SECTION H: PEDIATRIC NEUROLOGY & NEUROSURGERY
H1.Do you have a Pediatric Neurology/Neurosurgery program?
Yes – Go to Question H2
No – Skip to Section I
When responding to questions in this section, your hospital must consult with the chief of service (or equivalent) of your Pediatric Neurology/Neurosurgery 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 Neurology program and your Pediatric Neurosurgeryprogram.
Full name of chief of Pediatric Neurology program:
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.”
Full name of chief of Pediatric Neurosurgery program:
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.”
H2.Please indicate the total number of attending/on-staff physicians (excluding fellows)[1]who are currently members of the medical staff in your Pediatric Neurology/Neurosurgery 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 / ClinicalFTEs
a. / Pediatric neurologists (include only attending/on-staff physicians board certified/board eligible by the American Board of Psychiatry and Neurology with a general certificate in child neurology) / ______/ ______
b. / Pediatric neurosurgeons (include only attending/on-staff physicians board certified/board eligible by the American Board of Pediatric Neurological Surgerywith certification by American Board of Neurological Surgery or DOs certified by American Osteopathic Association in pediatric neurological surgery) / ______/ ______
c. / Other attending/on-staff physicians (include all other attending/on-staff physicians who are not subspecialty board certified/board eligible in child neurology or pediatric neurological surgery) / ______/ ______
VALIDATE:IF H2x1 IS NOT A WHOLE NUMBER, DISPLAY: “H2x (Total Physicians): Please enter a whole number (no decimals).”
Note: The preceding questions are used to determine eligibility for Pediatric Neurology/Neurosurgery. If you leave any part of these questions blank, your hospital will be considered ineligible for the rankings in Pediatric Neurology/Neurosurgery.
H3.Please indicate the total number of nurse practitioners and physician assistants who work in or directly support yourPediatric Neurology/Neurosurgery program. For each category, please indicate the total number of full-time equivalents (FTEs)[3] devoted to clinical neuroscience care.[If none, please enter 0.]
Total Staff / Clinical FTEsa. / Nurse practitioners / ______/ ______
b. / Physician assistants / ______/ ______
VALIDATE: IF H3x1 IS NOT A WHOLE NUMBER, DISPLAY: “H3x (Total Staff): Please enter a whole number (no decimals).”
H4.How many nurse FTEs (both inpatient and outpatient), with advanced neurologic certification[4], work in your Pediatric Neurology/Neurosurgery program?
______FTE
VALIDATE: 0 ≤ H4 ≤ 100. ELSE DISPLAY: “H4: Please enter a numeric value between 0 and 100.”
H5.Are the following available to patients in your Pediatric Neurology/Neurosurgery program?
Yes / Noa. / Neurophysiological intraoperative monitoring / ○ / ○
b. / EEG source localization[5] / ○ / ○
c. / Ketogenic diet evaluation[6] or modified diet evaluation (including Atkins) and management program / ○ / ○
d. / Neuroendovascular interventionalist[7] / ○ / ○
e. / Neuroanesthesia program[8] / ○ / ○
f. / Functional MRI (fMRI) / ○ / ○
g. / Availability of 24/7 EEG monitoring in PICU/NICU, not including amplitude integrated EEG (aEEG) / ○ / ○
h. / Nuclear medicine brain SPECT and/or brain PET / ○ / ○
H6.In the past calendar year, how many of the following types of IRB-approved trials, studies, or databases did your Pediatric Neurology/Neurosurgery program participate in: prospective randomized clinical trials, prospective observational studies, and prospective clinical database on patient care? [If none, please enter 0.]
______Number of trials, studies, or databases
WARNING: IF H6=BLANK, DISPLAY: “H6: If none, please enter 0.”
VALIDATE: IF H6 IS NOT A WHOLE NUMBER, DISPLAY: “H6: Please enter a whole number (no decimals).”
