SECTION I: PEDIATRIC ORTHOPAEDICS
I1.Do you have a Pediatric Orthopaedic program?
Yes
No – Skip to Section J
When responding to questions in this section, your hospital must consult with the chief of service (or equivalent) of your Pediatric Orthopaedic program to ensure that answers are accurate and consistent with both the care delivered and the intent of the survey.
As data are reviewed, U.S. News may have questions about responses to individual questions or about an entire submission. To ensure communication with the appropriate clinical leader, please provide the following information about the chief of service (or equivalent) for your Pediatric Orthopaedic program.
Full name:
Title:
Email:
Preferred phone:
REQUIRED: IF NAME, TITLE, EMAIL, OR PHONE=BLANK, DISPLAY: “A response is required for [Name/Title/Email/Phone] prior to submitting the survey. Click “OK” to continue with the survey and answer this question later. Click “Cancel” to provide a response to this question now.”
I2.Please indicate the total number of attending/on-staff physicians (excluding fellows)[1]who are currently members of the medical staff in your Pediatric Orthopaedic program in the following categories. For each category, please also indicate the total number of full-time equivalents (FTEs)[2] devoted to clinical care.[If none, please enter 0.]
Total Physicians / Clinical FTEsa. / Pediatric orthopaedic surgeons (board certified/board eligible by the American Board or American Orthopaedic Board of Orthopaedic Surgery or the American Osteopathic Board of Orthopaedic Surgery, with a fellowship or other training in pediatric orthopaedic surgery) / ______/ ______
b. / Other attending/on-staff physicians (include all other attending/on-staff physicians who are not subspecialty certified/eligible in pediatric orthopaedic surgery) / ______/ ______
VALIDATE:IF I2x1 IS NOT A WHOLE NUMBER, DISPLAY: “I2x (Total Physicians): Please enter a whole number (no decimals).”
Note: The preceding questions are used to determine eligibility for Pediatric Orthopaedics. If you leave any part of these questions blank, your hospital will be considered ineligible for the rankings in Pediatric Orthopaedics.
I3.Please indicate the total number of nurse practitioners and physician assistants whowork in or directly support your Pediatric Orthopaedic program. For each category, please indicate the total number of full-time equivalents (FTEs)[3] devoted to clinical care.[If none, please enter 0.]
TotalStaff / Clinical FTEs
a. / Nurse practitioners / ______/ ______
b. / Physician assistants / ______/ ______
VALIDATE:IF I3x1 IS NOT A WHOLE NUMBER, DISPLAY: “I3x (Total Staff): Please enter a whole number (no decimals).”
I3.1.What percentage of NPs and PAs received pediatric orthopaedic surgery-related CEUs/CMEs in the last calendar year?
______% of NPs and PAs
WARNING:IF 0 < I3.1 < 10, DISPLAY: “Please verify that you provided a percent and not a number of.”
VALIDATE: 0 ≤ I3.1 ≤ 100. ELSE DISPLAY: “I3.1: Please enter a numeric value between 0 and 100.”
I4.Please indicate the number of clinical nurse (RN) and Medical Assistant[4]FTEs[5]whowork in or directly support your Pediatric Orthopaedic program in the last calendar year.[If none, please enter 0.]
______FTE RNs
______FTE Medical Assistants
I4.1. What percentage of the staff identified in I4, received orthopaedic surgery-related CEUs in the last calendar year?
______% RNs receiving Orthopaedic surgery-related CEUs
______% Medical Assistants receiving Orthopaedic surgery-related CEUs
WARNING:IF 0 < I4.1x < 10, DISPLAY: “Please verify that you provided a percent and not the number of staff.”
VALIDATE: 0 ≤ I4.1x ≤ 100. ELSE DISPLAY: “I4.1x: Please enter a numeric value between 0 and 100.”
I5.Please indicate the number of pediatric orthopaedic surgeons currently working in your Pediatric Orthopaedic program who are members of the Pediatric Orthopaedic Society of North America (POSNA) in the following categories.[If none, please enter 0.]
