July 17, 2018

Texas Children’s Hospital’s Emergency Management and Bone Marrow Transplant teams recently conducted their first large scale functional radiation injury treatment exercise. As a member of the Radiation Injury Treatment Network (RITN), our organization conducts annual exercises as part of our emergency preparedness activities.

“This was new for us. We’ve never done an exercise on this scale,” said manager of the Emergency Management department, Aaron Freedkin. “Normally, we just do our own internal tabletop exercise, last year was a regional tabletop, and this year we wanted to make ours a large and more complex functional exercise.”

RITN is a system of hospitals affiliated with the National Marrow Donor Program providing comprehensive evaluation and treatment for victims of radiation exposure or other bone marrow toxic injuries.

This year’s exercise was a simulation of the arrival of 30 patients to the Medical Center Campus, six patients to Woodlands, and six patients to West Campus, that are victims of a terrorist event. The scenario starts two weeks after a nuclear explosion in Los Angeles and the victims are all suffering from acute radiation syndrome. The patients that are coming to Texas Children’s are in need of a bone marrow transplant or specialized supportive medical care.

To prevent overcrowding the Emergency Center, a Patient Reception Center (PRC) for the exercise was created in the first floor auditorium of Feigin Tower. Several supportive care staff were positioned strategically for the arrival of victims. Conference rooms at West and Woodlands Campuses were also set-up to simulate a reception center.

“You can kind of call it a stress test for how our hospital’s going to deal with an influx of real patients. It’s really a medical surge exercise for us,” Freedkin said. “We’ve done it with mass casualties where we’ve simulated a bus crash or a terrorist event for the ER, but we’ve never done something quite on this scale and in this vein.”

Prior to the exercise, the team had a quick introductory briefing to make sure everyone knew their roles. The simulation then began with patients arriving, some even on gurneys as they would possibly be during a real event. Upon arriving, patients and their family members or guardians received a preliminary health check for safety precautions before visiting with Patient Experience to offer comfort and any necessary information needed along with Language Services to assist with any language barriers.

“They are scanned for radiation contamination so that the Communications Team can make sure all of our current staff and patients who are in the hospital know we are ensuring there’s no risk from these patients arriving,” Freedkin said. There’s a lack of understanding among the general public about the difference between contamination and exposure to radiation. So they definitely would go and get checked first.”

The initial step of the process was registration before the patient and their family members were escorted through triage. They then met with a physician for a simulated exam, followed by a simulated blood drawing session. Texas Children’s Patient and Family Services departments such as Social Work, Chaplaincy, and Child Life were also available to offer patients whatever kind of support they needed. This is very important because in a real event they would have been taken from a familiar environment where the incident happened, to an unknown field hospital, and possibly even another level of care before arriving at Texas Children’s.

“They might not know where all their family is. They might not know who survived. There’s some big emotional issues there,” Freedkin said. “They might not have any belongings either. We’re going to bring them here and make sure that we’re meeting all of their physical and emotional needs.”

The simulation ended after the last patient went through the entire process successfully. Essentially, they would have gotten all of the stations checked off on their card, then transferred to a patient care room if necessary.

“The exercise was very successful in testing our PRC,” Freedkin added. The PRC was a new concept that we developed to allow the hospital to process a surge of patients into the hospital without putting stress on the Emergency Center.”

For next year the teams hope to do a more complex full scale exercise where they would be able to move a larger number of patients to and from Ellington Field, a local military airport, and create a greater simulation to possibly include other outside emergency services such as the fire department, state entities, and federal agencies.

“I look forward to seeing how the lessons learned from this exercise improve the process for the next time that we simulate it,” Freedkin said. “It’s something we hope never happens, but it’s something that we need to be prepared for and be able to support if something really does happen. In the big picture, it helps us with overall preparedness that we can use the lessons here to manage any large scale surge event.”