H7.Does your hospital offer an EEG lab accredited by the American Board of Registration of Electroencephalographic and Evoked Potential Technologists (ABRET)[9]?
Yes
No
H7.1 Does your hospital have in-house EEG technologists available 24/7 to place electrodes?
Yes
No
H7.2 Does your hospital have in-house EEG technologists available to review EEG continuously 24/7?
Yes
No
H8.How many unique patients with convulsive disorders received a surgical resection for epilepsy (see code list) in the last calendar year? Please exclude patients with seizures associated with brain tumors. [If none, please enter 0.]
______Unique patients
VALIDATE: IF H8 IS NOT A WHOLE NUMBER, DISPLAY: “H8: Please enter a whole number (no decimals).”
IF H8 IS BLANK, DISPLAY: “H8: If none, please enter 0.”
SKIP LOGIC: IF H8=0, SKIP TO H9; ELSE GO TO H8.1.
H8.1.Of the unique patients who received surgical resection(H8), how many had intraoperative electrocorticography and/or extraoperative monitoring of implanted intradural grids/strips/depth electrodes? [If none, please enter 0.]
_____ Number of patients
VALIDATE: IF H8.1 IS NOT A WHOLE NUMBER, DISPLAY: “H8.1: Please enter a whole number (no decimals).”
IF H8.1 IS BLANK, DISPLAY: “H8.1: If none, please enter 0.”
IF H8.1 > H8, DISPLAY: “Please check your responses. The number of patients in H8.1 cannot be greater than the number of patients in H8.”
H8.2.Of the unique patients who received surgical resection(H8), how many experienced a complication (e.g., surgical site infection, hemorrhage, or neurologic deficit/stroke) within 30 days of the procedure? [If none, please enter 0.]
_____ Number of patients
VALIDATE: IF H8.2 IS NOT A WHOLE NUMBER, DISPLAY: “H8.2: Please enter a whole number (no decimals).”
IF H8.2 IS BLANK, DISPLAY: “H8.2: If none, please enter 0.”
IF H8.2 > H8, DISPLAY: “Please check your responses. The number of patients in H8.2 cannot be greater than the number of patients in H8.”
H9.How many of unique patients with epilepsy (see code list) in each category were seen by your Pediatric Neurology/Neurosurgery program in the last calendar year?[If none, please enter 0.]
Unique Patientsa. / Initial medical evaluations with patients newly diagnosed with epilepsy(excluding febrile seizures). / ______
b. / Standard EEG evaluations (with or without video EEG) for epilepsy / ______
c. / Long-term(≥24 hrs) video EEG (vEEG) evaluations for epilepsy [Report total number of patients evaluated. Patients can only be counted once if evaluated more than one time.] / ______
d. / First-time surgical procedures for epilepsy[10], excluding vagus nerve stimulation (VNS) / ______
e. / VNS placements or surgical revision / ______
VALIDATE: IF H9x IS NOT A WHOLE NUMBER, DISPLAY: “H9x: Please enter a whole number (no decimals).”
H10.For the standard EEG (H9b) and long-termvEEG (H9c) evaluations reported above, what percentage of these patients’ tests were interpreted and recorded in the patient’s medical chart within the designated timeframes?
% Interpreted within timeframea. / Standard EEG medical evaluations interpreted and recordedwithin 36 hours of being conducted / ______%
b. / Long-termvEEGevaluations interpreted and recordedwithin 5 days from discharge / ______%
VALIDATE: 0 ≤ H10 ≤ 100. ELSE DISPLAY: “H10: Please enter a numeric value between 0 and 100.”
H11.This question was removed from the survey.
H12.Were the following specialized and multidisciplinary clinics, provided by your hospital in the last calendar year with the regular involvement[11] of your Pediatric Neurology/Neurosurgery program?
