Best Children's Hospitals 2012-13: Guide to the Terms

The meaning of Nurse Magnet, 'best practices,' and scores of other measures in the rankings.

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The following terms appear in the 2012-13 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 specified teams, programs, and resources that address the needs of particular types of patients. The mix of services varies by specialty. See individual specialties below.
Advanced technologies Availability of specified technologies for diagnosis and treatment. The technologies vary by specialty. See individual specialties below.
Clinical support services Access to selected medical and surgical services. The services vary by specialty. See individual specialties below.
Committing to best practices Use of guidelines, registries, and other accepted measures. The measures vary by specialty. See individual specialties below.
Committing 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.
Engaging parents and family Enlistment of 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.
Infection-prevention program Indicates diligence and success in reducing hospital-acquired infections through proven measures such as hand hygiene, vaccination, and use of antimicrobials.
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.
Patient and family services Reflects how many of these 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 Neonatology and Nephrology is shown below.
Patient volume Relative number of patients in past year who had certain specified disorders or received specified procedures).
Procedure volume Relative number of tests and noninvasive procedures (in Orthopedics, 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 2010, 2011, and 2012.
Specialized clinics and programs Availability of certain defined programs for patients with particular conditions. The programs vary by specialty. See individual specialties below.
Success in reducing ICU infections Measures success at minimizing bloodstream infections in pediatric ICU patients.
Surgical volume Relative number of patients who had specified operations in past year.
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

100-day BMT survival Survival of patients receiving stem cell transplants at 100 days following transplant.
Accredited transplant program Meets standards set by Foundation for the Accreditation of Cellular Therapy for transplanting bone marrow and tissue.
Advanced clinical services
(out of 18)
Examples: primary oncologist participates in more than half of clinical visits with each patient, pediatric cancer pharmacist rounds with care team, consultation with experts in complementary health.
Advanced technologies
(out of 14)
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; 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, infection control facilities.
Committing to best practices
(out of 21)
Examples: regular morbidity and mortality conferences, quarterly tumor boards, and significant time spent in managing certain conditions.
Committing to clinical research
(out of 12)
Examples: 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 endovascular surgical neuroradiology.
Five-year cancer survival Reflects survival of patients with acute lymphoblastic leukemia and neuroblastoma five years after beginning treatment.
New-patient volume Relative number of new cancer patients in past two years.
Palliative care program 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 9)
Examples: 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 14)
Having certain specialists, surgeons, and other medical staff available for consultation and care, such as a pediatric anesthesiologist and pediatric head and neck surgeon.
 

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, heart failure program.
Advanced technologies
(out of 5)
CT angiography, cardiac MRI, transcatheter arrhythmia ablation, ECMO program available 24/7, transesophageal echocardiographic testing during surgeries.
Catheter procedure volume Relative frequency 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.
Committing to best practices
(out of 21)
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.
Committing to clinical research
(out of 10)
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 three years
Norwood surgery volume Reflects number of Norwood Stage 1 procedures in past year.
Specialized clinics and programs
(out of 11)
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, 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 19)
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 10)
Examples: PET or PET/CT scanning, diagnostic radioisotope scan, endocrine testing, radiation isolation room, thyroidectomy, 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.
Committing to best practices
(out of 62)
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, high percentage of outpatients with documented blood sugar results.
Committing 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.
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 pediatric neurosurgeon and 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 10)
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, esophageal dilation.
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, infection control facilities.
Committing 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 9)
Examples: programs for intestinal rehabilitation, cystic fibrosis treatment, childhood obesity management, inflammatory bowel disease, chronic liver disease.
Subspecialist availability
(out of 8)
Having certain specialists, surgeons, and other medical staff available for consultation and care, such as pediatric general surgeon and pediatric gastroenterologist.
Survival after liver transplant Reflects patient survival three years following transplant.
 

