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 Neurosurgery program.

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.”

Last updated: 1/10/2018

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

Clinical FTEs

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 Surgery with 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 your Pediatric 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).”

1 Attending/on-staff physicians include those who have completed their training in their particular medical specialty, are actively providing clinical care to patients, and are currently considered a member of the “medical staff” at the hospital. This may include physicians employed by the hospital, an affiliated university, or some other entity as long as the physician is considered part of the medical staff at the hospital. 2 To calculate physician clinical FTEs, please take the percentage of typical clinical effort that a physician provides to the program and divide by 100. This resulting decimal will be the clinical FTE for this physician. For example, Dr. A spends 75% of his time in clinical care and 25% in research; the clinical FTE for Dr. A would be 0.75 FTE (i.e., 75/100=0.75).3 To calculate nurse practitioner and physician assistant clinical FTEs, please take the percentage of typical clinical effort that a NP or PA provides to the program and divide by 100. This resulting decimal will be the clinical FTE. For example, NP Smith spends 65% of her time in clinical care and 35% in administrative activities; the clinical FTE for NP Smith would be 0.65 FTE (i.e., 65/100=0.65).

Last updated: 1/10/2018

H4. How many nurse FTEs (both inpatient and outpatient), with advanced neurologic certification4, 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 localization5 ○ ○

c. Ketogenic diet evaluation6 or modified diet evaluation (including Atkins) and management program ○ ○

d. Neuroendovascular interventionalist7

○ ○

e. Neuroanesthesia program8

○ ○

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).”

4 Advanced neurologic certifications include Certified Neuroscience Registered Nurses (CNRN), Certified Brain Injury Specialists (CBIS), as well as Certified Pediatric Nurses (CPN) and Certified Critical Care Nurses (CCRN) who have a certification in pediatric neurocritical care, neurology nursing or some other related certification.5 Source localization is the process of identifying the origin or site of seizure activity within the brain. The most common methods of doing this are the use of MEG or EEG testing techniques. 6 A Ketogenic diet program should include initiation and management, standardized protocols, a full-time dietician (with knowledge of this type of dietary program), and nursing oversight.7 This is a pediatric neuro interventional radiologist or pediatric neurosurgeon interventionalist.8 An anesthesia program with anesthesiologists and critical care specialists designed to address the special needs of neurological patients with a variety of difficult and challenging conditions such as head trauma, spinal cord injuries, and others.

Last updated: 1/10/2018

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

911 http://abret.org/

Last updated: 1/10/2018

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 epilepsy10, 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-term vEEG (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 timeframe

a. Standard EEG medical evaluations interpreted and recorded within 36 hours of being conducted ________%

b. Long-term vEEG evaluations interpreted and recorded within 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.

10 For this question, hospitals may report based on either of the following approaches, but cannot use both options. Option 1: Select cases based on the ICD-10 diagnosis codes provided for H9 along with the CPT codes listed on the “H9d PROCS_Inc (CPT)” tab. Option 2: Select cases based on the ICD-10 diagnosis codes provided for H9 along with the ICD-10 PCS codes listed on the “H9d PROCS_Inc (ICD)” tab, and excluding the ICD-10 PCS codes listed on the “H9d DX_Exc” tab. DO NOT USE BOTH APPROACHES TO COUNT CASES—SELECT EITHER OPTION 1 OR 2.

Last updated: 1/10/2018

H12. Were the following specialized and multidisciplinary clinics, provided by your hospital in the last calendar year with the regular involvement11 of your Pediatric Neurology/Neurosurgery program?

Yes Noa. Cerebral palsy/spasticity multidisciplinary clinic12 ○ ○b. Cerebrovascular/stroke multidisciplinary clinic13 ○ ○c. Craniofacial surgical multidisciplinary clinic14 ○ ○d. Surgical movement disorders multidisciplinary clinic15 ○ ○e. Neurofibromatosis multidisciplinary clinic16 ○ ○f. Neuromuscular multidisciplinary clinic 17 ○ ○g. Neuro-oncology multidisciplinary clinic18 ○ ○h. Spina bifida multidisciplinary clinic19 ○ ○i. Tuberous sclerosis multidisciplinary clinic20 ○ ○j. Brachial plexus multidisciplinary clinic21 ○ ○k. Genetic Metabolic multidisciplinary clinic22 (i.e., leukodystrophy,

