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A Key to the Rankings
What Matters in Pediatrics
How we identified 90 outstanding children’s hospitals
by Ben Harder
W
HERE SHOULD anxious parents take a newborn with a life-threatening heart defect, or find ongoing care for a child with failing kidneys or lung-clogging cystic fibrosis? A local hospital’s pediatric department might be perfectly capable of managing ear infections, allergies, flu and other common childhood ailments. But it may not have the expertise to treat severely ill kids. That’s where children’s hospitals come in. There are approximately 200 hospitals in the country that either exclusively treat pediatric patients or possess a pediatric department that functions like a self-contained children’s hospital. Even within that group, some centers are better than others. U.S. News created the Best Children’s Hospitals rankings to help parents, in consultation with their doctors, find those best suited to their child.
The 2022-23 rankings highlight top children’s centers in 10 specialties: cancer, cardiology and heart surgery, diabetes and endocrinology, gastroenterology and gastrointestinal surgery, neonatology, nephrology, neurology and neurosurgery, orthopedics, pulmonology and lung surgery, and urology. This year, 90 hospitals ranked in at least one specialty, and 10 were named to the Honor Roll for scoring near the top in most or all specialties. Regional rankings for each of seven multi-state regions
We gathered over 1,000 data points per hospital.
(Page 210) list hospitals according to the number of specialties in which they were among the best.
Rich data. Judging the excellence of children’s hospitals is challenging, and no single metric or ranking should be viewed as a definitive guide. U.S. News gathered more than 1,000 data points on each hospital to determine its strengths and weaknesses. Many summary measures appear in the ranking tables that follow; more can be found at usnews.com/childrenshospitals, which also features data on dozens of additional children’s hospitals.
Almost all of the medical data used in these rankings were obtained by asking hospitals to complete a lengthy online data-collection process. This year, 119 hospitals surveyed by U.S. News provided enough data to be evaluated.
RTI International, a North Carolina-based research firm, oversaw data collection and produced the rankings. Collaborating with RTI staff, 168 pediatric experts serving in working groups helped design the data-collection survey.
Whether and how high an institution was ranked depended on three elements: its clinical outcomes (such as survival and surgical complications), its delivery of care (such as adhering to safe and effective practices), and its resources (such as staffing and technology). Each element contributed one-third of a hospital’s overall score in most specialties. A detailed FAQ about the rankings is available at usnews.com/aboutchildrens. Here are the basics:
Clinical outcomes. These reveal a hospital’s success at keeping kids alive after their treatment, protecting them from infections and complications, and improving their quality of life. While tough to measure, outcomes tend to matter most to both families and doctors. Delivery of care. How well a hospital handles day-to-day care was determined in part by compliance with accepted “best practices,” such as performing neuropsychological evaluation of patients with certain cancers. Another factor: a hospital’s demonstrated commitment to diversity, equity and inclusion by, say, screening patients for social determinants of health like food insecurity. U.S. News also surveyed pediatric specialists, asking them to identify up to 10 hospitals they consider best in their area of expertise for kids with complex medical problems.
Resources. Surgical volume, nursepatient ratio, clinics and programs for conditions such as asthma, and dozens of other measures were considered. l
USNEWS.COM/BESTHOSPITALS
Visit usnews.com regularly while researching your health care choices, as U.S. News often adds content aimed at helping patients and families make decisions about their medical care. We also update the Best Hospitals content and data on the website when new information becomes available.
A Word on the Terms
USED IN MORE THAN ONE SPECIALTY
A Nurse Magnet hospital:
hospital recognized by American Nurses Credentialing Center as meeting standards for nursing excellence.
Infection prevention score, ICU:
Infection prevention score, overall:
ability to prevent infections through measures such as hand hygiene and vaccination.
No. of best practices:
how well hospital adheres to recommended ways of diagnosing and treating patients, such as documenting blood sugar levels for a high percentage of outpatients (diabetes & endocrinology) and conducting hip exams with ultrasound specialists (orthopedics).
