January 27, 2020

On November 9, nearly 100 people gathered at the Meyer Building for Texas Children’s Microtia Awareness Day Celebration, sponsored by the Division of Otolaryngology’s Microtia Clinic.

The event featured educational talks and Q&A sessions offered by experts across numerous Texas Children’s specialties and subspecialties, including Pediatric Otolaryngology, Plastic Surgery, Speech and Language Pathology, Audiology, Anaplastology and a patient experience testimonial. There also was a full slate of games and activities for children, such as pottery painting, face painting, a bean bag toss, Hula-Hooping and mini bowling.

For patients and families alike, it was a wonderful opportunity to meet with members of the multidisciplinary care team in Texas Children’s Microtia and Atresia Program and to interact with other families who have been affected by these rare conditions.

Microtia is a rare congenital malformation of the ear, occurring in about one in 10,000 births. Typically, the condition affects only one ear and the severity of symptoms can vary widely. In less severe cases, the ear might be slightly smaller than normal. However, in the most severe cases, the ear may be completely absent. Because the external and internal structures of the ear are so developmentally linked, children with microtia may also experience atresia – an absence or underdevelopment of the ear canal and middle ear structures. Atresia can potentially cause hearing loss and speech difficulties, which can in turn contribute to poor academic performance.

The effects of these conditions on physical appearance and on speech, hearing and learning, especially during crucial early developmental years, could potentially have a lasting negative impact on self-esteem and overall quality of life.

To meet the complex needs of patients with microtia and atresia, Texas Children’s has built the only comprehensive program in the state that offers the full spectrum of care, from reconstruction of the outer ear, to complex repair of aural atresia, to hearing aids or implants for appropriate candidates.

“With our program, we have created a one-stop shop where families have access to care for children of all ages – and our demand is high,” said Dr. Rodrigo Silva, director of Texas Children’s Ear and Hearing Center. “These conditions may be rare, but because of Houston’s size and diversity we see a very large number of patients each year.”

The Microtia and Atresia Program offers families a multidisciplinary approach to care that includes audiology, with experts trained in age-appropriate hearing testing and solutions; speech and language pathology; and surgical interventions to address cosmetic needs and hearing loss. The event gave Texas Children’s caregivers an opportunity to share the many ways we can help.

“We wanted to highlight our capabilities and let families know that we offer individualized treatment paths for each child we see,” said Dr. Yi-Chun Liu, Texas Children’s pediatric otolaryngologist and associate program director for the Microtia and Atresia Program. “Whether the child needs a reconstruction surgery of the ear or ear canal, a hearing aid or implant, speech and language therapy, or some combination of all of these, we’re committed to providing them with the best possible care.”

At the end of the event, parents were given survey cards that asked for suggestions about the kinds of information regarding microtia and atresia that families might find most helpful when starting their care journey. There was also a section for feedback and comments.

Judging by some of the responses, the event was a success.

  • “The wealth of knowledge was amazing.”
  • “Loved that multiple options were discussed and the importance of team partnerships.”
  • “This is our second year, we will continue to come every year.”

“We’ve already had requests to make it an annual event,” said Jessie Marcet-Gonzalez, Microtia Day celebration coordinator with the Division of Otolaryngology. “We had so many volunteers who helped make this day special for our families and in letting them know that we really care.”

One patient who made the day particularly special was Liliana Montano. The 13-year-old raised the funds to make the awesome red shirts everyone was wearing at the event. Liliana donated the shirts to all attendees.

Learn more about Texas Children’s Microtia and Atresia Program by clicking here.

December 9, 2019

For the past two years, increasing access to care has been one of the central goals across the Texas Children’s system, resulting in several new programs and initiatives.

The most recent example was on December 2, when the Department of Surgery took yet another major stride in its effort to provide patients and families with even more access to Texas Children’s surgical care through the launch of the new After Hours Clinic for Surgical Care.

