Best Children's Hospitals 2011-12: Guide to the Terms

By U.S. News Staff

May 17, 2011 RSS Feed Print

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The following terms appear in the 2011-12 Best Children's Hospitals rankings. A complete explanation of the methodology and details of the measures defined below are available in a downloadable PDF report.

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Terms Used Across Specialties
Advanced clinical services	Availability of teams, programs, and resources from a designated list that address the needs of particular types of patients. The mix of services varies depending on specialty. See individual specialties below.
Advanced technologies	Availability of specified technologies for diagnosis and treatment. The technologies vary depending on specialty. See individual specialties below.
Clinical support services	Access to selected medical and surgical services. The services vary depending on specialty. See individual specialties below.
Commitment to best practices	Use of guidelines, registries, and other accepted measures. The measures vary depending on specialty. See individual specialties below.
Commitment to involving parents and family	Indicates hospital's efforts to enlist family members in the care process. Having a parent advisory committee; parents or family members on two key standing committees; and involving parents in clinical decisions through family-centered rounds, care conferences, and other participatory programs are examples.
Commitment to quality improvement	Participation in activities that can enhance care, such as external review of patient and parent satisfaction, public reporting of quality-related performance data, and participating in national quality initiatives.
Nurse Magnet hospital	Meets American Nurses Credentialing Center standards for excellence in nursing care.
Nurse-patient ratio	Relative ratio of fulltime registered nurses to daily average number of inpatients. The higher the ratio, the more nurses caring for patients. In Neonatology, the ratio reflects the number of neonatal ICU nurses and the average daily number of NICU patients.
Overall infection prevention	Indicates diligence and success in reducing hospital-acquired infections through proven measures such as hand hygiene, vaccination, and use of antimicrobials.
Patient and family services	Reflects how many of the following services are offered: family resource center, sleep rooms for parents and siblings, school intervention program, Ronald McDonald house or other residential facility, and family access to certified child life specialists, family support specialists, pediatric psychologists, and interpreters. Availability of additional services in Diabetes & Endocrinology, Neonatology, and Nephrology is shown below.
Patient volume	Relative number of patients in past year who had certain specified disorders or received specified procedures. In Nephrology, patient volume was calculated using two years of data.
Procedure volume	Relative number of tests and noninvasive procedures; in Orthopedics it is the relative number of tests and surgical procedures.
Rank	The top 50 hospitals in 10 specialties are ranked by U.S. News Score.
Reputation with specialists	Percentage of pediatric specialists responding to U.S. News surveys who named hospital as among the best for especially challenging cases and procedures. Responses were combined from surveys in 2009, 2010, and 2011.
Specialized clinics and programs	Availability of certain defined programs for patients with particular conditions. The programs vary depending on specialty. See individual specialties below.
Success in preventing ICU bloodstream infections	Measures success at minimizing bloodstream infections in pediatric ICU patients. In Cancer, non-ICU cancer patients were included. In Neonatology, only neonatal ICU patients were counted.
Surgical volume	Relative number of patients who had certain specified operations in past year. In Cancer, surgical volume reflects the number of selected procedures performed.
Use of health information technology	Hospitals received credit for implementation and appropriate use of electronic medical records and computerized physician order entry.
U.S. News Score	A number from 0 to 100 that sums up a hospital's quality of care as determined by the U.S. News methodology. The top-performing hospital in each specialty automatically received a score of 100.
NA	Not applicable.
NR	No response.

