SECTION E: PEDIATRIC AND CONGENITAL CARDIOLOGY/CARDIOTHORACIC SURGERY
E1.
Do you have a Pediatric and Congenital Cardiology/Cardiothoracic Surgery program?
 Yes – Go to Question E2
 No – Skip to Section F
REQUIRED: IF E1=BLANK, DISPLAY: “E1: A response is required for this question 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.”
When responding to questions in this section, we recommend that you consult with the medical director of your
Pediatric and Congenital Cardiology/Cardiothoracic Surgery program(s) to ensure accurate answers that are
consistent with 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 and Congenital Cardiology/Cardiothoracic
Surgery 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.”
Pediatric Hospital Survey (12/31/2015)
Pediatric Congenital Cardiology & Cardiothoracic Surgery E -1
E2.
Please indicate the total number of attending/on-staff physicians1 who are currently members of the medical
staff in your Pediatric and Congenital Cardiology/Cardiothoracic Surgery program in the following
categories. For each category, please indicate the total number of full-time equivalents (FTEs)2 devoted to
clinical care. [If none, please enter 0.]
Total
Clinical
Physicians
FTEs
a. Pediatric cardiothoracic surgeons (include only board certified/board
eligible by the American Board of Thoracic Surgery or equivalent for
foreign surgeons, with a fellowship or other training in pediatric and
congenital heart surgery)
________
________
b. Pediatric cardiac intensivists: Cardiologist - board certified/board
eligible in Pediatrics by the American Board of Pediatrics, with
subspecialty certification/eligibility in Pediatric Cardiology, plus
1 year of additional specific training in pediatric cardiac intensive
care, or > 10 years of experience as a dedicated pediatric cardiac
intensivist.
________
________
c. Pediatric cardiac intensivists: Pediatric Critical Care - board
certified/board eligible in Pediatrics by the American Board of
Pediatrics, with subspecialty certification/eligibility in Pediatric
Critical Care, plus 1 year of additional specific training in pediatric
cardiac intensive care (additional subspecialty certification in Pediatric
Cardiology satisfies this requirement), or > 10 years of experience as a
dedicated pediatric cardiac intensivist.
________
________
d. Pediatric cardiac intensivists: Anesthesiologist - board certified/board
eligible in Anesthesia by the American Board of Anesthesia, with at
least 6 months of additional training in pediatric cardiac anesthesia,
and 1 year of additional training in pediatric cardiac intensive care, or
> 10 years of experience as a dedicated pediatric cardiac intensivist
________
________
e. Pediatric cardiac interventionalists - board certified/board eligible in
pediatrics by the American Board of Pediatrics, with subspecialty
certification/eligibility in pediatric cardiology, and 1 year additional
specific training in pediatric cardiac intervention, or > 10 years of
experience as a dedicated pediatric cardiac interventionalist.
________
________
f. Pediatric cardiac electrophysiologists - board certified/board eligible
in pediatrics by the American Board of Pediatrics, with subspecialty
certification/eligibility in pediatric cardiology, and 1 year additional
specific training in pediatric cardiac electrophysiology, or > 10 years
of experience as a dedicated pediatric cardiac electrophysiologist.
________
________
g. Anesthesiologist - board certified/board eligible in Anesthesia by the
American Board of Anesthesia, with at least 12 months of additional
training in pediatric anesthesia or board certification/board eligible in
pediatric anesthesia, and at least 6 months additional training pediatric
cardiac anesthesia, or > 10 years of experience as a dedicated pediatric
cardiac anesthesiologist.
________
________
VALIDATE: IF E2x1 IS NOT A WHOLE NUMBER, DISPLAY: “E2x (Total Physicians): 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).
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Pediatric Congenital Cardiology & Cardiothoracic Surgery E -2
E2.1
How many of the surgeons listed in E2a also have obtained Subspecialty Certification in Congenital Heart
Surgery? [If none, please enter 0.]
________ Number of surgeons with subspecialty certification
VALIDATE: IF E2.1 IS NOT A WHOLE NUMBER, DISPLAY: “E2.1 (Total Physicians): Please enter a whole
number (no decimals).”