The After Hours Clinic is now open Monday through Friday, 5 p.m. to 7 p.m., on the eighth floor of Mark A. Wallace Tower, and is staffed by the Surgical APP Hospitalist Team, which currently cares for surgical patients in the Texas Children’s Emergency Center (EC) and inpatient areas.

This clinic provides access to care for post-surgical patients or those who need to be seen quickly for a large range of non-emergency or non-urgent medical issues.

“There are many situations, particularly in the early postoperative period, in which parents feel the need to have a surgical provider evaluate their child,” said Texas Children’s Surgeon-in-Chief Dr. Larry Hollier. “Often this is just for reassurance or to provide additional instructions or guidance. The After Hours Clinic is designed primarily for families who feel they cannot wait to be seen until the following day.”

In addition to convenient clinic hours, patients and families will benefit from the relative low cost of clinic visits compared with visits to the EC or to urgent care. Usually a visit to the After Hours Clinic will cost the same as a regular clinic visit; and for post-surgical patients, it may even be covered within the global period.

Staff within surgical divisions can directly schedule patients to the After Hours Clinic in Epic. And in the coming months, pediatricians and families will be able to schedule as well by calling 832-822-2778.

After Hours Clinic for Surgical Care FAQs

When: Monday through Friday, 5 p.m. to 7 p.m.

Where: Mark A. Wallace Tower, eighth floor

Who is eligible?

  • New patients
  • Postop patients
  • Established patients

What types of conditions are treated?

  • All postoperative concerns
  • All wound concerns
  • Minor burns
  • Cast and splint issues (e.g., pain, swelling, wet or loose casts/splints)
  • Suture, staple or glue concerns
  • Cellulitis
  • Hair tourniquet
  • Gastrostomy button concerns
  • Foreskin concerns (e.g., balanitis, phimosis)
  • Fingernail infection (e.g., felon, paronychia)
  • Non-displaced fractures (bones are still in proper alignment)
  • Superficial lacerations (do not extend into the muscle or have exposed bone)
  • Ear and nose foreign body removal

What kinds of patients should be sent to an EC?

  • Patients who need EC resources, such as CT scans, sedation, etc.
  • Congenital heart patients
  • Patients with Ophthalmology concerns
  • Patients with Neurosurgical concerns

Who sees the patients?

Surgical Advanced Practice Providers (APPs) on the dedicated Surgical APP Hospitalist Team. The Surgical APP Hospitalist Team is cross trained in Pediatric General Surgery, ENT, Urology, Orthopedics and Plastic Surgery. While surgeons and physicians are not physically present during clinic hours, they will be contacted as appropriate.

How is a visit to the After Hours Clinic for Surgical Care different from a Same Day/A+ Clinic Appointment?

These are patients with a surgical concern who would otherwise go to the emergency room.

How does a patient get on the clinic schedule?

Surgery clinic staff, schedulers and/or ambulatory service representatives can directly schedule patients into an after-hour visit type in Epic. The templates will have 20-minute time slots starting at 5 p.m., Monday through Friday.

Who can I contact with questions or for additional information about the clinic?

For additional information about the After Hours Clinic for Surgical Care, please contact Kris Marsack or Susannah Ferguson.

October 29, 2019

Your name, title and department. How long have you worked here?
My name is Mark Mazziotti and I’m an Associate Professor of Surgery and Pediatrics, and I work in the Division of Pediatric Surgery. I’ve been on staff at Texas Children’s since 2001 and joined the Baylor Faculty in 2006.

Tell us how you found out you won a super star award.
I was finishing clinic and the clinic staff told me that Jag Grooms, our office administrator, wanted to talk to me about a new hire in the conference room at the end of the hall. I thought that was strange but didn’t think twice and walked into a surprise. The staff, Jag, and my administrative assistant Vanessa Mose, presented me with the award.