Specialty-Specific Terms
Cancer
Advanced clinical services (out of 17)	Examples: primary oncologist participates in more than half of clinical visits with each patient, pediatric cancer pharmacist rounds with care team, multidisciplinary clinics, satellite offices/outreach clinics.
Advanced technologies (out of 12)	Examples: PET or PET/CT scanner, intraoperative magnetic resonance imaging, intensity-modulated radiation therapy, bone scan.
Bone marrow transplant services	Number of available bone marrow transplant services, such as transplantation from both related and unrelated donors; recognition by the National Marrow Donor Program; membership in the Pediatric Blood and Marrow Transplant Consortium, and transplant volume.
Clinical support services (out of 10)	Surgical ICU; genetic testing/counseling; pediatric acute pain/sedation service; neonatal ICU; pediatric anesthesia program; pediatric infectious disease program; pediatric pain management program; pediatric ICU; rapid response team; reverse isolation/infection control facilities.
Commitment to best practices (out of 13)	Examples: regular morbidity and mortality conferences, tumor boards that meet quarterly, and significant time spent in managing certain conditions.
Commitment to clinical research (out of 9)	Degree of participation in clinical trials and bench-to-bedside research, such as cancer research networks and phase 1 and 2 clinical trials for leukemia, brain tumors, and sarcomas.
Fellowship programs (out of 2)	Active training programs in pediatric hematology-oncology and pediatric pathology.
New-patient volume	Relative number of new cancer patients in past two years.
Palliative care	Formal program for families of children with end-of-life illnesses or with chronic or life-limiting conditions. Additional credit for cancer patients referred to program.
Specialized clinics and programs (out of 6)	Clinical brain tumor program, clinical bone and soft tissue sarcomas program, clinical leukemia/lymphoma program, comprehensive longer-term survivors program, pediatric limb-sparing surgery program, and fertility preservation program.
Subspecialist availability (out of 13)	Having certain specialists, surgeons, and other medical staff available for consultation and care, such as a pediatric anesthesiologist and pediatric head and neck surgeon.
Survival, acute lymphoblastic leukemia	Reflects survival of patients with acute lymphoblastic leukemia five years after beginning treatment.
Transplant accreditation	Meets standards set by Foundation for the Accreditation of Cellular Therapy for transplanting bone marrow and tissue.

Cardiology & Heart Surgery
Adult congenital heart program	Availability of adult heart program for inherited or congenital heart disorders. Additional credit if program was listed with Adult Congenital Heart Association and if program offers formal plan to transition patients from pediatric to adult program, among other features.
Advanced clinical services (out of 18)	Examples: dedicated cardiac surgical OR, remote patient monitoring, fetal echocardiographic testing, ventricular assist devices, congenital heart disease clinic, and heart failure program.
Advanced technologies (out of 5)	CT angiography, cardiac MRI, transcatheter arrhythmia ablation, ECMO program, ECMO program designated a center of excellence by Extracorporeal Life Support Organization (ELSO).
Catheter procedure volume	Relative number of catheter procedures such as stent and atrial and ventricular tachycardia procedures performed in past year.
Clinical support services (out of 9)	Surgical ICU; pediatric acute pain/sedation service; neonatal ICU; pediatric anesthesia program; pediatric infectious disease program; pediatric pain management program; pediatric ICU; rapid response team; reverse isolation/infection control facilities.
Commitment to best practices (out of 8)	Examples: participation in regular morbidity and mortality conferences, active home surveillance for infants with heart defects, follow-up program for patients with or at risk for neurodevelopmental complications.
Commitment to clinical research (out of 7)	Degree of participation in clinical trials and bench-to-bedside research. Examples: externally audited, national quality improvement research networks such as Pediatric Heart Research Network, Congenital Cardiac Anesthesia Society, and National Cardiovascular Disease Registry.
Congenital heart program	Credit for tracking and reporting data and for volume and type of procedures performed, including 100 or more congenital heart procedures in past year and treating at least one patient with a Berlin heart or other ventricular assist device.
Fellowship programs (out of 2)	Active training programs in pediatric cardiology and thoracic surgery.
Heart transplant program	Reflects recognition by United Network for Organ Sharing as heart or heart-lung transplant program and number of transplants in past two years
Norwood surgery volume	Reflects number of Norwood Stage 1 procedures for patients with and without hypoplastic left heart syndrome.
Specialized clinics and programs (out of 10)	Certain catheter procedures offered to one or more patients in past year. Examples: balloon angioplasty, stent implantation, transcatheter occlusion of cardiac shunts, transcatheter arrhythmia ablation, and ablation for atrial tachycardia.
Subspecialist availability (out of 14)	Having certain specialists, surgeons, and other medical staff available for consultation and care, such as a pediatric cardiothoracic surgeon, pediatric cardiac intensivist, interventionalist, and electrophysiologist.
Survival after heart transplant	Reflects one- and three-year post-transplant survival.
Survival after Norwood surgery	Reflects survival from Norwood Stage 1 procedure.
Survival after surgery	Survival following moderately complex to very difficult heart surgery in past two years.