Note: The preceding questions are used to determine eligibility for Pediatric & Congenital Cardiology/Cardiothoracic
Surgery. If you leave any part of these questions blank, your hospital will be considered ineligible for the rankings in
Pediatric Congenital Cardiology/Cardiothoracic Surgery.
E3.
Does your center provide 24 hour in-house coverage every day to the cardiac-specific ICU3 with providers
who are trained in the management of congenital heart disease and can provide immediate evaluation and
intervention for critical cardiac issues, such as an emergency echocardiogram and pericardiocentesis (any
method of 24 hour in house echocardiography support is acceptable)?
 Yes – Go to Question E3.1
 No – Skip to Question E4
E3.1
If yes to E3, which of the following in-house4 coverage options does your center provide for nights
and weekends? (Check all that apply.)
□
□
□
□
□
Attending coverage by pediatric cardiac intensivists as defined in question E2b, E2c or E2d
Attending coverage by pediatric intensivists, who do not meet the criteria in question E2b, E2c or E2d, but
regularly cover the cardiac ICU patients
Pediatric cardiology, pediatric cardiac intensive care, or pediatric cardiac surgery trainees, with back-up offsite by attendings who regularly cover the cardiac ICU during the day
Non-physician advanced practitioners who are dedicated to cardiac intensive care management, with back-up
off-site by attendings who regularly cover the cardiac ICU during the day
Other staff offering coverage (please specify below)
E3.2
If you selected “other” in E3.1, please describe the staff that provide coverage and any off-site
support that they receive from attendings or other medical staff from the cardiology and
cardiothoracic surgery program at your hospital:
3
A CICU is a specialized unit designed to meet the needs of pediatric cardiac patients, including (a) newborns diagnosed with critical congenital
heart disease, (b) infants and children with congenital or acquired heart disease, (c) infants and children with arrhythmias, (d) candidates for
heart transplantation, and (e) patients with heart disease who require intensive care services following noncardiac surgery. The CICU is staffed with a
multidisciplinary care team, including cardiac intensivists, cardiothoracic surgeons, and dedicated cardiac nurses. “Dedicated” indicates the beds and
staff are used virtually exclusively for cardiac patients
4
In-house attending coverage means that the listed providers are physically onsite and available at the hospital for night and weekend
coverage throughout the shift.
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E4.
Please indicate the number of clinical nurse (RN) and Physician Assistants (PA) FTEs5 who work in or
directly support your Pediatric and Congenital Cardiology/Cardiothoracic Surgery program. [If none,
please enter 0.]
Staff FTEs
a. FTE RNs
________
b. FTE PAs
________
E5.
Does your Pediatric and Congenital Cardiology/Cardiothoracic Surgery program currently offer an
echocardiography laboratory certified by the Intersocietal Commission for the Accreditation of
Echocardiography Laboratories (ICAEL)6 in any of the following areas?
Yes
No
a. Transthoracic echocardiographic testing
○
○
b. Transesophageal echocardiographic testing
○
○
c. Fetal echocardiographic testing
○
○
E6.
Does your Pediatric and Congenital Cardiology/Cardiothoracic Surgery program currently offer the
following pediatric cardiovascular services and/or facilities on-site?
Yes
No
a. Inpatient cardiology consultation services
○
○
b. Dedicated pediatric cardiac surgical operating room(s)7
○
○
c. Cardiac intensive care unit (CICU)8 or dedicated beds and staff in a NICU or PICU
○
○
for cardiac patients
d. Remote monitoring capability of cardiac patients in the CICU, NICU, or PICU9
○
○
e. Cardiac diagnostic catheterization laboratory10
○
○
f.
Cardiac interventional catheterization laboratory11
○
○
g. Electrophysiology laboratory12
○
○
h. Ventricular assist program13
○
○
i.
Availability of 24/7 cannulation for ECMO for cardiac patients
○
○
j.
Cardiovascular genetics clinic14
○
○
k. Intra-operative transesophageal echocardiographic testing supervised and
○
○
interpreted in the operating room by board certified/eligible pediatric cardiologists
l.
Pediatric Cardiac Anesthesia services15
○
○
5
Calculate nurse (RN) clinical FTEs based on total paid hours for the period of review divided by 2080.