Nurse-patient ratio:
balance of full-time registered nurses to inpatients.
Patient volume score:
% of specialists recommending hospital:
percentage of physician specialists surveyed in 2020, 2021 and 2022 who named hospital among best for very challenging patients.
Procedure volume score:
relative number of tests and nonsurgical procedures in past one, two or three years, such as implanting radioactive seeds in a cancerous thyroid (diabetes & endocrinology) and using an endoscope for diagnosis (gastroenterology). Surgical procedures are included in orthopedics.
Surgery volume score:
relative number of patients who had specified surgical procedures in past year.
Surgical complications prevention
score: ability to prevent surgery-related complications and readmissions within 30 days (neurology & neurosurgery, orthopedics, urology).
U.S. News score:
0 to 100 summary of overall performance in specialty. NA: not applicable; service not provided by hospital. NR: data not reported or unavailable.
USED IN ONE SPECIALTY
CANCER Bone marrow transplant survival score:
survival of stem cell recipients at 100 days.
Five-year survival score:
survival five years after treatment for acute lymphoblastic leukemia, acute myeloid leukemia and neuroblastoma.
Palliative care score:
how well program meets specified training and staffing standards for children with terminal or life-limiting conditions, and number of cancer patients referred to program.
CARDIOLOGY & HEART SURGERY Catheter procedure volume score:
relative number of specified catheter-based procedures in past year, such as inserting stents and treating heart rhythm problems. Length of stay after surgery score: success in minimizing how long certain congenital heart patients spend in the hospital for care related to their heart condition.
Norwood/hybrid surgery survival score:
survival at one year after the first in a series of reconstructive surgeries, evaluated over past four years.
Risk-adjusted surgical survival score:
survival in the hospital and 30 days from discharge after congenital heart surgery, adjusted for operative and patient risk, evaluated over past four years.
ability to prevent serious problems in children with Type 1 diabetes and to keep blood sugar levels in check. Hypothyroid management score: relative proportions of children treated for underactive thyroid who test normal and of infants who begin treatment by 3 weeks of age.
GASTROENTEROLOGY & GI SURGERY
Liver transplant survival score: one- and three-year survival after liver transplant. Nonsurgical procedure volume score: relative number of tests and noninvasive procedures. Selected treatments success score: shown, for example, by high remission rates for inflammatory bowel disease and few complications from endoscopic procedures.
NEONATOLOGY Infection prevention score, NICU:
Keeping breathing tube in place score:
ability to minimize inappropriate breathingtube removal in intubated infants.
Leaves NICU on breast milk score:
relative percentage of infants discharged from NICU receiving some nutrition from breast milk.
NICU temperature management score:
success in managing NICU patients’ temperature at the time of admission and postoperatively.
NEPHROLOGY Biopsy complications prevention score:
ability to minimize complications after kidney biopsy.
Dialysis management score:
relative proportion of dialysis patients in past two years who tested normal.
Infection prevention score, dialysis:
ability to minimize dialysis-related infection.
Kidney transplant survival score:
based on patient survival and functioning kidney at one and three years.
ability to treat children with epilepsy.
Surgical survival score:
survival at 30 days after complex surgery and procedures, such as those involving brain tumors, epilepsy and head trauma.
ORTHOPEDICS Fracture repair score:
ability to treat complex leg and forearm fractures efficiently.
PULMONOLOGY & LUNG SURGERY
Asthma inpatient care score: ability to minimize asthmatic children’s asthma-related deaths, length of stay and readmissions.
Cystic fibrosis management score:
ability to improve lung function and nutritional status.
Lung transplant survival score:
reflects number of transplants in past two years, one-year survival, and recognition by United Network for Organ Sharing.
UROLOGY Minimally invasive volume score:
relative number of patients in past year who had specified nonsurgical procedures.
Testicular torsion care score:
promptness of emergency surgery to correct twisted spermatic cord.