inborn errors of metabolism, mitochondrial disorders) ○ ○

l. Neonatal neurology multidisciplinary clinic23 ○ ○11 Regular participation is defined as having your pediatric Neurology and Neurosurgery program’s neurologists or neurosurgeons regularly scheduled to see patients in the clinic.12 To answer “yes”, the program needs to have a dedicated team including a pediatric neurologist with fellowship training in movement disorders, pediatric neurosurgeon, pediatric orthopedic surgeon, pediatric physiatrist, physical therapist, occupational therapist, social worker, and nursing coordinator.13 To answer “yes”, the program needs to have a dedicated medical team including a pediatric neurologist with fellowship training in vascular neurology, pediatric neurosurgeon, vascular neurosurgeon, neuro-interventional radiologist or other endovascular surgeon, pediatric hematologist, pediatric physiatrist, neuropsychologist, physical therapist, occupational therapist, social worker, and nursing coordinator.14 To answer “yes”, this program needs to have a dedicated medical team including a pediatric neurosurgeon, craniofacial plastic surgeon, pediatric otolaryngologist, pediatric dentist, pediatric orthodontist, speech language pathologist/occupational therapist, social worker, and nursing coordinator.15 To answer “yes”, this program needs to have a dedicated medical team including a pediatric neurologist with fellowship training in movement disorders, movement disorders neurosurgeon, psychiatrist, neuropsychologist, physical therapist, social worker, and nursing coordinator. 16 To answer “yes”, this program needs to have a dedicated medical team including a pediatric neurologist, pediatric oncologist, pediatric neurosurgeon, medical geneticist, pediatric ophthalmologist, pediatric orthopedic surgeon, plastic surgeon, pediatric physiatrist, neuropsychologist, social worker, and nursing coordinator.17 To answer “yes”, this program needs to have a dedicated medical team including a pediatric neurologist with fellowship training in neuromuscular disorders, pediatric cardiologist, pediatric pulmonologist, pediatric physiatrist, pediatric gastroenterologist, pediatric endocrinologist, psychiatrist, physical therapist, occupational therapist, respiratory therapist, genetic counselor, social worker, and nursing coordinator. This program encompasses significant maladies that cause dysfunction of the peripheral nervous system, neuromuscular junction, and/or muscle. Depending on the area affected, there may be motor symptoms (e.g., muscle weakness, fatigue, wasting, incoordination), sensory symptoms (e.g., tingling, decreased sensation, pain), or autonomic symptoms (e.g., incontinence, diarrhea, lack of sweating).18 To answer “yes”, this program needs to have a dedicated medical team including a pediatric neurologist, pediatric neuro-oncologist, pediatric neurosurgeon, pediatric radiation oncologist, pediatric physiatrist, neuro-endocrinologist, neuro-ophthalmologist, neuropsychologist, social worker, and nursing coordinator.19 To answer “yes”, this program needs to have a pediatric neurosurgeon, pediatric orthopedic surgeon, pediatric urologist, pediatric physiatrist, physical therapist, occupational therapist, social worker, and nursing coordinator. 20 To answer “yes”, this program needs to have a dedicated medical team including a pediatric neurologist, pediatric dermatologist, pediatric neurosurgeon, medical geneticist, pediatric ophthalmologist, pediatric cardiologist, neuropsychologist, social worker, and nursing coordinator.21 To answer “yes”, this program needs to have a dedicated medical team including a pediatric neurologist with fellowship training in neuromuscular disorders, pediatric neurosurgeon, pediatric plastic surgeon, pediatric orthopedic surgeon, pediatric physiatrist, physical therapist, occupational therapist, social worker, and nursing coordinator.22 To answer “yes”, this program needs to have a dedicated medical team including a pediatric neurologist, medical geneticist, genetic counselor, pediatric physiatrist, physical therapist, occupational therapist, nutritionist, social worker and nursing coordinator.

Last updated: 1/10/2018

m. Head trauma and/or post-concussion24 ○ ○n. New-onset seizure clinic25 ○ ○o. Neuro-fetal multidisciplinary clinic26 (coordinated prenatal review

with Neurology/Neurosurgery) ○ ○

p. Headache multidisciplinary clinic27 ○ ○q. Pain multidisciplinary clinic28 ○ ○r. Demyelinating disorders multidisciplinary clinic29 (e.g., multiple

sclerosis, acute disseminated encephalomyelitis (ADEM)) ○ ○

s. Autism/neurodevelopmental disorders multidisciplinary clinic30 ○ ○

H12.1 Question 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

H13.2 Does your inpatient pediatric rehabilitation program participate in and submit data to the Universal Data System for Medical Rehabilitation (UDSMR)?