Neonatology

Advanced clinical services
(out of 5)
Examples: 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, unsedated 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, infection control facilities.
Committing to best practices
(out of 33)
Examples: adhering to recommended maximum patient loads, standardized handoff tools, simulation/training laboratories for neonatal intensive care procedures, newborn cardiac patients receiving neonatology consults.
Committing to clinical research
(out of 4)
Degree of participation in clinical trials and bench-to-bedside research. Examples: externally audited, national NICU treatment, quality-improvement research networks such as the Vermont Oxford Network and Extracorporeal Life Support Organization (ELSO) data exchange network.
ECMO (heart-lung machine) 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 17)
The eight services listed in "Terms used across specialties," above, plus an additional nine. 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.
Specialized clinics and programs
(out of 12)
Examples: craniofacial 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 15)
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; infection control facilities.
Committing to best practices
(out of 25)
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.
Committing 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 12)
The eight services listed in "Terms used across specialties," above, and four 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 8)
Having certain specialists, surgeons, and other medical staff available for consultation and care, such as pediatric infectious disease specialist, pediatric anesthesiologist, and pediatric nephrologist.
Success in preventing dialysis-related infections Success in minimizing dialysis-related infections.
Survival after kidney transplant Reflects one- and three-year survival of patients and transplanted kidneys.
 

Neurology & Neurosurgery

Advanced clinical services
(out of 18)
Examples: pediatric headache clinic with psychologists specializing in headache biofeedback and preventive therapy, specialized epilepsy treatment center, sleep lab, neuroanesthesia program, neurological rehabilitation program.
Advanced technologies
(out of 7)
Examples: PET or PET/CT scan, 3T MRI, neurophysiological intraoperative monitoring, 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.
Clinic volume Relative number of clinic patients in past year with certain disorders or who received certain specified care.
Committing to best practices
(out of 15)
Examples: neuropsychological evaluations before and after surgery for benign and malignant brain tumors, maintaining a surgical mortality database, regular interdisciplinary care conferences.
Committing to clinical research
(out of 4)
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.
Preventing surgical complications Success in avoiding surgical complications and readmissions.
Specialized clinics and programs
(out of 15)
Examples: clinics or programs for cerebrovascular accident, movement disorders, spina bifida, tuberous sclerosis, brachial plexus, and neonatal neurology.
Subspecialist availability
(out of 12)
Having certain specialists, surgeons, and other medical staff available for consultation and care, such as pediatric neurosurgeon, pediatric neurologist, 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, motion laboratory.
Advanced technologies
(out of 3)
PET/CT scanning, bone scan, 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; infection control facilities.
Committing to best practices
(out of 15)
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.
Committing 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 16)
Having certain specialists, surgeons, and other medical staff available for consultation and care, such as pediatric anesthesiologist, pediatric radiologists specializing in diagnostic and interventional radiology, pediatric orthopedic surgeon.
 

Pulmonology

Advanced clinical services
(out of 11)
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 sleep 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, 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, infection control facilities.
Committing to best practices
(out of 14)
Examples: consensus treatment and management plans for asthma exacerbations, bronchiolitis, croup, cystic fibrosis, pneumonia, and tracheostomy or ventilator-dependent patients.
Committing 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.
Neuromuscular weakness disorder 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 10)
Having certain specialists, surgeons, and other medical staff available for consultation and care, such as pediatric radiologist, pediatric pulmonologist, pediatric sleep medicine physician.
 

Urology

Advanced clinical services
(out of 8)
Examples: 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, infection control facilities.
Committing to best practices
(out of 8)
Examples: having a formal program for tracking surgical site infections for major urological procedures and regular mortality and morbidity conferences.
Committing 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 12)
Having certain specialists, surgeons, and other medical staff available for consultation and care, such as pediatric critical care specialist, pediatric urology surgeon, 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.
Success in reducing urinary tract infections

Success in preventing catheter-associated urinary tract infections (CAUTI).