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?
It is a great honor to even be considered for an award that is based on the core values of Texas Children’s Hospital. I’ve been fortunate to work at one of the best children’s hospitals in the world over the past 18 years. The amazing clinical volume and the ability to attract patients from all over the United States has helped me fulfill my career goals. Although I perform the full complement of procedures of a pediatric surgeon, I focus on correcting chest wall deformities. I’ve had the privilege of treating patients from 4 different countries and ten different states. I also have the opportunity to teach medical students, residents, and fellows and this is incredibly rewarding.

What do you think makes someone at Texas Children’s a super star?
To me, a Super Star always goes the extra mile and makes sure that they excel at their craft. For me, I want to make the patient experience special. I gladly add patients to my clinical schedule so they don’t have to make a second trip to the hospital. Patients and their families are anxious and need their health care problems addressed and resolved. As a surgeon, I deal with very anxious patients and parents and it’s my job to inform them, care for them, and do my best to get them back to their usual activities.

What is your motivation for going above and beyond every day at work?
I have always had a motivation to excel at everything I do. It is an inherent motivation, but also one instilled by my parents to be the best that I can be, as well as to seek to help others. I think what helps me the most is to put myself in the shoes of those I care for – when that occurs, you almost don’t require motivation.

What is the best thing about working at Texas Children’s?
Without a doubt, I would have to say the people. No matter what their level of experience or their role, it’s clear that we all pull together and have common goals. It’s no wonder that Texas Children’s Hospital is always among the best places to work.

What does it mean to you that everyone at Texas Children’s is considered a leader? What is your leadership definition?
In my opinion, it means that everyone at Texas Children’s should strive to lead by example. The definition of a leader is someone that motivates and inspires others around them. I believe the best leaders influence the actions of others by demonstrating qualities such as compassion, patience, honesty, integrity, decision-making capabilities, good communication skills and accountability.

Anything else you want to share?
I love art and art history. I have over one hundred published medical illustrations and I enjoy oil painting. I have historically painted a canvas for our graduating fellow, although for the past two years I have created movies.

October 15, 2019

From November 14 to 15, Texas Children’s Hospital will host the 7th Annual Meeting of the International Society of Pediatric Wound Care (ISPeW), one of the premier societies in the world devoted to education, collaboration and the state of the art in pediatric wound care.

The two-day conference will be held in the beautiful new auditorium at the Jan and Dan Duncan Neurological Research Institute at Texas Children’s Hospital, and will feature experts in basic science, surgery and nursing discussing the latest advancements in the care, prevention and research of pediatric wounds. These will include Texas Children’s own Shannon McCord, director of Advanced Practice Providers and Nursing Clinical Support Services, Community; MaryAnne Lewis, wound ostomy nurse; and Dr. Sundeep Keswani, pediatric surgeon, surgical director of basic science research, immediate past president of ISPeW, and the event’s local chair. Also from Texas Children’s are Chief of Plastic Surgery Dr. Edward Buchanan and Texas Children’s Director of Surgical Advanced Practice Providers Ryan Krasnosky, who are serving on the conference’s Program Committee.

ISPeW meetings receive abstracts from wound care providers all around the world, a testament to the advancement of the society and to the importance of the field in wound care. New to the conference this year will be three keynote sessions, led by:

  • Dr. Steven Wolf, a leader in the field of pediatric burn care and a Professor of Surgery at Shriners Hospital in Galveston
  • Dr. Paul Bollyky, an immunologist and infectious diseases expert from Stanford, who will talk about his innovative work in biofilms
  • Sandy Quigley, Judi Stellar and Cathy Caillouette, three nurses who will be speaking about their work with the Braden QD pressure injury prevention scale and its implementation
Becoming the epicenter

The field of wound care in the United States, particularly for children, is not as mature as it is in Europe. Until the upcoming ISPeW meeting, there will not have been a meeting of this kind in the U.S. It has been a goal to form a coalition for pediatric wound care in the U.S. with Texas Children’s at the epicenter. A key step toward recognizing that vision was the launch of the Wound Care Clinic – one of only a few in the country, and the first and only one of its kind in Texas. Hosting one of the world’s premier pediatric wound care societies on our home turf is an important opportunity for Texas Children’s.