April 24, 2018

Texas Children’s emergency operations plan was put to the test during a comprehensive active shooter exercise on April 16. This was the first time an emergency exercise of this scale and scope with external and internal participants was completed at Texas Children’s Hospital Medical Center Campus. Two similar exercises were previously conducted at the Woodlands and West campuses in 2017.

The exercise included over 200 Texas Children’s staff and employees and 30 members of local law enforcement including, the University of Texas Police Department, Harris County SWAT Team, and the state department diplomatic security service. There were also multiple external observers and evaluators onsite. Having multiple agencies involved in simulating an active shooter incident creates an environment that is as realistic as possible and allows law enforcement agencies to practice their skills in a new environment. A secondary benefit is having the opportunity to train in our hospital footprint which would be valuable in the event of a real active shooter incident.

After the participants arrived, they were put through a safety briefing with Texas Children’s Hospital Emergency Management, followed by further orientation with The University of Texas Police Department, and “Run, Hide, Fight” Training provided by Texas Children’s Security. During these exercises blank ammunition was used to simulate gunfire increasing realism while maintaining safety.

The exercise was held on the twelfth floor of the Legacy Tower, a new extension of Texas Children’s Hospital that officially opens Tuesday, May 22. Legacy Tower was the perfect place to host this exercise since it is vacant, so patient care would not be disturbed, and due to its convenient location on Texas Children’s Hospital Medical Center Campus.

The exercise involved two scenarios both presented within each of the five sessions. The first scenario was a disgruntled parent seeking retribution against the staff following the recent death of his child. The enraged father came into the hospital looking for a particular physician, became agitated, pulled out a weapon, and then started shooting. Once the father started shooting, people began to scramble, and at that point, all the staff were expected to execute the “Run-Hide-Fight” training that was provided. The shooter eventually isolated himself then took his own life.

After law enforcement entered the scene they began searching the area, located the shooter, secured the floor and evacuated all of the participants to a safe area. At that point the first evolution of the exercise ended and all the participants were gathered for a quick debriefing to discuss what happened before being repositioned for the next evolution of the exercise with participants changing roles.

“So that first time kind of startles them,” Aaron Freedkin, manager of Emergency Management, said. “Then they really settle into the “Run-Hide-Fight” training.”

The second scenario was a domestic dispute involving a person looking for his ex-wife, accusing her of taking custody of their kids and seeking retribution. While the scenes played out looked and sounded real, fortunately, this was only an exercise. However, these realistic situations are needed to evoke the intensity that would arise in the event of a real active shooter incident.

According to Texas Children’s Hospital Emergency Management, the first time they ran through the drill participants had the tendency to hesitate rather than react. However, the second time they were more comfortable and as a result, their performance improved. After the second evolution of the exercise, Texas Children’s Hospital Emergency Management conducted a follow-up discussion and debriefing in a process to capture lessons learned from the exercise.

“We are always seeking to improve our processes and our plans, so we do what’s called an after action debriefing or a hot wash,” Freedkin said. “This is where we sit them down and talk about what they went through and ask them what went well and if there are any opportunities for improvement.”

During the process, Everbridge, our emergency notification system, was tested by sending messages stating that there is an active shooter, the specific floor, and everyone is told to “run-hide-fight.”

“Overall, it was a very successful exercise. We really want people to get that visceral reaction,” Freedkin said. “It’s one thing to show people a video or to give them a PowerPoint and show them how to respond during an active shooter event. It’s very different to stick them on a floor and then have somebody shooting off a weapon. So, this really gets your adrenaline going and gives them more of a realistic feel for what a real event would be like.”

We are better prepared today than we were before, and the lessons learned from this exercise will drive improvements to our planning and response for many months to come.

September 12, 2017

A 4-year-old child undergoes a Fontan procedure to correct a heart problem. The child’s medical team is unaware that the proposed post-surgical plan of care may endanger not only the patient but also the patient’s family – and is also financially wasteful. If the care team is unaware of these potential risks, how can they offer the patient and patient’s family the best, most appropriate care that yields the best possible outcomes?