Yes / Noa. / Cerebral palsy/spasticity multidisciplinary clinic[12] / ○ / ○
b. / Cerebrovascular/stroke multidisciplinary clinic[13] / ○ / ○
c. / Craniofacial surgical multidisciplinary clinic[14] / ○ / ○
d. / Surgical movement disorders multidisciplinary clinic[15] / ○ / ○
e. / Neurofibromatosis multidisciplinary clinic[16] / ○ / ○
f. / Neuromuscular multidisciplinary clinic[17] / ○ / ○
g. / Neuro-oncologymultidisciplinaryclinic[18] / ○ / ○
h. / Spina bifida multidisciplinaryclinic[19] / ○ / ○
i. / Tuberous sclerosis multidisciplinary clinic[20] / ○ / ○
j. / Brachial plexus multidisciplinary clinic[21] / ○ / ○
k. / Genetic Metabolic multidisciplinary clinic[22] (i.e., leukodystrophy, inborn errors of metabolism, mitochondrial disorders) / ○ / ○
l. / Neonatal neurology multidisciplinary clinic[23] / ○ / ○
m. / Head trauma and/or post-concussion[24] / ○ / ○
n. / New-onset seizure clinic[25] / ○ / ○
o. / Neuro-fetal multidisciplinary clinic[26] (coordinated prenatal review with Neurology/Neurosurgery) / ○ / ○
p. / Headache multidisciplinary clinic[27] / ○ / ○
q. / Painmultidisciplinary clinic[28] / ○ / ○
r. / Demyelinatingdisorders multidisciplinary clinic[29] (e.g., multiple sclerosis, acute disseminated encephalomyelitis (ADEM)) / ○ / ○
s. / Autism/neurodevelopmental disorders multidisciplinary clinic[30] / ○ / ○
H12.1Question removed from the 2018-19 Survey.
H13.Does your hospital offer an inpatient pediatric rehabilitation program that includes a board certified/board eligible pediatric physiatrist for rehabilitation of neurology/neurosurgery pediatric patients?
Yes – Go to H13.1
No – Skip to H14
H13.1 If yes, is your inpatient pediatric rehabilitation program certified by the Commission on Accreditation of Rehabilitation Facilities (CARF)?
Yes
No
H13.2Does your inpatient pediatric rehabilitation program participate in and submit data to the Universal Data System for Medical Rehabilitation (UDSMR)?
Yes
No
H14.Does your Pediatric Neurology/Neurosurgery program provide neuropsychological testing by a pediatric neuropsychologist at your center?
Yes – Go to Question H15
No – Skip to Question H16
H15.Does your Pediatric Neurology/Neurosurgery program offer postoperative neuropsychological evaluations for the following conditions:
Yes / Noa. / Brain tumors (benign/malignant) / ○ / ○
b. / Traumatic brain injury/concussion / ○ / ○
c. / Medically intractable epilepsy / ○ / ○
d. / Craniofacial disorders / ○ / ○
H16.How many unique patients received the following surgical procedures in your pediatric neurosurgery program in the last calendar year? [Please only include patients for whom this is the first surgical procedure or no other similar procedure in prior 6 months.] Of these unique patients, how many deaths occurred within 30 days of surgery primarily due to the neurological condition which was the focus of surgery?[If none, please enter 0.]
Unique Patients / Deathsa. / Brain tumors (benign/malignant) (See code list. Must have at least one diagnosis code and at least one procedure code.) / ______/ ______
b. / Craniosynostosis (See code list. Must have at least one diagnosis code and at least one procedure code.) / ______/ ______
c. / Hydrocephalus patient shunt procedures (See code list. Must have at least one diagnosis code and at least one procedure code.) / ______/ ______
d. / Medically intractable epilepsy (See code list. Must have at least one of the included diagnosis codes and at least one procedure code, but cannot have any of the excluded diagnosis codes.) / ______/ ______
e. / Spinal dysraphism (See code list. Must have at least one diagnosis code and at least one procedure code.) / ______/ ______
f. / Chiari I malformation/syringomyelia (See code list. Must have at least one diagnosis code and at least one procedure code.) / ______/ ______
g. / Endoscopic third ventriculostomy as well as other endoscopic procedures (See code list.) / ______
h. / Brachial plexus exploration/reconstruction performed by neurosurgeons(See code list.) / ______
i. / Spasticity (including ITB pumps and catheters implantation and replacement, SDR, DBS implantation) (See code list.) / ______
j. / Vascular cases including endovascular procedures performed by neurosurgeons(See code list.) / ______
k. / Deep brain stimulation for dystonic cerebral palsy(See code list.) / ______
l. / Spinal instrumentation performed by pediatric neurosurgeons(See code list.) / ______
VALIDATE: IF H16x IS NOT A WHOLE NUMBER, DISPLAY: “H16x: Please enter a whole number (no decimals).”
