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Methodology: Best Pediatric Hospitals

11 min read

The Leapfrog Group is a nonprofit organization that aims to help consumers make informed decisions about their health and access safe, high-value care. For over two decades, it has collected and published data on patient safety and quality of care from voluntary surveys and other sources.

The Leapfrog Group applied the following criteria to determine which pediatric hospitals qualified for the Best Pediatric Hospital List. All pediatric hospitals that completed a Leapfrog Survey were eligible for consideration.

For the complete methodology, read below.

I. A hospital must achieve, make considerable progress, or make some progress towards achieving Leapfrog’s standard for Patient Experience, based on responses to the CAHPS Child Hospital Survey.

Hospitals that care for children should survey those children and their families on important issues like communication with doctors and nurses, communication about medicines, and whether they were told how to report problems they observed. Hospitals report on the results of a nationally standardized patient experience survey called the CAHPS Child Hospital Survey. Leapfrog has additional information on Experience of Children and their Parents.

Hospitals that achieve Leapfrog’s standard are in the top percentile of hospitals, based on points achieved through aggregate scoring of individual domains’ Top Box Scores. Quartiles were determined using hospital performance reported in 2019 and 2020 Leapfrog Hospital Surveys submitted by Aug. 31, 2020.

II. A hospital must achieve, or make considerable progress towards achieving, Leapfrog’s standards for Head and Abdomen/Pelvis Pediatric Computed Tomography (CT) Radiation Doses.

Because radiation used for Computed Tomography (CT) is far higher than conventional radiographs (x-rays), it is important for hospitals to monitor their dosage when scanning children given their smaller size and lower body weights. Hospitals report their doses for routine abdomen/pelvis and head CT scans. Read more about Leapfrog has additional information on Radiation Dose for Head Scans and Radiation Dose for Abdomen/Pelvis Scans.

Leapfrog assesses hospitals on their performance for head scans and abdomen/pelvis scans separately by comparing the median radiation dose length product (DLP) for each anatomic region and age stratum to two benchmarks. The first benchmark is the Median Benchmark, which is the median of the median doses reported across all Leapfrog-reporting hospitals from 2020 Leapfrog Hospital Surveys submitted by January 31, 2021. The second benchmark is the 75th Percentile Benchmark, which is the median of the 75th percentile doses reported across all Leapfrog-reporting hospitals from 2020 Leapfrog Hospital Surveys submitted by Jan. 31, 2021.

Hospitals that achieve Leapfrog’s standard on each type of body scan are in the top percentile of hospitals, based on points achieved through aggregate scoring of individual age range strata. Hospitals that do not perform CT scans on pediatric patients or have fewer than 10 CT scans for all age ranges for a type of body scan are not assessed on one or both standards.

Given that doses of radiation used for Computed Tomography (CT) are far higher than conventional radiographs (x-rays), it is important for hospitals to review the dosage exposure for their patients, especially pediatric patients given their smaller size and lower body weights. The goal of the measure is to provide a framework where facilities can easily assess their doses, compare them to benchmarks, and take corrective action to lower their doses if they exceed threshold values.

III. A hospital must achieve Leapfrog’s standard for Computerized Physician Order Entry (CPOE).

Note: For pediatric hospitals, the CPOE Evaluation Tool does not apply.

Doctors and other licensed prescribers should order medications through a computer that alerts them to serious ordering errors, such as a wrong dose or a patient allergy, to reduce and prevent adverse drug events. Hospitals report on both the utilization of computerized physician order entry (CPOE) and the effectiveness of that system in alerting prescribers to ordering errors. Leapfrog has more information on Safe Medication Ordering.

Leapfrog’s standard for Computerized Physician Order Entry (CPOE) measures the extent to which a hospital has adopted CPOE, and whether decision-support tools in the CPOE system are working effectively. To achieve this standard, physicians must enter at least 85% of medication orders through a CPOE system and demonstrate via an online, timed evaluation, that their inpatient CPOE system can alert physicians to at least 60% of common, serious prescribing errors.

CPOE systems can reduce the number of ADEs by up to 88%, preventing 3 million serious medication errors in the U.S. each year.