Yes No

23 To answer “yes”, this program needs to have a dedicated medical team including a pediatric neurologist, developmental pediatrician, pediatric physiatrist, physical therapist, occupational therapist, social worker, and nursing coordinator.24 To answer “yes”, this program needs to have a dedicated medical team including a pediatric neurologist, pediatric neurosurgeon, pediatric orthopedic surgeon, pediatric physiatrist, neuropsychologist, physical therapist, occupational therapist, speech therapist, social worker, and nursing coordinator.25 To answer “yes”, this program needs to have a dedicated medical team including a pediatric epileptologist, social worker and nursing coordinator.26 To answer “yes”, this program needs to have a dedicated medical team including a pediatric neurologist, pediatric neurosurgeon, pediatric surgeon with expertise in fetal surgery, and nursing coordinator.27 To answer “yes”, this program must be led by a pediatric neurologist with fellowship training in headache, and have a pediatric psychologist able to perform cognitive behavioral therapy, social worker and nursing coordinator.28 To answer “yes”, this program needs to have a dedicated medical team including a pediatric neurologist, pediatric anesthesiologist, pediatric psychologist trained in cognitive behavioral therapy, social worker, and nursing coordinator.29 To answer “yes”, this program needs to have a dedicated medical team including a pediatric neurologist with fellowship training in multiple sclerosis, pediatric physiatrist, neuropsychologist, physical therapist, occupational therapist, speech therapist, social worker, and nursing coordinator.30 To answer “yes”, this program needs to have a dedicated medical team including a pediatric neurologist, pediatric psychiatrist, sleep specialist with fellowship training in sleep, pediatric geneticist, genetics counselor, nutritionist, developmental psychologist/neuropsychologist, occupational therapist, speech pathologist, school and education specialist, and nursing coordinator.

Last updated: 1/10/2018

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 ○ ○

Last updated: 1/10/2018

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 Deaths

a. 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.”

Last updated: 1/10/2018

H17. How many unique patients had the following surgical procedures performed by pediatric neurosurgeons in 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).”

Last updated: 1/10/2018

H18. How many unique patients received an intrathecal baclofen pump insertion procedure (new or replacement – see code list) in the last year31? Of these patients, how many were readmitted to your hospital due to any type of complications (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

H20.1 If 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

31 You may use the most recent 12-month period for which 90-day data is available.32 More information on the collaborative can be found at: http://neurology.georgetown.edu/research/internationalpediatricstrokestudy/

Last updated: 1/10/2018

H22. Does your Pediatric Neurosurgery program engage in any of the following activities?Yes No

a. Maintain a surgical mortality database used by the program to evaluate performance ○ ○

b.

Multidisciplinary morbidity and mortality conferences33which 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 ○ ○

H23.1 If “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 offer multidisciplinary 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

33 These are regularly scheduled conferences to provide a forum for faculty and trainees to explore the management of cases in which injury or death occurred. They are also a requirement of all fellowship programs of the Accreditation Council for Graduate Medical Education (ACGME).

Last updated: 1/10/2018

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 surgeries in 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]

34 Note that CPT codes are no longer provided as the CDC does not recommend their use in calculating SSI rates due to concerns about standardization of records.

Last updated: 1/10/2018

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 percentage36 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 CNS MENINGITIS 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.]

________ (1) Number of SSIs following surgery in 2016 ________ (2) Number of ventricular shunt surgeries in 2016

________ (3) SSI Percentage in 2016

VALIDATE: IF H27=Yes AND H28(1)=BLANK, DISPLAY: “Please provide a value for SSIs or answer no to monitoring SSIs in H27. If none, please enter 0.”IF H27=Yes AND H28(2) = (0 OR BLANK), DISPLAY: “H28: Please provide a value greater than 0 for shunt surgeries or answer no to monitoring SSIs in H27.”IF H28(1) > H28(2) DISPLAY, “H28: Please check your responses. The number of compliant cannot be greater than the number of cases reviewed.”IF H28x IS NOT A WHOLE NUMBER, DISPLAY: “H28x: Please enter a whole number (no decimals).”

AUTOCALC:H28(3) = [(H28(1) / H28(2)) *100]

H29. Of the patients receiving new/initial neurosurgical shunt placements (See code list) by your Pediatric Neurology/Neurosurgery program in 2016, what percentage had an unplanned return to the operating room within 30 days for a shunt revision?

________ %

VALIDATE: 0 ≤ H29 ≤ 100. ELSE DISPLAY: “H29: Please enter a numeric value between 0 and 100.”

35For guidelines on calculating the SSI rate, see the following CDC publication: http://www.cdc.gov/nhsn/PDFs/pscManual/9pscSSIcurrent.pdf. 36 We encourage you to pull data from your hospital’s reports regarding the SSI percentage if you participate in the National Healthcare Safety Network (NHSN) reporting program. If not, the details are provided above to enable you to calculate the rate.37 Provide SSI data from CY2016 to ensure that all surgeries in which an implant was placed where under surveillance for 90 days or more.