IF H16x1 IS BLANK, DISPLAY: “H16x (Unique Patients): If none, please enter 0.”
IF H16x2>H16x1, DISPLAY: “H16x: Please check your responses. The number of deaths cannot be greater than the number of patients.”
H17.How many unique patients had the following surgical procedures performed by pediatric neurosurgeonsin the last calendar year? Of these patients, how many were readmitted within 30 days of surgery?[If none, please enter 0.]
Unique Patients / ReadmittedPatients
a. / Craniotomy (See code list.) / ______/ ______
b. / Spinal surgery for dysraphism (See code list. Must have at least one diagnosis code and at least one procedure code.) / ______/ ______
c. / Chiari decompression (See code list. Must have at least one diagnosis code and at least one procedure code.) / ______/ ______
d. / Shunt placement (Include initial placement and revision, endoscopic third ventriculostomy, and endoscopic third ventriculostomy with choroid plexus coagulation) (See code list.) / ______/ ______
VALIDATE: IF H17x IS NOT A WHOLE NUMBER, DISPLAY: “H17x: Please enter a whole number (no decimals).”
IF H17x1 IS BLANK, DISPLAY: “H17x (Unique Patients): If none, please enter 0.”
IF H17x2>H17x1, DISPLAY: “H17x: Please check your responses. The number of readmitted patients cannot be greater than the number of unique patients.”
SKIP LOGIC:IF H17a=0, GO TO H18. ELSE GO TO H17.1
H17.1 Of the patients who received a craniotomy in the last calendar year (reported in H17a), how many unique patients had unplanned returns to the OR for any reason related to the initial surgery within 30 days of initial surgery?[If none, please enter 0.]
______Unique patients with returns to the OR
VALIDATE: IF H17.1 IS NOT A WHOLE NUMBER, DISPLAY: “H17.1: Please enter a whole number (no decimals).”
IF H17.1 IS BLANK, DISPLAY: “H17.1: If none, please enter 0.”
IF H17.1>H17a1, DISPLAY: “Please check your responses. The number of patients with returns to the OR (H17.1) cannot be greater than the number of unique patients with craniotomy (H17a).”
H18.How many unique patients received an intrathecal baclofen pump insertion procedure (new or replacement – see code list) in the last year[31]? Of these patients, how many were readmitted to your hospital due to any type ofcomplications (e.g., pump malfunction or infection) within 90 days from surgical insertion?[If none, please enter 0.]
UniquePatients
a. / Patients receiving an intrathecal baclofen pump insertion procedure in the last year (new or replacement) / ______
b. / Patients readmitted within 90 days of an intrathecal baclofen pump insertion procedure (new or replacement) / ______
VALIDATE: IF H18x IS NOT A WHOLE NUMBER, DISPLAY: “H18x: Please enter a whole number (no decimals).”
IF H18x IS BLANK, DISPLAY: “H18x: If none, please enter 0.”
IF H18b > H18a, DISPLAY: “Please check your responses. The number of patients readmitted (H18b) cannot be greater than the number of unique patients (H18a).”
H19.Does your Pediatric Neurology/Neurosurgery program participate in the following nationally audited programs that include a focus on specific outcome measures related to neurology and neurosurgery?