As one of the top five pediatric hospitals in the country, Texas Children’s cares for many patients with a number of medical conditions. Across our hospital system, care teams follow clinical standards related to specific medical conditions to ensure the best care is delivered to the right patient at the right time, leading to improved long-term outcomes.

“Clinical standards provide a way to align our clinicians, families and other organizations with a more streamlined approach to improve the safety, quality and cost efficiency in the delivery of patient care,” said Dr. Charles Macias, chief clinical systems integration officer at Texas Children’s and director of the Center for Clinical Effectiveness and Evidence Based Outcomes Center. “By allowing this type of standardization, hospitals can minimize wasteful expenditures caused by medical errors and ordering of unnecessary tests which can lead to inefficiencies in health care.”

From developing patient care guidelines for post-surgical care to treating common conditions like asthma and diabetes – among many other clinical conditions – our health care teams rely heavily on the instrumental work of Texas Children’s Evidence Based Outcomes Center (EBOC). The team reviews and translates scientific evidence into clinical standards that detail the essential steps in the care of patients with a particular clinical condition.

“Once a specific disease is selected, our team conducts a thorough review of evidence using the GRADE methodology,” said EBOC Research Specialist Andrea Jackson. “We review clinical questions and assess potential benefits and harms of different treatment options. We guide multidisciplinary teams to incorporate clinical expertise from our physician and nursing partners as well as input from patient family advocates on their own experiences into the development of practice recommendations based on available evidence regarding the specific clinical condition.”

Since the opening of the EBOC in 2010, the team has developed 95 clinical standards, some of which have led to publications in peer-reviewed health journals. In addition to the Connect website, Texas Children’s clinical standards for medical conditions are available here on the Outcomes and Safety external site.

“We are adding new clinical standards to that site about every three months,” said Anne Dykes, assistant director of Texas Children’s Outcomes and Impact Service. “All 10 years’ worth of work that we’ve built internally to help our own clinicians and those across our system, we’re now making available to the public. These standards are not just for physicians, clinicians and administrators at other hospitals, but also for patient families to help them understand the essential steps in the care of patients with a particular condition.”

The center also provides an evidence-based practice course that has educated more than 150 health care professionals on how to develop practice guidelines. Since 2007, more than 300 physicians, 275 nurses along with many of our patient family advocates have participated in guideline developments to enhance patient outcomes.

Additionally, the EBOC has launched a national collaborative with 11 other children’s hospitals to bring clinical standardization across the nation.

“Through this strategic collaboration, we are identifying where clinical standards could be done in unison so that we could all share in our products and still offer an opportunity to tailor them to our own individual institutions,” Macias said. “We have a national need for the science of it and a local need for the process of care delivery.”

Click here for a complete list of the EBOC’s 95 clinical guidelines developed to treat specific medical conditions.

May 9, 2017

The Department of Emergency Management is presenting its 11th Annual Emergency Management Bridge Event from 10 a.m. to 2 p.m. Wednesday, May 17, on The Auxiliary Bridge.

Representatives from various Texas Children’s departments as well as external partners such as the City of Houston Office of Emergency Management will be onsite to help you prepare for hurricane season by assisting you with registering in the Employee Disaster Roster (EDR), getting your emergency supplies ready, and making sure you know where to go and what to do during a disaster.

Plan to stop by The Auxiliary Bridge to learn safety tips to help you prepare yourself, your family and your patients for the 2017 hurricane season.

April 4, 2017

Hundreds of employees with Texas Children’s Hospital The Woodlands recently poured into the grand lobby of the new hospital for a day-long employee orientation that covered everything from welcoming remarks by hospital leadership to expectations regarding emergency preparedness, patient experience and quality and safety protocols.

The doors of the new 550,000-square-foot building will open its doors to the public on Tuesday, April 11. The recent orientation sessions mark the near end of a long and thorough preparation process leaders and staff have undergone to ready themselves to serve the patients and families of The Woodlands and surrounding communities north of Houston.