“Texas Children’s is proud to support the International Society of Pediatric Wound Care annual meeting,” said Surgeon-in-Chief Dr. Larry Hollier, who will also deliver welcome remarks to open the conference. “We’ve spent a lot of time together building Texas Children’s into the magnificent place that it is today. We see the amazing things that are happening here every day because we live it. But others around the country don’t fully appreciate what is happening here. When we host conferences, not only is our expertise on display, but it becomes apparent to anyone who steps through our doors that this place is special. That helps spread the word, builds referrals and strengthens our reputation in our peers’ eyes.”

Surgical leadership and Nursing leadership are also strongly supporting the conference. Thirty complimentary surgical physician assistant (PA) registrations were generously provided and have already been filled.

Nursing leadership has arranged for any interested Texas Children’s nurses to attend the conference at no cost. In addition, continuing nursing education (CNE) units may be earned.

“PAs and nurses are leading the charge in wound care in the United States,” said Keswani. “We have free registrations available for our nursing and PA colleagues, and want to get the word out that this is an amazing opportunity for Texas Children’s nurses to learn about advancements in pediatric wound care, and to also earn CNEs in the process.

If you are a Texas Children’s Hospital employee and interested in attending the ISPeW meeting, please contact Linda Cao at llcao@texaschildrens.org.

October 7, 2019

 

Texas Children’s Orthopedics Department jumped five spots from No. 15 to No. 10 in this year’s U.S. News and World Report survey.

The team worked quickly, relentlessly and collaboratively to achieve this ranking, a first for the Orthopedics department at Texas Children’s.

Service chief Dr. Brian Smith expressed his sentiments with the ranking, “The Orthopedics Division is thrilled and honored to be recognized as one of the top 10 Orthopaedic programs in the country. This is a tribute to our entire team of physicians, physician’s assistants, nurses and staff whose primary goal every day is to provide the best musculoskeletal care possible to our patients and families.”

But seriously, how did they move so far so fast?

Specifically, the Orthopedics Department accomplished four big wins for patients:

  • Gait Lab accreditation: Dr. Jeffery Shilt, chief surgical officer in The Woodlands, led efforts to ensure that our Gait Lab was accredited as a clinical motion laboratory. The Texas Children’s Hospital Gait Lab received this accreditation in record time after opening, providing exceptional care to patients with movement disorders.
  • Continuing education: 100 percent of nurse practitioners and physician assistants received pediatric orthopedic surgery related continuing education units. Janai’ Buxton, manager of Advanced Practice Providers in Orthopedics is proud of this dedication to education, saying, “Such education ensures our APPs are providing the very best current, evidence-based care for patients.”
  • Scoliosis outcomes: The spine surgery team implemented several changes, including a multi-disciplinary meeting, to reduce unplanned readmissions and reoperations for complex scoliosis surgery patients.
  • Gap closures: The team worked together to close out 90 percent of gaps related to the department structure.
Deserved recognition

The dedication and leadership of Dr. Larry Hollier, surgeon-in-chief, Dr. David Wesson, interim chief of Orthopedics, and Rachel Warfield, Director of Surgical Ambulatory Services, helped the team accomplish this ranking. Additional recognition goes to the many physician champions who led efforts to improve quality as well as the data team led by Ken Kocab and Debasis Dash.

The Orthopedics department sees this accomplishment as a testament to all the hard work that has been done to improve patient quality and access to care over the past several years.

Every year from October 6 to 12, the American Academy of Physician Assistants (PAs) honors the 50-plus-year history of the PA profession, and the immeasurable contributions to health care made by PAs during that time, with a week-long celebration – National PA Week.