Diabetes & Endocrinology
Advanced clinical services (out of 17)	Examples: certified trainers in continuous glucose monitoring for families; diabetes and endocrinology support staff with social workers, dietitians, and psychologists; diabetes-specific support group for parents and families.
Advanced technologies (out of 9)	Examples: PET or PET/CT scanning, diagnostic radioisotope scan, endocrine testing, radiation isolation room, thyroidectomy, and fine needle aspiration of thyroid nodule.
Clinical support services (out of 9)	Surgical ICU; genetic testing/counseling; neonatal ICU; pediatric anesthesia program; pediatric infectious disease program; pediatric pain management program; pediatric ICU; rapid response team; reverse isolation/infection control facilities.
Commitment to best practices (out of 48)	Examples: clinical database for assessing quality of diabetes care, written consensus protocols for inpatient management of diabetic ketoacidosis, high percentage of inpatients seen by member of diabetes program, and high percentage of outpatients with documented blood sugar results.
Commitment to clinical research	Degree of participation in specialty-specific research activities such as clinical trials and other bench-to-bedside research.
Diabetes management	Reflects successful prevention of serious problems in children with type 1 diabetes and keeping blood sugar levels in check.
Diabetes options	How many of four alternatives are available to patients in a pediatric diabetes program: insulin pump for children age 5 or older, insulin pump for children younger than age 5, pump plus basal insulin injection, and basal insulin injection with rapid-acting insulin analog.
Fellowship program	Active training program in pediatric endocrinology.
Hypothyroid management	Relative percentage of treated hypothyroid children who test normal and of hypothyroid infants who began treatment before three weeks of age.
Patient and family services (out of 9)	Eight services listed in "Terms used across specialties," above, plus support groups for special populations such as those with Turner syndrome.
Specialized clinics and programs (out of 7)	Programs for lipid disorders, hypertension, comprehensive weight management, and Turner syndrome; clinics for outpatients with type 2 diabetes, outpatients with pre-diabetes, and adolescents and young adults with diabetes.
Subspecialist availability (out of 11)	Having certain specialists, surgeons, and other medical staff available for consultation and care, such as a pediatric neurosurgeon and a pediatric endocrinologist.

Gastroenterology
Advanced clinical services (out of 8)	Examples: pediatric GI and liver specialists; pediatric interventional radiologists; support groups for inflammatory bowel disease, celiac disease, liver disease and other digestive disorders.
Advanced technologies (out of 9)	PET or PET/CT scanner, magnetic resonance cholangiopancreatography, magnetic resonance enterography, dual-emission X-ray absorptiometry (DXA) scan, capsule endoscopy, endoscopic band ligation, esophageal impedance monitoring, endoscopic retrograde cholangiopancreatography, and antroduodenal and full colonic motility studies.
Clinical support services (out of 9)	Surgical ICU; pediatric acute pain/sedation service; neonatal ICU; pediatric anesthesia program; pediatric infectious disease program; pediatric pain management program; pediatric ICU; rapid response team; reverse isolation/infection control facilities.
Commitment to clinical research	Degree of participation in specialty-specific research activities such as clinical trials and other bench-to-bedside research.
Fellowship program	Active training program in pediatric gastroenterology.
Liver transplant program	Reflects United Network for Organ Sharing-recognized liver transplant program and relative number of patients receiving liver transplants in the past 2 years.
Nonsurgical procedure volume	Reflects relative number of tests and noninvasive procedures.
Specialized clinics and programs (out of 8)	Examples: programs for intestinal rehabilitation, cystic fibrosis treatment, childhood obesity management, inflammatory bowel disease, and chronic liver disease.
Subspecialist availability (out of 9)	Having certain specialists, surgeons, and other medical staff available for consultation and care, such as a pediatric critical care specialist and a pediatric gastroenterologist.
Survival after liver transplant	Reflects patient survival three years following transplant.