“Opening day is almost here and I feel confident that we have done everything in our power to prepare ourselves and the entire Texas Children’s system for what will be a monumental day in our service to patients and their families,” said Texas Children’s Hospital The Woodlands President and Texas Children’s Executive Vice President Michelle Riley-Brown. “Our efforts have spanned many topics but have consistently focused on quality, safety and the overall patient experience people will have when they arrive at our doorstep for care.”

During the past year, more than 600 employees and providers who will staff the new hospital have been involved in one or more of the following initiatives to prepare themselves as a team to serve the thousands of patients and families expected to seek high quality care and pediatric services in their community from Texas Children’s Hospital The Woodlands.

Connections: The Experience and The Vision: All Woodlands employees, physician partners, and leadership completed two courses focused on hardwiring a culture based on both the patient and the employee experience. The goal of these sessions is to build on the existing Texas Children’s core values of living compassionately, amplifying unity, embracing freedom and leading tirelessly. In addition, the sessions aspire to establish behaviors that unify Woodlands employees as a team and leave patients and families feeling connected to the new hospital and staff as their healthcare provider.

Breakthrough Communications: Eighty physicians and advanced practice providers completed this Texas Children’s Hospital led physician communication course focusing on enhancing the conversation and dialogue between patients, families and caregivers.

Error Prevention Training: Hundreds of providers and staff working at The Woodlands campus took this three-hour class taught by members of the Texas Children’s Quality and Safety Department and trained Woodlands campus instructors. The course focused on sustaining a culture of safety and strategies for reducing medical errors and serious safety events.

Provider Orientation: The entire medical staff have either attended or is scheduled to attend provider-dedicated sessions focusing on operational details specific to The Woodlands campus. Training includes topics such as emergency response, community outreach, personal safety and security, environmental safety, quality metrics, new equipment training, useful communication tools and resources for providers, and a hospital tour.

Advanced Quality Improvement (AQI) Boot Camp: A group of about 40 leaders and medical providers attended this intense program aimed at improving care delivery and quality of care. The training occurred over three days and was based on a national patient safety training program that has shown significant improvement in patient outcomes.

Simulation Training: The leadership team at Texas Children’s Hospital The Woodlands partnered with the Texas Children’s Hospital Simulation Center to design and facilitate a robust simulation training for the care teams and testing of the hospital environment. Using advanced technology and equipment to create life-like scenarios ranging from routine patient care to emergency code situations, the simulations allowed providers, staff, and even family members to respond as a team and test the hospital’s systems, environmental layout, and processes. The scenarios were recorded on video, allowing hospital leaders to review the training exercises and make any necessary adjustments before opening the hospital.

Emergency Management Drills: Texas Children’s Hospital, in partnership with the Montgomery County Sherriff’s office, University of Texas Police Houston, the Montgomery County Office of Emergency Management, and Houston Police Department, have conducted two active shooter exercises at Texas Children’s Hospital The Woodlands. The purpose of the exercises was to test the emergency notification procedures, train staff to respond to an active shooter, and give our law enforcement partners a chance to practice their tactical response to an active shooter in the new building.

In addition to these formal training programs, leaders, physicians and staff have been meeting weekly to discuss things such as system optimizations, scopes of service, workflows, staff onboarding, teambuilding and more. Everyone involved has been working collaboratively to ensure we transition smoothly into operations on April 11, said Director of Patient Care Services Ketrese White.

“We have a unique opportunity to provide world class dedicated pediatric care to this community and surrounding communities nestled in the North,” White said. “We are excited to see the positive impact we will make in this community.”

Located off of I-45 in The Woodlands, Texas Children’s Hospital the Woodlands will serve children and families in the Woodlands, Kingwood, Conroe, Spring, Magnolia, Humble, Huntsville and beyond. The new hospital will build on a decade’s worth of relationships Texas Children’s has built in the community through our primary and sub-specialty care services offered at Texas Children’s Pediatrics locations and the Texas Children’s Health Center The Woodlands.