Cliniciansa. / Active members(including corresponding, or associate members) / ______
b. / Candidate members / ______
VALIDATE:IF I5x IS NOT A WHOLE NUMBER, DISPLAY: “I5x: Please enter a whole number (no decimals).”
I6.Please indicate the number of pediatric specialists in your Pediatric Orthopaedic program who have fellowship or other specialized training in the following categories? [If none, please enter 0.]
Number of specialistsa. / Hand surgery / ______
b. / Spinal surgery / ______
c. / Musculoskeletal oncologists / ______
d. / Sports medicine / ______
e. / Hip preservation specialist / ______
f. / Musculoskeletal radiologists / ______
VALIDATE:IF I6x IS NOT A WHOLE NUMBER, DISPLAY: “I6x: Please enter a whole number (no decimals).”
I6.1. Please indicate the pediatric orthopaedic surgery ACGME fellow and resident full-time equivalents (FTEs) that were a part of your Pediatric Orthopaedic program in the last calendar year.Note that these should only include fellows or residents who fully participate in the educational and patient review activities of the program.[If none, please enter 0.]
______Pediatric orthopaedic surgery ACGME fellows
______Pediatric orthopaedic surgery residents
I7.Does your Pediatric Orthopaedic program offer a designated inpatient unit[6] for pediatric patients?
Yes
No
I8.Does your hospital have a dedicated pediatric imaging center that is located in your outpatient orthopedic clinics (and not in a separate facility)?
Yes – Go to Question I9
No – Skip to Question I10
I9.Is your imaging center staffed by pediatric radiologists with certification for added qualification in pediatric radiology by the American Board of Radiology?
Yes, with an in-house/on-site radiologist at the same institution
Yes, with an off-site radiologist at the same institution
Yes, at another institution within the same city/metro area
No
I9.1What percentage of your patients’ MRI and CT examinations in your Pediatric Orthopaedic program are read by pediatric radiologists with musculoskeletal imaging expertise[7]?
______% of patient MRI and CT examinations read by musculoskeletal radiologists
VALIDATE: 0 ≤ I9.1 ≤ 100. ELSE DISPLAY: “I9.1: Please enter a numeric value between 0 and 100.”
I10.Does your pediatric imaging center have the following services?
Yes / Noa. / Pediatric protocols to reduce radiation exposure during X-rays and CT scans / ○ / ○
b. / Digitally stored test results, images, and medical records accessible from locations off-site or away from the hospital (electronic records) / ○ / ○
c. / Intraoperative navigation system / ○ / ○
d. / Low dose, three-dimensionalupright body imaging for evaluating scoliosis / ○ / ○
e. / Pediatric anesthesia services to support sedation and general anesthesia for imaging in very young children / ○ / ○
f. / MR arthrography / ○ / ○
I11.Is your Pediatric Orthopaedic program currently engaged in any of the following activities demonstrating continuous quality improvement?
Yes / Noa. / Developed and implemented a written plan for program review and quality improvement / ○ / ○
b. / Determined appropriate data-based performance metrics for the program / ○ / ○
c. / Regularly tracked patient data (e.g., diagnoses, treatment plans, test results, emergency department visits, outpatient visits, current treatment regimens) and other supporting information to measure progress against program performance metrics / ○ / ○
d. / Presented results of your program’s clinical quality performance metrics to your clinical staff on a regular basis / ○ / ○
e. / Participated in one or more quality-of-care or improvement initiatives specific to pediatric orthopaedic care / ○ / ○
I11.1. If “yes” to any part of I11, please describe one quality improvement initiative and how it improved the quality of your program in the last calendar year. To receive credit, you must discuss what actions your hospital took as a result of this quality initiative and the impact it had on your program:
I12.This question was removed from the survey.
I13.This question was removed from the survey.