6
http://www.intersocietal.org/echo/main/standards.htm
7
These surgical operating rooms are designed and maintained for the surgical care of pediatric and adult congenital cardiac patients only.
A CICU is a specialized unit designed to meet the needs of pediatric cardiac patients, including (a) newborns diagnosed with critical congenital
heart disease, (b) infants and children with congenital or acquired heart disease, (c) infants and children with arrhythmias, (d) candidates for
heart transplantation, and (e) patients with heart disease who require intensive care services following noncardiac surgery. The CICU is staffed with a
multidisciplinary care team, including cardiac intensivists, cardiothoracic surgeons, and dedicated cardiac nurses. “Dedicated” indicates the beds and
staff are used virtually exclusively for cardiac patients.
9 This is an inpatient unit with specialized equipment allowing physicians, nurses, and other medical staff to monitor each patient’s status using realtime remote electronic monitoring equipment.
10 This diagnostic facility is where cardiac catheterization is performed to detect the presence of pediatric and congenital heart disease. Cardiac
catheterization is a procedure that involves puncturing an artery or vein and inserting a catheter that can be guided into the heart and major vessels
around the heart. The catheter is moved through the heart with the aid of fluoroscopy (x-ray machine). This is usually performed to help in providing
a diagnosis of heart problems.
11 This laboratory is a diagnostic facility where interventional catheterization is used to treat pediatric and congenital cardiac conditions. The use of
specialized catheters includes balloon catheters that can open up narrowed valves or arteries and catheters that can be deployed to close extra
openings or vessels in the heart.
12 An electrophysiology laboratory is designed to perform diagnostic, therapeutic, and interventional electrophysiology-based procedures in pediatric
and congenital patients such as pacemaker, internal cardiac defibrillator, loop device, and biventricular device insertions; arrhythmia mapping;
catheter ablation for atrial fibrillation; and supraventricular tachycardias.
13 This program should be present in addition to ECMO and is designed to support the placement, monitoring, and support of patients who require the
implantation of a ventricular assist device (VAD) to treat their heart condition. A VAD is a mechanical blood pump that takes over the function of a
heart ventricle.
14 To answer “Yes,” the clinic must have a designated pediatric cardiologist, a pediatric geneticist, a genetic counselor, and a nursing coordinator.
15
To answer “Yes,” these services should include consultation or care of cardiac patients having non-cardiac surgery, and care for patients
undergoing cardiac catheterization or other diagnostic or therapeutic procedures.
8
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Pediatric Congenital Cardiology & Cardiothoracic Surgery E -4
E7.
Does your hospital provide the following on-site for use with patients in your Pediatric and Congenital
Cardiology/Cardiothoracic Surgery program?
a.
b.
c.
d.
E8.
Yes
○
○
○
○
EKG gated CT Angiography
Cardiac MRI
Stress echo testing
Quantitative Pulmonary Perfusion Scan
No
○
○
○
○
Does your Pediatric and Congenital Cardiology/Cardiothoracic Surgery program offer the following
procedures? If so, how many were performed during the last calendar year? [Count only one procedure16
per category completed on a patient within a single day. For example, if two stents were implanted in the
same day, the count would be 1 procedure for E8c for that patient; if one stent and one balloon
valvuloplasty were performed in the same encounter, the count would be 1 procedure for E8b and 1 for
E8c.]
a.
b.
c.
d.
e.
f.