Neonatology
Advanced clinical services (out of 4)	Level 1 or 2 pediatric trauma center status as certified by American College of Surgeons or state licensing board, neonatal ICU-specific pharmacist who rounds with clinical team, NICU-designated nutritionist, social workers.
Advanced technologies (out of 5)	PET or PET/CT scanner, continuous EEG monitoring with pediatric neurology support, un-sedated MRI, molecular diagnostic/virology laboratory, specialized chemistry laboratory with tandem mass spectroscopy.
Clinical support services (out of 7)	Genetic testing/counseling; pediatric acute pain/sedation service; pediatric anesthesia program; pediatric infectious disease program; pediatric pain management program; rapid response team; reverse isolation/infection control facilities.
Commitment to best practices (out of 14)	Examples: adhering to recommended maximum patient loads, standardized handoff tools, simulation/training laboratories for neonatal intensive care procedures, newborn cardiac patients receiving neonatology consults.
Commitment to clinical research (out of 4)	Degree of participation in clinical trials and bench-to-bedside research. Examples: externally audited, national NICU treatment and quality-improvement research networks such as the Vermont Oxford Network and Extracorporeal Life Support Organization (ELSO) data exchange network.
ECMO (heart-lung machine) services	24-hour availability of heart-lung machine for newborns (extracorporeal membrane oxygenation), trained ECMO team.
Fellowship programs (out of 15)	Active training programs in pediatric neonatology. Examples: pediatric neurology, congenital cardiac surgery, neonatal-perinatal medicine, pediatric cardiology.
Patient and family services (out of 18)	The eight services listed in "Terms used across specialties," above, plus an additional 10. Examples: family support center, breast pumping rooms, lactation specialists, 24/7 parental visitation, sibling visitation, neonatal ICU-specific parent advisory committee, and NICU-specific parent-to-parent support groups. Additional credit for NICU beds in private rooms.
Specialized clinics and programs (out of 9)	Craniofacial team, ECMO team, spina bifida team, comprehensive retinopathy of prematurity program, neonatal-neuro intensive care program, NICU specific palliative care program, metabolic team, bowel rehabilitation team, home ventilator management team, and neuro-developmental follow-up clinic for high-risk NICU patients.
Subspecialist availability (out of 16)	Having certain specialists, surgeons, and other medical staff available for consultation and care, such as a pediatric head and neck surgeon, pediatric neonatologist, and critical care certified registered nurse.

Nephrology
Advanced clinical services (out of 8)	Continuous renal replacement therapy; hemodialysis; peritoneal dialysis; UNOS-recognized kidney transplant program; maintenance dialysis staff that includes clinical nurses, social workers, and dietitians, and level 1 or 2 pediatric trauma center.
Advanced technology	PET or PET/CT scanning.
Catheter procedure volume	Relative number of catheter placements in past two years.
Clinical support services (out of 9)	Surgical ICU; pediatric acute pain/sedation service; neonatal ICU; pediatric anesthesia program; pediatric infectious disease program; pediatric pain management program; pediatric ICU; rapid response team; reverse isolation/infection control facilities.
Commitment to best practices (out of 14)	Examples: participation in regular interdisciplinary clinical conferences for urology/uroradiology and renal pathology to review and coordinate patient care, offering formal transition program for kidney transplant patients from pediatric to adult care, maintaining database of kidney transplant patients.
Commitment to clinical research	Participation in specialty-specific research activities such as clinical trials and other bench-to-bedside research.
Dialysis patients receiving transplants	Reflects percentage of patients on maintenance dialysis who received kidney transplant within two years.
Dialysis volume	Relative number of patients in past two years who received regular dialysis.
Fellowship program	Active training program in pediatric nephrology.
Kidney biopsy volume	Relative number of kidney biopsies during past two years.
Kidney transplant volume	Relative number of transplants during past two years from deceased or living donors.
Managing dialysis patients	Reflects percentage of patients on dialysis in past two years with satisfactory lab tests.
Patient and family services (out of 11)	The eight services listed in "Terms used across specialties," above, and three additional services: programs to support patients in maintenance dialysis such as teachers dedicated to working with patients, standard review of patient's individualized education program, and/or summer camp.
Preventing biopsy complications	Reflects percentage of patients without complications after receiving kidney biopsy.
Subspecialist availability (out of 9)	Having certain specialists, surgeons, and other medical staff available for consultation and care, such as pediatric infectious disease specialist, pediatric anesthesiologist, and pediatric nephrologist.
Survival after kidney transplant	Reflects one- and three-year survival of patients and transplanted kidneys.