I14.How many unique pediatric trauma patientswith fractures or musculoskeletal injuries were treated by pediatric orthopaedistsat your hospital in the last calendar year?[If none, please enter 0.]
______Unique pediatric trauma patients with fractures or musculoskeletal injuries
VALIDATE:IF I14 IS NOT A WHOLE NUMBER, DISPLAY: “I14: Please enter a whole number (no decimals).”
I14.1In the last calendar year, how many of the following types of pediatric trauma patients with fractures or musculoskeletal injuries did your Pediatric Orthopaedic program treat? [If none, please enter 0.]
Unique Patientsa. / Patients transferred from another hospital to your hospital for inpatient care / ______
b. / Patients that received pediatric orthopaedic trauma surgery or other pediatric orthopaedic procedures (e.g., closed reduction) within 72 hours of admission / ______
VALIDATE:IF I14.1x IS NOT A WHOLE NUMBER, DISPLAY: “I14.1x: Please enter a whole number (no decimals).”
I15.Does your hospital offer the following clinics that are regularly attended (i.e. available for consultation during the clinic session) by the Pediatric Orthopaedic service and saw a minimum of 25 patients in 2017?
Yes / Noa. / Spina bifida clinic[8] (myelodysplasia) / ○ / ○
b. / Spasticity or cerebral palsy clinic[9] (includes evaluation of patients for Baclofen pumps) / ○ / ○
c. / Skeletal dysplasia clinic[10] (includes osteogenesis impefecta) / ○ / ○
d. / Brachial plexus clinic[11] / ○ / ○
e. / Neurofibromatosis clinic[12] / ○ / ○
f. / Muscle disease clinic[13] (includes muscular dystrophy) / ○ / ○
g. / Pain clinic[14] / ○ / ○
h. / Sports medicine clinic / ○ / ○
i. / Sports concussion program[15] / ○ / ○
j. / Arthrogryposis clinic[16] / ○ / ○
k. / Limb deficiency/limb reconstruction/prosthetics clinic[17] / ○ / ○
l. / Skeletal health/metabolic bone health clinic[18] / ○ / ○
I16.Does your Pediatric Orthopaedic program have a multidisciplinary musculoskeletal oncology program?
Yes – Go to Question I17
No – Skip to Question I18
I17.Are musculoskeletal cancer patient cases in the pediatric cancer program discussed at a tumor board at least once a quarter?
Yes – Go to Question I17.1
No – Skip to Question I18
I17.1When these cases were discussed at tumor boards in the last calendar year, what percentage of the time were each of the following specialists in attendance at the tumor board?
______% attendance by musculoskeletal oncologist
______% attendance by musculoskeletal tumor surgeon
VALIDATE: 0 ≤ I17.1x ≤ 100. ELSE DISPLAY: “I17.1x: Please enter a numeric value between 0 and 100.”
I18.Does your Pediatric Orthopaedic program have regular multidisciplinary morbidity and mortality conferences[19] to review orthopaedic patient cases?
Yes
No
I19.Does your hospital provide an Advanced Motion Analyses Laboratory (Gait Laboratory)[20] which is available to Pediatric Orthopaedic patients either on-site or through a formal contractual relationship with another hospital/institution?
Yes – Go to Question I19.1
No – Skip to Question I21
I19.1Is the Gait Laboratoryaccredited by the Commission for Motion Laboratory Accreditation (CMLA)?
Yes
No
I20.In the last calendar year how many diagnostic evaluations did your Pediatric Orthopaedic program conduct with pediatric patients in the Motion Laboratory (Gait lab)?[If none, please enter 0.]
______Evaluations
VALIDATE:IF I20 IS NOT A WHOLE NUMBER, DISPLAY: “I20: Please enter a whole number (no decimals).”