Balloon angioplasty17 without stent implantation (ICD-9-CM code
00.66 OR CPT codes, 35472, 35475, 35476, 92997, NCDR-IMPACT
Codes 30 to 200, NCDR-IMPACT sequence number 5002)
Balloon valvuloplasty (ICD-9-CM code 35.96 OR CPT codes 92986,
92987, 92990, NCDR-IMPACT Codes 205, 210, 215, 220)
Stent implantation (ICD-9-CM code 36.06, 36.07 OR CPT code
37236-37239, NCDR-IMPACT Codes 675 through 850, NCDRIMPACT sequence number 5002)
Transcatheter occlusion of cardiac shunts (ICD-9-CM code 35.52,
35.53 OR CPT codes 37241-44, 93580, 93581, 93582, NCDRIMPACT Codes 240 through 365 coil occlusions, 370-520 device
occlusions)
Transcatheter placement (or attempted placement) of a stented
pulmonary valve (e.g., Melody or other commercially manufactured
valves, may be investigational) (Since no specific code for this
procedure exist, it should be counted separately and the number
subtracted from b above)
Stent re-dilation18 (ICD-9-CM code 00.66 OR CPT codes, 35472,
35475, 35476, 92997, NCDR-IMPACT Codes 855 through 1030,
NCDR-IMPACT sequence number 5002)
Yes
No
○
○
Procedures
________
○
○
○
○
________
________
○
○
________
○
○
________
○
○
________
WARNING:
IF E8x1=“Yes” AND E8x2=(0 OR BLANK), DISPLAY:: “E8x: Please check your responses. You
marked that you offer these procedures, but did not report any.”
VALIDATE: IF E8x IS NOT A WHOLE NUMBER, DISPLAY: “E8x (Procedures): Please enter a whole
number (no decimals).”
16
Note that we recommend using the CPT codes for identifying these procedures as they are more specific than the provided ICD-9 codes. However,
if using the ICD-9 codes to identify these procedures, please make sure you only include thoracic catheter procedures.
17
The same vessel may be counted for a balloon angioplasty (E8a) and a stent re-dilation (E8f), only if the angioplasty occurs proximally or distally
to the stent at a separate lesion. Please review the definitions carefully to avoid double counting.
18
The same vessel may be counted for a balloon angioplasty (E8a) and a stent re-dilation (E8f), only if the angioplasty occurs proximally or distally
to the stent at a separate lesion. Please review the definitions carefully to avoid double counting.
Pediatric Hospital Survey (12/31/2015)
Pediatric Congenital Cardiology & Cardiothoracic Surgery E -5
E9.
Does your Pediatric and Congenital Cardiology/Cardiothoracic Surgery program conduct aortic and
pulmonary catheter-based valvuloplasty (ICD-9-CM procedure code 35.96 OR CPT codes 92986 and/or
92990) in neonates (< 30 days of age)? [NCDR-IMPACT Codes are 205 for aortic valvuloplasty and 215 for
pulmonary valvuloplasty.]
 Yes – Go to Question E10
 No – Skip to Question E11
E10.
How many aortic and/or pulmonary catheter-based valvuloplasty procedures (ICD-9-CM procedure code
35.96 OR CPT codes 92986 and/or 92990) were performed in neonates (< 30 days of age) in the last
calendar year? [NCDR-IMPACT Codes are 205 for aortic valvuloplasty and 215 for pulmonary valvuloplasty.]
[If none, please enter 0.]
________ Procedures
VALIDATE: IF E10 IS NOT A WHOLE NUMBER, DISPLAY: “E10: Please enter a whole number (no
decimals).”
E11.
Does your Pediatric and Congenital Cardiology/Cardiothoracic Surgery program offer transcatheter
arrhythmia ablations (ICD-9-CM procedure code 37.34 or CPT 93651)?
 Yes – Go to Question E12
 No – Skip to Question E15
E12.
Does your Pediatric and Congenital Cardiology/Cardiothoracic Surgery program offer transcatheter
arrhythmia ablations procedures (ICD-9-CM procedure code 37.34 or CPT codes 93653, 93654, and 93656)
for the following diagnoses? If so, how many were performed during the last calendar year? [Count only
one procedure per category completed on a patient within a single day. For example, if one supraventricular
tachycardia (SVT) and atrial tachycardia ablation take place in the same day, the count would be 1 each for E12a
and E12b for this patient.]
Yes No
Procedures
a. Atrial tachycardia (ICD-9-CM diagnosis code 427.31, 427.32, 427.89
○
○
AND ICD-9-CM procedure code 37.34 OR CPT codes 93653 or 93656)
________
b. Supraventricular tachycardia (SVT) or Wolff-Parkinson-White (WPW)
syndrome (ICD-9-CM diagnosis code 427.0, or 426.7 AND ICD-9-CM
○
○
procedure code 37.34 OR CPT code 93653)
________
c. Ventricular tachycardia (ICD-9-CM diagnosis code 427.1 AND ICD-9○
○
CM procedure code 37.34 OR CPT code 93654)
________
WARNING:
IF E12x1=“Yes” AND E12x2=0 OR BLANK), DISPLAY: “E12x: Please check your responses. You
marked that you offer these procedures, but did not report any.”