Last updated: 1/10/2018

H30. Does your Pediatric Neurology/Neurosurgery program have an Epilepsy Monitoring Unit (EMU)?

Yes – Go to Question H30.1 No – Skip to Question H31a

H30.1 Of the unique patients admitted to your EMU during the last calendar year for evaluation of epilepsy, what percent developed a convulsive seizure during the admission that persisted longer than 30 minutes despite the use of antiseizure medication?

________ %

VALIDATE: 0 ≤ H30.1 ≤ 100. ELSE DISPLAY: “H30.1: Please enter a numeric value between 0 and 100.”

H31a. How many unique patients38 received temporal lobe epilepsy surgery (See code list- must have at least one diagnosis code and at least one procedure code.) in 2016? [If none, please enter 0.] Of those, how many achieved Engel Class 1-2 after 12 months? [Please exclude patients with brain tumors and vascular lesions.]

________ (1) Unique patients 2016

________ (2) Number achieving Engel class 1-2 after 12 months ________ (3) Percent achieving Engle class 1-2 after 12 months

H31b. How many unique patients39 received Extra-temporal lobe epilepsy surgery (See code list - must have at least one diagnosis code and at least one of the included procedure codes, but cannot have any of the excluded procedure codes.) in 2016? [If none, please enter 0.] Of those, how many achieved Engel Class 1-2 after 12 months?

________ (1) Unique patients 2016

________ (2) Number achieving Engel class 1-2 after 12 months

________ (3) Percent achieving Engle class 1-2 after 12 months

38 If patients received more than one of the above procedures, please count only one time for purposes of this question. They should be included in your count of the most recent of the above surgical procedures performed in calendar 2016.39 If patients received more than one of the above procedures, please count only one time for purposes of this question. They should be included in your count of the most recent of the above surgical procedures performed in calendar 2016.

Last updated: 1/10/2018

H31c. How many unique patients40 received Hemispherectomy, either functional or anatomical (See code list) in 2016? [If none, please enter 0.] Of those, how many achieved Engel Class 1-2 after 12 months?

________ (1) Unique patients 2016

________ (2) Number achieving Engel class 1-2 after 12 months ________ (3) Percent achieving Engle class 1-2 after 12 months

H32. Will the hospital’s epilepsy program be a Level IV member of the National Association of Epilepsy Centers as of March 1, 2018?

Yes No

H33. How many unique patients received a craniofacial procedure (See code list) from your Pediatric Neurology/Neurosurgery in 2016? [If none, please enter 0.]

_________ Unique patients

VALIDATE: IF H33 IS NOT A WHOLE NUMBER, DISPLAY: “H33: Please enter a whole number (no decimals).”

SKIPLOGIC: IF H33=0, SKIP TO H35; ELSE GO TO H34.

H34. Of the patients reported in H33, how many returned to the OR for an unplanned revision surgery within 12 months? [If none, please enter 0.]

_________ Unique patients returned for revision

VALIDATE: IF H34 IS NOT A WHOLE NUMBER, DISPLAY: “H34: Please enter a whole number (no decimals).”IF H34 IS BLANK, DISPLAY: “If none, please enter 0.”IF H34 > H33, DISPLAY: “The number of patients that returned for a revision surgery (H34) cannot be greater than the number of unique patients reported in H33.”

AUTOCALC:NEURO_CRANIO_COMPLICATION = (H34 / H33) * 100

40 If patients received more than one of the above procedures, please count only one time for purposes of this question. They should be included in your count of the most recent of the above surgical procedures performed in calendar 2016.

Last updated: 1/10/2018

The following are being collected for information purposes only. They will not be factored into the rankings in 2018-19.

H35. Please indicate whether your Pediatric Neurology/Neurosurgery program could provide the following information if requested on the 2019-20 survey:

Yes, with no

difficulty

Yes, with some

difficulty

Yes, with great

difficulty Noa. Availability of bi-plane neuro

interventional radiology room. If so, then how many pediatric patients received procedures in this setting?

○ ○ ○ ○

b. Availability of fiber tract imaging (diffusion tensor imaging). If so, then how many pediatric patients received evaluation in this setting?

○ ○ ○ ○

COMMENTS FOR SECTION H:If needed, you may provide clarifications to the responses you provided to the questions asked in this section only. All other comments, suggestions or questions should be sent to PediatricHospSurvey@rti.org.

Last updated: 1/10/2018