Yes / Noa. / Pediatric Neurocritical Care Research Group / ○ / ○
b. / International Pediatric Stroke Study (IPSS)[32] / ○ / ○
H20.Does your Pediatric Neurology/Neurosurgery program participate in any community outreach programs to improve health in the community?
Yes
No – skip to H21
H20.1If Yes to H20,please describe what your program does and how it has impacted the health of the community:
H21.Is your hospital a member of a neuro-oncology clinical research consortium (Pediatric Brain Tumor Consortium, Children’s Oncology Group,Pediatric Neuro-Oncology Consortium, or other)?
Yes
No
H22.Does your Pediatric Neurosurgery program engage in any of the following activities?
Yes / Noa. / Maintain a surgical mortality database used by the program to evaluate performance / ○ / ○
b. / Multidisciplinary morbidity and mortality conferences[33]which meet regularly to review neurology and neurosurgery cases / ○ / ○
c. / Interdisciplinary clinical conferences held monthly or more often and attended by pediatric neurologists, neurosurgeons, neuroradiologists and neuropathologists to review and improve the care of patients / ○ / ○
H23.Is your Pediatric Neurology/Neurosurgery program currently engaged in any of the following activities?
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 neurology/neurosurgery care / ○ / ○
H23.1If “yes” to any part of H23, 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:
H24.Does your Pediatric Neurology/Neurosurgery program offermultidisciplinary neurocritical care that is coordinated by both pediatric critical care attending physicians and either pediatric neurologists or neurosurgeons for children with neurological or neurosurgical disorders, respectively?
Yes
No
H25.Does your Pediatric Neurology/Neurosurgery program have an ongoing system to monitor compliance with preoperative antibiotic prophylaxis timing for ventricular shunt surgeries (See code list), including placement and revision? The ongoing program 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 ventricular surgeries – Go to Question H26
Yes, we have an ongoing monthly program (12 months a year) that monitors timing for a sample of cases – Go to Question H26
Yes, we have a program, but monitor less frequently than every month – Go to Question H26
No – Skip to Question H27
H26.Of all shunt surgeries performed in the last calendar year, what was your percentage of cases with documented compliance with currently accepted antibiotic prophylaxis standards?Compliance is defined as antibiotic infusion initiated within 60 minutes of incision time, or 120 minutes of incision time if vancomycin is used. [Calculate as follows: (1) Determine the number of pediatric ventricular shunt surgeriesin which perioperative antibiotic timing was documented to be compliant with guidelines. (2) Determine the total number of ventricular shunt surgeries (See code list)[34]performed. (3) Divide the number of compliant cases by the total number of cases, and multiply by 100. Round your result to 2 decimals.]
______(1) Number of cases compliant
______(2) Number of cases performed
______(3) Percent compliant
VALIDATE:IF H26(1) > H26(2) DISPLAY, “H26: Please check your responses. The number of compliant cannot be greater than the total number of cases.”
IF H26x IS NOT A WHOLE NUMBER, DISPLAY: “H26x: Please enter a whole number (no decimals).”
AUTOCALC:H26(3) = [(H26(1) / H26(2)) *100]
H27.Does your Pediatric Neurology/Neurosurgery program monitor surgical site infections (SSI) using NHSN criteria for ventricular shunt surgeries?[35]
Yes – Go to Question H28
No – Skip to Question H29
H28.Using the NHSN criteria and definition for case selection and SSI, what was the SSI percentage[36] for ventricular shunt surgeries performed in 2016?[37][Calculate as follows: (1) Determine the number of SSIs where a ventricular shunt was placed (for replacement, include revision and removal of shunt (See code list). Do not include cases that fit the description of CNSMENINGITIS for shunt infections.(2) Determine the number of ventricular shunt surgeries. (3)Divide the number of SSIs by the number of surgeries and multiply by 100. Round your result to 2 decimals.]