IV. A hospital must achieve, or make considerable progress towards achieving Leapfrog’s standard for Bar Code Medication Administration (BCMA).

Bar code medication administration (BCMA) systems are electronic scanning systems that use both a bar code on a patient’s ID bracelet and the medication package to help ensure the right patient gets the right medication at the right time. Hospitals report on the percentage of inpatient units in which BCMA is used, the percentage of medication administrations where both the patient and medication were scanned in units where BCMA is being used, the use of clinical decision support to alert nurses if something is wrong (i.e. wrong patient), and structures to reduce workarounds that decrease the effectiveness of BCMA systems. Leapfrog has more information on Safe Medication Administration.

Leapfrog’s standard for Bar Code Medication Administration measures the utilization of BCMA in select inpatient units, compliance with scanning, decision support offered by the system, and adherence to structures that can reduce workarounds that decrease the effectiveness of BCMA systems. To achieve the standard, hospitals must utilize a BCMA system in 100% of applicable units (medical and/or surgical units (adult and pediatric), intensive care units (adult, pediatric, and neonatal), and labor and delivery units), have at least 95% compliance with scanning, have all 5 decision support elements, and have implemented at least 6 of the 8 practices to reduce workarounds.

V. A hospital must achieve Leapfrog’s standard for ICU Physician Staffing (IPS).

Hospitals are asked whether physicians who are board-certified in critical care medicine (known as “intensivists”) care for adult and pediatric critical care patients, the extent of their coverage of that care, and whether they are responsible for admission and discharge decisions. A critical care unit or Intensive Care Unit (ICU) is a special part of the hospital that provides care for extremely ill patients. Leapfrog has more information on Critical Care.

Hospitals achieving Leapfrog’s standard for ICU Physician Staffing must operate adult and/or pediatric ICUs that are managed or co-managed by intensivists who: a) Are present during daytime hours and provide clinical care exclusively in the ICU OR are present via telemedicine 24/7, with some on-site intensivist presence, and, b) When not present on site or via telemedicine, return pages at least 95% of the time (i) within five minutes and (ii) arrange for a certified physician or physician extender to reach ICU patients within five minutes. Hospitals that do not have an ICU are not assessed on this standard.

Mortality rates are significantly lower in hospitals with ICUs managed exclusively by board-certified intensivists (physicians trained in critical care medicine). Research has shown that there is a 30% reduction in overall hospital mortality and a 40% reduction in ICU mortality in ICUs where intensivists manage or co-manage all patients.

VI. A hospital must fully comply with the elements of Leapfrog’s Never Events policy.

Although rare, some medical errors are so serious that experts agree they should never happen to a patient. These kinds of errors include leaving an object inside a patient’s body after surgery or operating on the wrong body part. Hospitals report on their adoption of nine (9) actions that should occur following a never event. Leapfrog has more information on Responding to Never Events.

Leapfrog utilizes the National Quality Forum's list of serious reportable events in asking hospitals to adopt a Never Events policy. Leapfrog's Never Events policy asks hospitals to commit to nine basic acts if a Never Event does occur: apologize to the patient and family, waive all costs related to the event and follow-up care, report the event to an external agency, conduct a root-cause analysis of how and why the event occurred, make a copy of this policy available to patients, interview patients/families to inform root cause analysis, inform patient/families of actions taken by hospital to prevent similar Never Events in the future, have a protocol to provide support for caregivers involved in Never Events, and perform an annual review to ensure compliance with Leapfrog’s Never Events Policy for each Never Event that occurred. Hospitals that achieve Leapfrog’s standard have all nine elements of the policy in place and are demonstrating their commitment to treating patients, purchasers, and payers with respect when a Never Event occurs.

VII. Safe Practices: A hospital must excel on the majority of the Safe Practices.

To provide safe, high-quality care, hospitals must implement policies and protocols to manage and reduce errors. Patient outcomes are impacted when hospital leaders make deliberate and hospital-die commitment to these practices. More information about Leapfrog’s information on Preventing and Responding to Patient Harm and on Handwashing.

Hospitals meeting this element earned “Achieved the Standard” for at least three of the four Safe Practices and did not earn “Limited Achievement” for any of the four.

These practices include:

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