Biography

Dr. Tsao is the Children’s Fund, Inc. Distinguished Professor in Pediatric Surgery and Professor of Pediatric Surgery at McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth) in the Department of Pediatric Surgery. He is the chief of Division of General and Thoracic Surgery. He is board certified in general and pediatric surgery with a special interest in minimally invasive surgery and fetal surgery. He completed his General Surgery Residency at the University of Cincinnati and Pediatric Surgery Training at Children’s Mercy Hospital in Kansas City, Missouri. In addition, he completed a two year fellowship in Fetal Medicine and Therapy at the University of California, San Francisco. He joined The University on August 1, 2007.

Clinically, Dr. Tsao is the co-director of The Fetal Center at Children’s Memorial Hermann Hospital, one of the few programs that performs fetal surgery. In addition, Dr. Tsao is a clinical researcher with interests in quality and safety in pediatric surgery. As the Vice-chair of Quality for the Department of Pediatric Surgery, he leads the Pediatric Surgical Safety Initiative at Children’s Memorial Hermann Hospital. His primary research is focused on the errors and adverse children’s events as well as efficacy of the surgical safety checklist in children’s surgery. Dr. Tsao’s research program supports medical students and surgical residents interested in pediatric surgical clinical research.

Education

BA
Biochemistry - University of Kansas, Lawrence, KS
MD
Doctor of Medicine - University of Kansas School of Medicine, Kansas City, KS
Residency
General Surgery - University of Cincinnati College of Medicine, Cincinnati, OH
Fellowship
Pediatric Surgery - Children's Mercy Hospital, Kansas City, MO
Fellowship
Fetal Medicine & Therapy - University of California, San Francisco School of Medicine, San Francisco, CA

Areas of Interests

Clinical Interests

Open Fetal Surgery


Research Interests

Quality and Safety in Pediatric Surgery

Research Information

  • Errors and Adverse events in the setting of the Neonatal Surgery performed in the Neonatal Intensive Care Unit
    Operations and procedures are commonly performed in the NICU. However, this is often performed in suboptimal conditions. Errors, adverse events, and good catches in this operative environment is unknown. This NIH-funded observational study will determine the types and incidence of errors and adverse events associated with neonatal surgery performed in the neonatal intensive care unit.
  • Operative team compliance with Preoperative Checklist and Antibiotic Administration: A quality Improvement Project & Assessment of the Implementation of a Pediatric Surgical Preoperative Checklist
    Peri-operative checklists are mandated by many hospitals based on the reduction in morbidity and mortality seen with utilization of the World Health Organization’s (WHO) “Surgical Safety Checklist.”  Although an adapted peri-operative checklist was implemented within our hospital system without formal system-wide training, compliance with the checklist is reported to be 100%.  However the clinical practice is not consistent with the reported compliance.
    Recognition of the deficiency in the current checklist process has developed into a hospital-wide initiative to develop a pediatric-specific, meaningful checklist that incorporates and addresses key issues in caring for pediatric surgical patients. This prospective observational study, evaluates the completion of the 12 pre-incision components of the WHO surgical checklist during the 6 month post-implementation period.
  • Analysis of Compliance with SCIP-Based Antibiotic Prophylaxis.
    The Surgical Care Improvement Project (SCIP) recommends appropriate spectrum and timing of antibiotic prophylaxis to prevent surgical site infections (SSIs).  However, emerging data has demonstrated that despite increased compliance, SSIs are not decreasing.  Furthermore, there is an all-or-none phenomenon associated with SCIP infection guidelines.  Despite the routine administration of antibiotic prophylaxis in pediatric surgical operations, adherence with appropriate evidence-based practice may not occur in every case. This observational study is designed to evaluate the adherence and compliance of SCIP-based surgical antibiotic prophylaxis.
  • Hospital Quality Reporting Does Not Accurately Measure Hospital Quality.
    Surgical site infections (SSI) are utilized as a measure of hospital quality. Typically, hospital infection control programs assign surgical wound classification (SWC) based on data from the medical record.  This SWC is frequently recorded by the operating room support staff and may not be confirmed by the operative surgeon.  The hospital assigned SWC is used to risk-stratify operations for the likelihood of SSI development. The purpose of this study was to assess the accuracy of hospital-documented compared to surgeon-based SWC in pediatric appendectomies, considered to be the correct classification in a multi-center study.
  • Timing of Inguinal Hernia Repair in Premature Infants: A Randomized Trial
    The impact of the timing of inguinal hernia (IH) repair on the overall incidence of adverse events in premature infants who have an IH diagnosed while in the neonatal intensive care unit (NICU) is unknown.  Due to the lack of evidence related to the impact of timing of this surgical treatment, we aim to complete a pilot multi-center randomized clinical trial (RCT) with a limited enrollment period to assess the feasibility of a subsequent definitive trial.  This study evaluates the impact of the timing of inguinal hernia repair on the overall incidence of adverse events in premature infants who have an inguinal hernia diagnosed while in the Neonatal Intensive Care Unit.
  • Improvements in patient safety culture in a pediatric perioperative environment requires a multi-faceted approach
    Given increased healthcare costs and concerns about patient safety, the Institute of Medicine (IOM) issued two landmark reports that explained to the healthcare community the importance of examining the role of organizational factors on healthcare quality and patient safety outcomes (HQPSO).  To Err is Human focused on the importance of patient safety culture and Crossing the Quality Chasm discussed ways in which organizations can best support and engage employees to provide safe and high-quality care.  The IOM argued that these organizational factors should be important in predicting HQPSO in healthcare settings because these factors are vital in predicting outcomes in other high-risk industries (i.e., aviation, nuclear power).  The first of these organizational factors – patient safety culture – refers to “the product of individual and group values, attitudes, perceptions, competencies, and patterns of behavior that determine the commitment to, and the style and proficiency of, an organization’s health and safety management.”1The safety culture concept, exhibited by high reliability organizations (HROs) and adopted by healthcare, minimizes adverse events in complex and hazardous setting.  To improve a sustainable patient safety culture, we instituted a multi-faceted safety program, patterned after HROs and designed specifically for the pediatric perioperative environment (micro-system). This study evaluates the impact of this program on safety culture in a pediatric perioperative environment.