I21.Does your Pediatric Orthopaedic program have an ongoing system to monitor compliance with preoperative antibiotic prophylaxis timing for spinal fusion surgeries (see code list)? The ongoing system should capture all surgeries, or at minimum capture a monthly sampling of cases, based on standard (e.g. Joint Commission) sampling recommendations
Yes, we monitor for ALL spinal fusion surgeries
Yes, we have an ongoing monthly program (12 months a year) that monitors timing for a sample of cases
Yes, we have a program, but monitor less frequently than every month
No – Skip to Question I23
I22.Of the cases reviewed (in I21), what was your percentage of compliance with the preoperative antibiotic prophylaxis timing (i.e., incision “cut” time within 60 minutes of antibiotic infusion, or 120 minutes if vancomycin is used) in spinal fusion surgeries in the last calendar year?[Calculate as follows: (1) Determine the number of pediatric spinal fusion surgeries in which perioperative antibiotic timing was compliant with guidelines. Exclude cases in which patients are already on scheduled antibiotics that substitute for prophylaxis.(2) Divide by the number of spinal fusion cases (from I21). (3) Multiply by 100. (4) Insert the results of steps 1-3 below. Insert the result below.]
______Number of cases compliant
______Number of cases reviewed
______Percent compliant
WARNING:IF I22 (2) = (0 OR BLANK), DISPLAY: “I22: Please provide a value greater than 0 for cases reviewed or answer no to monitoring compliance in I21.”
VALIDATE:IF I22 (1) > I22 (2) DISPLAY, “I22: Please check your responses. The number of compliant cannot be greater than the number of cases reviewed.”
IF I22x IS NOT A WHOLE NUMBER, DISPLAY: “I22x: Please enter a whole number (no decimals).”
AUTOCALC:I22 (3) = [(I22 (1) / I22 (2)) *100]
I23.Which of the following established surveillance systems to monitor surgical site infections (SSI) for spinal fusion surgeries are used for tracking and/or reporting by your Pediatric Orthopedic program?[Check all that apply.]
NHSN/CDC standards – Skip to Question I24
NSQIP standards – Skip to Question I24
We track using some “other” standard than those listed above – Go to Question I23.1
N/A, we do not track SSIs– Skip to Question I24
I23.1. If you marked “yes” to some “other” standard please provide the definitions used to identify cases, your case-finding method, and the reporting process (including reporting of surgeon- or service-specific SSI rates, stratification of SSI rate by procedure type, and frequency of reports).
I24.How many unique patients were seen in your Pediatric Orthopaedic program for the following diagnoses and procedures[21] in the last calendar year? For each, indicate the number of surgical procedures performed on these patients in the operating room or in another clinical setting related to their diagnosis.[If none, please enter 0.]
Unique Patients / Surgical ProceduresOpen reduction developmental dysplasia of the hip (see code list – must have at least one diagnosis code and at least one procedure code) / ______/ ______
Ponseti treatment for clubfoot in patients 1 years old (see code list) / ______/ ______
Bernese pelvic osteotomy in patients 18 years old (see code list – must have at least one diagnosis code and at least one procedure code) / ______/ ______
Cast treatment for infantile scoliosis < 5 years old (see code list) / ______/ ______
ACL reconstruction (males < 14 years old or females < 12 years old) (see code list – must have at least one diagnosis code and at least one procedure code) / ______/ ______
Femoral and tibial leg lengthening surgery (see code list – must have at least one diagnosis code and at least one procedure code) / ______/ ______
Pollicization hand surgeries (see code list – must have at least one diagnosis code and at least one procedure code) / ______/ ______
VALIDATE:IF I24x IS NOT A WHOLE NUMBER, DISPLAY: “I24x: Please enter a whole number (no decimals).”
I25.How many of the patients who underwent operative reduction and fixation of supracondylar fracture of the humerus (see code list – must have at least one diagnosis code and at least one procedure code) during the last calendar year, received their care (OR start time) within 18 hoursor longer following time of admission to your Emergency Department[22]? [If none, please enter 0.]