Texas Children’s will again be celebrating amazing PAs across the system with events and festivities throughout the week. These include:

Tuesday, October 8

  • Taco Tuesday at each of our three Texas Children’s Hospital campuses

Wednesday, October 9

  • West Campus main lobby: Poster display, games, crafts, and a chance to meet and thank PAs
  • Texas Medical Center campus, Pavilion for Women 4th-floor conference rooms: “Get It Poppin’” Snack Break

Thursday, October 10

  • Texas Medical Center campus, Auxiliary Bridge: Poster displays, games, crafts and photos

Friday, October 11

  • The Woodlands main lobby: Poster displays, games, crafts, and a chance to meet and thank PAs
Helping lead the way in health care

Over the past half century, health care delivery has changed dramatically, with emphasis no longer solely placed on the expertise of a doctor, but rather on a team of caregivers. And because of the rising demand for health care, combined with the ongoing shortage of physicians in the United States, advanced practice providers (APPs) – PAs and nurse practitioners – have become major, even indispensable, players on that team.

APPs work in most areas of medicine, from primary care, to the emergency room, to surgical subspecialties. While they do not replace a physician, they work collaboratively on the care team and perform many of the duties a doctor might, including performing minor procedures, providing routine diagnoses, delivering health care education, assisting in the operating room and writing prescriptions.

“Because of the high demand for health care, it is widely accepted that much of that work couldn’t be accomplished without the partnership of PAs and nurse practitioners,” said Veronica Victorian, assistant director of Quality and Safety. “The collaborative relationship with the physician, and the increased opportunities and diverse responsibilities, also often mean a more autonomous role for PAs, in both the clinic and surgical settings.”

It’s then perhaps unsurprising that there has been a proliferation of APPs across the Texas Children’s system over the past few years.

“When I arrived at Texas Children’s in 2011, we had fewer than five PAs,” said Ryan Krasnosky, director of APPs at Texas Children’s. “The Department of Surgery alone now has more than 130 PAs.”

In fact, surgical PAs currently outnumber surgeons at Texas Children’s, an intentional part of the department’s strategy for growth. The Department of Surgery, moreover, is an excellent example of how PAs have added immense value that has led to improved patient access and the development of several key initiatives.

“There is no way that the Department Surgery can hire enough surgeons to keep up with the clinical demand of our rapidly growing city,” said Texas Children’s Surgeon-in-Chief Dr. Larry Hollier. “No one comes close to our surgical volume – 40,000 surgeries a year across every possible subspecialty. We rely on our PA partners to provide access at all of our locations throughout Greater Houston, so that patients and their families can be seen wherever and whenever they need help.”

PAs, along with nurse practitioners, have also proven to be key administrative leaders for the Department of Surgery, driving several critical initiatives around safety and quality, and have also been at the forefront of efforts to expand access to care in Houston, in Texas and across the southeastern United States.

“Saturday clinics, remote appointments via telemedicine and after-hours clinics have all largely been accomplished thanks to APPs, and we feel like we’re only scratching the surface,” said Kris Marsack, director of Surgical APPs.

Training the next generation of leaders

As the PA profession has evolved, so has the way Texas Children’s trains providers. One example is the Surgery Physician Assistant Fellowship, which was created in 2013 and was the first of its kind in the country.

You can watch this video to learn more about the fellowship.

“Pediatric surgery is not covered in most PA schools,” said Hollier. “We thought it would be a wonderful opportunity to take PA graduates and expose them to the broad diversity of pediatric surgery that exists here.”

During the intensive one-year program, fellows are fully immersed in the culture at Texas Children’s as they rotate through each surgical subspecialty service, including:

  • Congential heart
  • General pediatrics
  • Hand/microsurgery
  • Neuro
  • Ophthalmology
  • Orthopedic
  • Oto
  • Plastic/reconstructive
  • Surgical ICU
  • Surgical hospitalist
  • Trauma
  • Urology

The program also includes dedicated research time and suture, cadaver, and simulation labs. Training is provided in clinics, on the surgical floors and in the operating room, and involve pre-, intra- and post-operative care. Fellows can also participate in and help lead several community service initiatives, including the Family Fun Runs at Texas Children’s Hospital campuses in The Woodlands and Katy, the annual APP backpack drive.

