May 28, 2019

Texas Children’s Center for Childhood Injury Prevention and its Safe Kids Greater Houston Partners were recently recognized as the 2019 “Team of the Year” by the National Child Passenger Safety Board at the 2019 Lifesavers National Conference on Highway Safety Priorities in Louisville, Kentucky.

The Safe Kids Greater Houston Coalition, of which the Children’s Center for Childhood Injury Prevention is the lead organization, was selected because of its unwavering commitment to child passenger safety. The coalition conducts seat check events at over 20 inspection site that span five counties, totaling nearly 2,000 miles.

“The people on this team are special,” said National Child Passenger Safety Board Chair Tammy Franks. “Their willingness to go that extra mile in an effort to educate parents and caregivers on car seat safety is extraordinary. Their work prevents unnecessary injuries and saves countless lives.”

More than 300 nationally certified Child Passenger Safety Technicians serve on the Safe Kids Great Houston team, which is made up of health and safety experts, law enforcement, community advocates and other volunteers. Members check more than 5,000 car seats every year and distribute more than 1,000 seats to families in need. They also raise awareness among adults and children by providing lifesaving education and resources in the areas of Child Passenger Safety, Water Safety, Home Safety and Bicycle and Pedestrian Safety.

May 6, 2019

Texas Children’s Emergency Management and Bone Marrow Transplant teams recently conducted their first full-scale radiation injury treatment exercise partnering with outside agencies to simulate their roles in a radiation-related event.

As a member of the Radiation Injury Treatment Network (RITN), Texas Children’s conducts annual exercises as part of our emergency preparedness activities. RITN is a system of hospitals affiliated with the National Marrow Donor Program providing comprehensive evaluation and treatment for victims of radiation exposure. MD Anderson Cancer Center is the only other RITN member organization in the Greater Houston area.

“Over the past three years, the Emergency Management team at Texas Children’s has worked closely with the Radiation Injury Treatment Network to increase the fidelity and realism of the drills we have been conducting,” said Dr. Brent Kaziny, Medical Director of Emergency Management. “Developing plans for such hopefully never-in-our-lifetime events is one of the many responsibilities of Emergency Management. Seeing plans tested first as tabletop drills and eventually as full scale exercises allow us to pinpoint where improvements need to be made. Texas Children’s Hospital has come so far, and watching these plans become operational is extremely rewarding.” 

Texas Children’s Emergency Management Manager Aaron Freedkin agreed and said if there was a radiation event nearby, Texas Children’s would get many of the affected pediatric patients.” 

“That’s why it’s so important for us to practice and prepare for such an event,” Freedkin said. “Last week’s exercise gave us a great opportunity to do that.”

The seven-hour event was the first full-scale radiation injury treatment exercise the organization has participated in and tested our response following the mock detonation of an improvised nuclear device that sends patients requiring bone marrow transplant or supportive medical care to Houston by way of the National Disaster Medical System.

The exercise involved various outside local, state and federal agencies including the Southeast Texas Regional Advisory Council, Veteran’s Affairs, and American Medical Response. The exercise began at Ellington Field, a joint military and civilian airport that would host the Patient Reception Center during a large-scale disaster. Run by the Veteran’s Affairs Federal Coordinating Center, the center would receive patients from outside Houston and coordinate available local resources.

Texas Children’s Bone Marrow Team Member Dr. John Craddock said understanding who the local players are and how to work with them is a great addition to the annual exercise, which typically has been a tabletop exercise with the exception of last year when it expanded to a large scale functional exercise involved Texas Children’s Hospital West Campus and Texas Children’s Hospital The Woodlands.

“This year, the exercise was full scale, giving us a more realistic idea of what we would be dealing with,” Craddock said. “I think it was very informative.”

During the exercise, Craddock and another members of the Bone Marrow Transplant team helped receive, triage and assign for transport to area hospitals 50 mock pediatric patients and 50 adult patients. The pediatric patients at Ellington Field were played by high school students from Friendswood High School. The adult patients at Ellington Field were played by adult volunteers from various civic groups including Bay CERT, a local Community Emergency Response Team.

The second half of the exercise took place on the fourth floor of the Pavilion for Women, part of which was turned into a Patient Reception Center for the patients coming to Texas Children’s Hospital for evaluation and/or treatment. Those mock patient and their family members were played by DeBakey High School students and saw members of our pathology, chaplain, social work, patient experience and case management teams before being transferred to a patient care room if necessary.

“This is the first time we’ve simulated going from plane to hospital,” said James Mitchell director of Organizational Resilience and Emergency Management. “Going through the entire process really expanded our knowledge about how this would work.”

October 2, 2018

Texas Children’s Hospital Hygiene Work Group for the Central Line Acquired Bloodstream Infection, Hospital Acquired Conditions (CLABSI HAC) recently spearheaded a poster competition on the five moments of hand hygiene.

“Performing proper hand hygiene is our first line of defense in preventing hospital acquired infections,” said Mona Clark, assistant clinical director of Nursing (General Medicine and operational lead for the Hygiene Work Group. “Our organizational goal for hand hygiene is equal to or greater than 95 percent. Through collaboration with our infection control department and nursing, all ancillary care providers received education and training on the five moments of hand hygiene.”

To further engage and capitalize on the momentum of awareness and compliance for hand hygiene, the system-wide poster competition was created. Across the system there was a total of 28 outstanding posters submitted from Texas Children’s Medical Center Campus, Texas Children’s Hospital West Campus and Texas Children’s Hospital The Woodlands. Posters were placed at entrances to the units and clinical areas to be viewed by both staff and visitors.

Senior executive leaders from all campuses graciously participated as judges for the competition – Mark Mullarkey, Mary Jo Andre, Jackie Ward, Bert Gumeringer, Dr. Judith Campbell, Dr. Paul Sirbaugh and Dr. Jeffrey Shilt.

A first place winner was selected at each campus:

Medical Center Campus – 12WT General Medicine Transplant Unit poster “Now Showing the 5 Moments of Hand Hygiene”
West Campus – Emergency Center “Hand Hygiene Challenge”
The Woodlands Campus – Emergency Center “Be Incredible – They wash their hands”

“This fun competition further engaged our teams in working together to ensure we all perform proper hand hygiene for the safety of our patients and families,” Clark said. “Thank you all for participating. Our hand hygiene scores clearly reflect your dedication and hard work.”

Bert Gumeringer, Vice President, Facilities Engineering & Support Services, is now the Texas Children’s Environment of Care Safety Officer. In accordance with Texas Children’s policy #331 as the EOC Safety Officer, Bert Gumeringer is authorized to take action necessary to assure a safe working and patient care environment in this capacity, he has full access to all personnel and facilities in order to identify and correct safety hazards.

The EOC Safety Officer will take immediate and direct action to alleviate conditions that pose an immediate threat to life or health, or a threat of damage to equipment or buildings for Texas Children’s’ Hospital and/or designee of senior management before taking any action which will prevent or interrupt the delivery of patient care according to policy #331.

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.