The hospital will offer services in more than 20 areas of specialty care at a state of the art facility with 32 acute care beds, four operating rooms, 12 radiology rooms with two MRIs, an emergency center with 25 patient rooms, a sleep center, a helipad, 1,000 free parking spaces and 28 critical care rooms (14 NICU and 14 PICU). Patients will receive expert care from highly skilled clinicians, and may also benefit from support services such as translation services, child life specialists, social work, care management, chaplains, volunteer services, and patient/family advocacy.

Texas Children’s Hospital in partnership with the Montgomery County Sheriff’s Office, University of Texas Police at Houston, Montgomery County Hospital District, Montgomery County Office of Homeland Security and Emergency Management, and the Houston Police Department conducted two active shooter exercises on March 3 and then an active shooter exercise followed by a mass casualty exercise on March 10. The exercises were conducted in the Emergency Center, lobby and cafeteria of the hospital, which will open its doors to the public on April 11.

“I think these are critical exercises to undertake and am proud to see Texas Children’s Hospital performing these,” said Dr. Jennifer Arnold, medical director of the Texas Children’s Hospital Pediatric Simulation Center. “The opportunity to identify system flaws before a real life threatening emergency occurs is priceless.”

View photos from the exercises below.

The scenario for one of the exercises was of a disgruntled family member of a deceased patient seeking retribution on the Emergency Center physician. A police officer dressed in normal clothes and carrying a plastic training weapon played the shooter and 25 employees from across the Texas Children’s system played either an employee, patient, or family member.

The purpose of the exercise was to test Texas Children’s emergency notification procedures, staff training for response to an active shooter (Run, Hide, Fight), and to give our law enforcement partners a chance to practice their tactical response to an active shooter in our new building.

“As nurses we enter the profession to provide care to others and in these situations there is a pivotal moment where you must place yourself first to ensure safety,” said Tarra Kerr, director of nursing for Texas Children’s Hospital Emergency Center. “This is hard to do and we must continue these training opportunities to prepare, and more importantly create an avenue to have open dialogue about these prevalent issues.”

The second exercise involved an active shooter exercise in the cafeteria and common areas of the hospital, followed by a mass casualty incident and medical surge exercise in the Emergency Center using 20 young people volunteering to be patients and dressed in Moulage or simulated injuries using special effects makeup.

According to various participants, the exercises were very successful and lessons learned will allow staff to improve Texas Children’s emergency plans for an active shooter event, improve our emergency notification processes, and improve our staff training.

“While I hope to never encounter a scenario such as an active shooter on site, this drill certainly gave me and my colleagues the skills to be prepared for and to survive this terrible and hopefully exceedingly rare event,” said Dr. Joseph Allen, medical director of Texas Children’s Hospital The Woodlands Emergency Center.

February 28, 2017

Dr. Laura Monson, co-director of the Craniofacial/Craniosynostosis Clinic, was recently appointed Chief Surgical Quality and Safety Officer for Texas Children’s Hospital.

Monson was selected for the position after a thorough nationwide search and will succeed neurosurgeon Dr. Tom Luerssen, who has been the voice of surgery within Quality Operations Management at Texas Children’s driving surgical quality efforts at the hospital and throughout the system.

Among the many quality projects Luerssen was instrumental in establishing during his tenure are the OR-specific Surgical Checklist and the Surgical Quality Committee. Luerssen also was essential to the success of the hospital’s American College of Surgeons Level 1 Children’s Surgery Center Verification.

Surgeon-in-Chief Dr. Charles D. Fraser and Senior Vice President/Chief Quality Officer Dr. Angelo Giardino said Monson distinguished herself in the selection process as having just the right vision and passion to lead the Texas Children’s surgical quality program into the future.

“Dr. Monson has demonstrated a remarkable commitment to improving the quality of care and quality of life for her patients as evidenced by her many cleft lip and palate and craniofacial research programs,” Fraser and Giardino said. “She is continually educating herself on quality improvement and has been an internal champion for it within the Department of Surgery.”

Monson will begin her new role on Wednesday, March 1. Click here for more information about Monson and her clinic experience and interests.