Neurology & Neurosurgery
Advanced clinical services (out of 19)	Examples: pediatric headache clinic with psychologists specializing in headache biofeedback and preventive therapy; specialized epilepsy treatment center, sleep lab, neuroanesthesia program, and neurological rehabilitation program.
Advanced technologies (out of 4)	PET or PET/CT scan, 3T MRI, neurophysiological intraoperative monitoring, and magnetoencephalography.
Clinical support services (out of 9)	Surgical ICU; pediatric acute pain/sedation service; neonatal ICU; pediatric anesthesia program; pediatric infectious disease program; pediatric pain management program; pediatric ICU; rapid response team; reverse isolation/infection control facilities.
Commitment to best practices (out of 8)	Examples: tracking outcomes 30 days after admission, neuropsychological evaluations before and after surgery for benign and malignant brain tumors, maintaining a surgical mortality database.
Commitment to clinical research (out of 2)	Participation in clinical trials and bench-to-bedside research. Additional credit for belonging to a national Phase 1 neuro-oncology clinical research consortium.
Epilepsy management	Relative success at treating children and infants with epilepsy.
Epilepsy treatment volume	Relative number of evaluations and procedures for epilepsy in past year.
Fellowship programs (out of 2)	Active training programs in pediatric neurology and neurosurgery.
New-patient volume	Relative number of new patients in past year with certain disorders such as brain tumors, hydrocephalus, cerebal palsy, and chronic headaches.
Specialized clinics and programs (out of 13)	Examples: clinics or programs for brain tumor, cerebrovascular accident, movement disorders, spina bifida, tuberous sclerosis, brachial plexus, and neonatal neurology.
Subspecialist availability (out of 13)	Having certain specialists, surgeons, and other medical staff available for consultation and care, such as a pediatric neurosurgeon, pediatric neurologist, and certified neuroscience nurse.
Surgical survival	Reflects relative number of deaths following surgery for selected neurological disorders such as brain tumors, head trauma, and medically untreatable epilepsy.

Orthopedics
Advanced clinical services (out of 6)	Examples: comprehensive pediatric orthopedic program with dedicated pediatric imaging center, multidisciplinary musculoskeletal oncology program, and motion laboratory.
Advanced technologies (out of 3)	PET/CT scanning; bone scan; and remote retrieval of test results, images, and medical records.
Clinical support services (out of 9)	Surgical ICU; pediatric acute pain/sedation service; neonatal ICU; pediatric anesthesia program; pediatric infectious disease program; pediatric pain management program; pediatric ICU; rapid response team; reverse isolation/infection control facilities.
Commitment to best practices (out of 5)	Examples: having one or more active or candidate members of the Pediatric Orthopaedic Society of North America; pediatric imaging center with ultrasonographers having specialized training in hip exams; pediatric imaging center that minimizes radiation exposure; regular multidisciplinary morbidity and mortality conferences.
Commitment to clinical research	Degree of participation in specialty-specific research activities such as clinical trials and other bench-to-bedside research.
Fellowship program	Active training program in pediatric orthopedics.
Preventing surgical complications	Reflects percentage of patients without complications following surgery for scoliosis; additional credit for low percentage of infections following spinal fusion surgery
Specialized clinics and programs (out of 8)	Clinics or programs for brachial plexus, muscular dystrophy, neurofibromatosis, pain, skeletal dysplasia, spasticity, spina bifida, and sports medicine.
Subspecialist availability (out of 17)	Having certain specialists, surgeons, and other medical staff available for consultation and care, such as a pediatric anesthesiologist, pediatric radiologists specializing in diagnostic and interventional radiology, and pediatric orthopedic surgeon.