______Unique patients OR start time < 18 hours
______Unique patients OR start time in 18 hours
VALIDATE: IF I25x IS NOT A WHOLE NUMBER, DISPLAY: “I25x: Please enter a whole number (no decimals).”
I26.How many patients with isolated femoral shaft fracture (see code list – must have at least one diagnosis code and at least one procedure code) during the last calendar year, received their care (OR start time) within 18 hours or longer following time of admission to your Emergency Department?[If none, please enter 0.]
______Unique patients OR start time < 18 hours
______Unique patients OR start time in 18 hours
VALIDATE: IF I26x IS NOT A WHOLE NUMBER, DISPLAY: “I26x: Please enter a whole number (no decimals).”
I27.In the past year, how many radiographically-assisted reductions of displaced (closed) forearm fractures (see code list) were conducted and successfully treated by your Pediatric Orthopaedics program in your Emergency Department (or other out-patient setting) such that they did not require a hospital admission? (Do not count as successfully treated forearm fractures that lose position within 1-2 weeks and require operative intervention.)
______Total number of radiographically-assisted reductions
______Total number of successful outpatient treated
VALIDATE: I27bI27a. ELSE DISPLAY: “I27: The number of successful outpatients treated cannot be greater than the total number of reductions.”
I28.Does your hospital have a designated trauma operating room that99% guarantees orthopaedics a “First case of the day start” with at least one half day (minimum 4 hours) of OR time in that room every day throughout the year? [To answer Yes, you must provide documentation (via Upload Documents link on survey navigation menu) that your hospital 99% guarantees a “First case of the day start.” Examples include a copy of the block OR schedule that accommodates trauma in such a fashion or a copy of a written policy that describes their system for prioritizing trauma cases.]
Yes
No
I29.Do you have a policy in place that provides even greater OR access based on periodic demand (e.g., if orthopaedic trauma patient care demands exceed 4 hours, is there a system in place that provides full day access or a second room)? To answer yes, you must provide documentation of the policy at your institution; this documentation should be uploaded to the survey website using the “upload documents” function.
Yes
No
I30.Do you have a preoperative coordinated care review process led by a nursing coordinator (or similar professional) that meets at least monthly to evaluate high risk[23] patients and prepare them for surgery and hospitalization?
Yes
No
I31.How many unique patients in each of the following diagnosis categories received surgical correction[24] for scoliosis in the last two calendar years?[If none, please enter 0.]
Unique Patientsa. / Idiopathic scoliosis (see code list) / ______
b. / Neuromuscular scoliosis (see code list) / ______
c. / Congenital scoliosis (see code list) / ______
VALIDATE: IF I31x IS NOT A WHOLE NUMBER, DISPLAY: “I31x: Please enter a whole number (no decimals).”
SKIP LOGIC:IF (I31a + I31b + I31c) = 0, SKIP TO I33. ELSE GO TO I32.
I32.Of the unique scoliosis patients who received surgical correction for scoliosis in the last two calendar years, how many had the following complications afterthe surgery? [Please fill in all response blanks even if there is no change to the specific data element.Please count patients in all categories that apply.] [If none, please enter 0.]
Unplannedadmissions within
30 days (for
any cause) / Reoperation within 90 days
(for any cause)
a. / Idiopathic scoliosis (see code list) / ______/ ______
b. / Non-idiopathic scoliosis (includes both neuromuscular and congenital scoliosis)(see code list) / ______/ ______
VALIDATE: IF I32x IS NOT A WHOLE NUMBER, DISPLAY: “I32x: Please enter a whole number (no decimals).”
IF I32ax > I31a, DISPLAY: “I32a: The number of unplanned admissions or reoperations cannot be greater than the number of total patients reported in I31a.”
IF I32bx > I31b + I31c, DISPLAY: “I32b: The number of unplanned admissions or reoperations cannot be greater than the number of total patients reported in I31b and I31c.”
IF I32x1 IS BLANK, DISPLAY: “I32x (Unplanned admissions): If none, please enter 0."