Since its inception, the fellowship has grown to include eight providers, and is a valuable pipeline for talent and a unique training opportunity for providers who want to join the Department of Surgery team at Texas Children’s.

“We aim to retain every fellow and we are thrilled to see the number of applicants rise each year,” said Jackie Broda, PA-C and clinical lead of PA Fellowships.

Learn more about the Surgery Physician Assistant Fellowship.

September 30, 2019

Texas Children’s Hospital has announced the two new leaders of the Adult Congenital Heart Disease (ACHD) Program at Texas Children’s Heart Center® – esteemed cardiologist, Dr. Peter Ermis, as medical director and Dr. Edward Hickey, a recognized cardiovascular surgeon, as surgical director. Beginning on October 1, they will together guide the largest ACHD program in the state.

Texas Children’s is ranked No. 1 in the nation for pediatric cardiology and heart surgery by U.S. News & World Report, but for years the hospital has also offered expert care for adults with congenital heart disease. Texas Children’s ACHD Program allows patients with congenital heart disease to receive seamless continuity of care from birth throughout adulthood. As pediatric patients with congenital heart defects transition into adulthood, the program’s multidisciplinary team of experienced congenital heart disease specialists advises them on health and lifestyle choices for their adult needs, including physical challenges, exercise options and family planning. The program offers comprehensive medical and surgical care in collaboration with colleagues at Texas Children’s Pavilion for Women® and Texas Children’s Fetal Center®. The hospital’s ACHD Program is accredited by the Adult Congenital Heart Association (ACHA) and is one of only three accredited programs in Texas.

Ermis, a native Houstonian and dedicated member of Texas Children’s ACHD Program team since 2014, also serves as assistant professor at Baylor College of Medicine, Texas Children’s academic partner.

“I’m honored to take on a leadership role in the program where I began my cardiology career,” said Ermis. “As this population of patients grows, it is even more important they are cared for by congenital heart disease specialists who recognize their specific needs as they transition to and live through adulthood. Our team is revolutionizing the way we care for these patients, and I look forward to continuing to do so in partnership with Dr. Hickey.”

Ermis received his undergraduate degree at Rice University. He earned his medical degree from the University of Texas Health Science Center at San Antonio, and went on to complete his residency and pediatric and adult cardiology fellowship at Baylor. He is board certified in pediatric cardiology, adult cardiology and adult congenital heart disease. Ermis is a fellow in the American College of Cardiology and a member of the American Academy of Pediatrics, Texas Heart Institute Cardiac Society and the International Society on Adult Congenital Heart Disease.

Hickey, a proven leader in cardiovascular surgery, most recently served as associate professor of cardiac surgery at the University of Toronto and cardiac surgeon and chief of the ACHD program at The Hospital for Sick Children. In addition to his leadership role, he will also perform congenital heart surgeries and serve as associate professor of surgery at Baylor.

“I’m thrilled to join Texas Children’s and lead the ACHD Program alongside Dr. Ermis,” said Hickey. “Treating these unique patients requires dedication from an entire team, and it is evident Texas Children’s is paving the way in this field. I’m looking forward to joining this innovative and collaborative group as we continue to develop tailored approaches for our patients.”

Hickey received a Bachelor of Medicine degree from the University of Southampton in the U.K., where he also completed his general surgery residency. He went on to complete higher surgical training in cardiothoracic surgery and simultaneously earned his Doctorate of Medicine research thesis from Oregon Health & Science University and the University of Southampton, respectively. Later, he received the John Kirklin Fellowship from the Congenital Heart Surgeons’ Society, University of Toronto and spent two years at The Hospital for Sick Children in Toronto. He then pursued residency training in Cardiovascular Surgery at the University of Toronto, followed by a clinical fellowship in congenital heart surgery.

Learn more about Texas Children’s ACHD Program.