Pulmonology
Advanced clinical services (out of 12)	Examples: respiratory therapists; certified asthma educators; gastroenterologist and endocrinologist who participate in patient care conferences; cystic fibrosis center accredited by Cystic Fibrosis Foundation, sleep center and lab accredited by American Academy of Sleep Medicine.
Advanced technology	Availability of PET or PET/CT scanning.
Asthma inpatient care	Reflects care for asthma patients admitted to hospital based on mean length of stay, percentage of inpatient deaths attributable to asthma, and percentage of inpatients readmitted within seven days of discharge for asthma-related symptoms.
Asthma management	Reflects percentage of patients following specific asthma management protocols.
Clinical support services (out of 9)	Surgical ICU; pediatric acute pain/sedation service; neonatal ICU; pediatric anesthesia program; pediatric infectious disease program; pediatric pain management program; pediatric ICU; rapid response team; reverse isolation/infection control facilities.
Commitment to best practices (out of 6)	Examples: having consensus treatment and management plan for asthma exacerbations, bronchiolitis, croup, cystic fibrosis, pneumonia, and tracheostomy or ventilator-dependent patients.
Commitment to clinical research	Degree of participation in specialty-specific research activities such as clinical trials and other bench-to-bedside research.
Cystic fibrosis management	Reflects success at managing lung function and nutritional status in cystic fibrosis patients.
Fellowship program	Active training program in pediatric pulmonology.
Lung disease of prematurity management	Reflects percentage of patients younger than 24 months of age receiving recommended care for this condition.
Lung transplant program	Reflects United Network for Organ Sharing recognition, number of transplants in past two years, and three-year survival rate.
Muscular dystrophy management	Reflects percentage of muscular dystrophy patients age 5 or older who had a lung function test in past year or within 90 days of undergoing general anesthesia.
Preventing deaths of patients on ventilators	Reflects success at preventing deaths of patients on ventilators as a result of accidental obstruction or other events.
Subspecialist availability (out of 11)	Having certain specialists, surgeons, and other medical staff available for consultation and care, such as a pediatric radiologist, pediatric pulmonologist, and pediatric sleep medicine physician.

Urology
Advanced clinical services (out of 6)	Shock wave lithotripsy, ureteroscopy, American College of Surgeons level 1 or 2 pediatric trauma center certification, laparoscopic variococelectomy and orchiopexy, and percutaneously nephrolithotripsy.
Advanced technologies (out of 4)	PET or PET/CT scan, onsite urodynamic equipment, video pediatric urodynamic fluoroscopy, surgical robot.
Clinical support services (out of 9)	Surgical ICU; pediatric acute pain/sedation service; neonatal ICU; pediatric anesthesia program; pediatric infectious disease program; pediatric pain management program; pediatric ICU; rapid response team; reverse isolation/infection control facilities.
Commitment to best practices (out of 3)	Examples: having a formal program for tracking surgical site infections for major urological procedures and regular mortality and morbidity conferences.
Commitment to clinical research (out of 3)	Degree of participation in clinical trials and bench-to-bedside research. Additional credit for prospective randomized clinical trials, prospective observational studies, or prospective clinical databases on patient care.
Fellowship program	Active training program in pediatric urology.
Minimally invasive procedure volume	Relative number of patients in past year who had any of certain minimally invasive procedures such as shock wave lithotripsy, uteroscopy, and laparoscopic orchiopexy.
Specialized clinics and programs (out of 6)	Clinics or programs for spina bifida; voiding difficulties; kidney and urinary-tract stones; prenatal intervention; disorders of sexual differentiation; and genitourinary reconstructive surgery.
Subspecialist availability (out of 11)	Having certain specialists, surgeons, and other medical staff available for consultation and care, such as a pediatric critical care specialist, pediatric urology surgeon, and pediatric urologist.
Success in preventing surgical complications	Reflects relative success at avoiding surgical complications and readmissions. Complications and adverse events include pyeloplasty failure, orchiopexy failure, reoperation or readmission.