. A grueling wait that was expected to last six to eight months, was a mere week as Shelby underwent a 14-hour lung-liver transplant on November 8.

A multidisciplinary team of surgeons performed the procedure which is deemed so uncommon that Texas Children’s has done, including Shelby, only six of these cases since the inception of the transplant program.

“Shelby’s case is quite unusual,” said the teenager’s pulmonologist Dr. Ernestina Melicoff-Portillo. “There are only a small number of cystic fibrosis patients who have both lungs and the liver affected.”

Now, two weeks post-transplant, Shelby is feeling “ten times better” than she did and “can enjoy more in everyday life.” Her dad, Brian Standridge, noted that he hasn’t seen her grin so wide in years.

Dr. John Goss, medical director of Transplant Services, said the expertise of and the collaboration with the clinical staff and the two different surgical teams are what made Shelby’s outcome a success.

“This type of procedure only could happen at a place like Texas Children’s where our transplant program continues to earn its reputation as one of the best pediatric transplant programs in the country,” he said.

Click here to watch KHOU 11 News’ story about Shelby’s dual-organ transplant.

September 20, 2016

It’s been more than a year and a half since a team of Texas Children’s surgeons and medical staff separated conjoined twins Knatalye Hope and Adeline Faith Mata in an historic, more than 24-hour-long procedure. Since then, the girls – now 2 years old and living at home near Lubbock – have worked hard with various types of therapists, medical experts and on their own to recover from the monumental surgery.

During a recent visit to Texas Children’s Hospital, physicians and medical personnel got an up-close look at just how far the girls have come. When a nurse in pulmonologist Dr. Fadel Ruiz’s office weighed the girls, they walked up to the scale and hopped on. When the nurse bent over to take their blood pressure, they sat on the exam table and reached for her stethoscope like it was a toy. And, while the girls were waiting for Dr. Ruiz to enter the room, they, like most toddlers, ran around, chattered and begged for snacks.

“They are growing and reaching milestones every day,” the twins’ mother Elysse Mata said. “It’s non-stop around our house. We aren’t getting much sleep but that’s OK.”

The girls’ father, Eric Mata, said watching his girls grow and get stronger every day feels good and that he sometimes has to stop and think just how far they have come. “It’s amazing really,” he said. “I never imagined our lives would be like they are today.”

Dr. Darrell Cass, one of the lead surgeons in the separation case and co-director of Texas Children’s Fetal Center, said Knatalye and Adeline are doing “awesome!” He said Adeline is slowly being weaned off of her ventilator and G-tube, devices she only uses occasionally versus all the time after the separation. The toddler’s pelvis is healing well and her lungs are continuing to grow and become stronger, progress Cass said will help her walk, talk and eat even better than she is now.

Knatalye’s breathing is so good Cass said cardiovascular surgeon Dr. Dean McKenzie recently removed a metal plate from her chest and closed her sternum, a procedure they were waiting to do following sufficient lung strength and growth. Like her sister, Knatalye is being weaned from the G-tube and is learning to eat on her own. She is walking well, Cass said, but her pelvis is still a bit separated, something she might have to get more work done on in the future.

“I’ve always said the girls will walk into kindergarten one day together and I definitely think that will still be true,” Cass said.

View a series of photos from the Mata’s visit below.

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.”