VALIDATE: IF E12x IS NOT A WHOLE NUMBER, DISPLAY: “E12x (Procedures): Please enter a whole
number (no decimals).”
E13.
This question has been removed from the survey.
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Pediatric Congenital Cardiology & Cardiothoracic Surgery E -6
E14.
Does your Pediatric and Congenital Cardiology/Cardiothoracic Surgery program use the following
methods for transcatheter arrhythmia ablations?
Yes
No
a.
Three-dimensional mapping19
○
○
b.
Cryoablation20
○
○
c.
Radiofrequency ablation21
○
○
E15.
How many implantation procedures (new or replacement) of permanent transvenous pacing /
cardioversion / defibrillation or event recording devices (ICD-9-CM-procedure codes 37.80-37.87; 37.94;
OR CPT codes 33206, 33207, 33208, 33212, 33224, 33225, 33240, 33249, 33282) were performed by an
electrophysiologist in the catheterization laboratory or the OR during the last calendar year? [Count only
one procedure per patient day when calculating your total, and do not count procedures performed by a surgeon
since they are separately counted in E38.] [If none, please enter 0.]
________ Number of procedures
VALIDATE: IF E15 IS NOT A WHOLE NUMBER, DISPLAY: “E15: Please enter a whole number (no
decimals).”
E16.
Does your Pediatric and Congenital Cardiology/Cardiothoracic Surgery program have an organized adult
congenital heart program22 for patients > 18 years of age?
 Yes – on site at your hospital, go to Question E17
 Yes – off site at a single affiliated hospital, go to Question E17 (If at multiple affiliated sites, must answer
no.)
 No – Skip to Question E18
19
This includes the use of three-dimensional imaging systems, such as MRI or ultrasound, to guide ablation probes.
This process uses cooled, thermally conductive gases and fluids circulated through hollow needles (cryoprobes) that are inserted adjacent to
diseased tissue in order to kill the tissue.
21 This procedure involves placing probes that emit radiofrequency energy into the heart using a catheter. The radiofrequency energy is then used to
destroy abnormal electrical activity in the heart tissue.
22 This is a multidisciplinary care program designed to addresses the needs of adults with congenital heart disease. Programs should include
cardiothoracic surgeons, cardiac intensivists, cardiac interventionalists, and cardiac electrophysiologists. In addition, to address the needs of adult
patients, the program should have access to specialists in high-risk pregnancy, genetics, fetal echocardiography, GI and liver disease, pulmonary, and
hematology.
20
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Pediatric Congenital Cardiology & Cardiothoracic Surgery E -7
E17.
Does your adult congenital heart program provide the following?
a.
b.
c.
d.
e.
f.
E18.
Formal plan to actively transition patients from the pediatric to adult congenital
heart program.
Joint participation from pediatric and adult cardiologists who focus on congenital
heart disease.
Cardiothoracic surgeons who have specialty expertise in the care of adults with
congenital heart disease (Only check yes if the surgeon/s either have subspecialty
certification in Congenital Heart Surgery Board or have >10 years of experience
with at least 50% of their practice in congenital heart surgery.).
Cardiothoracic interventionalists who have specialty expertise in the care of adults
with congenital heart disease (Only check yes if the interventionalist(s) either meet
the criteria in Question E2e or have >10 years of experience with at least 50% of
their practice in congenital heart interventions.).
Cardiothoracic electrophysiologists who have specialty expertise in the care of
adults with congenital heart disease (Only check yes if the electrophysiologist/s
either meet the criteria in Question E2f or have >10 years of experience with at least
25% of their practice in congenital heart electrophysiology.).
Specialty care for high risk obstetrics for patients with congenital heart disease.
Yes
No
○
○
○
○
○
○
○
○
○
○
○
○
Please indicate which of the following mechanisms you will use for reporting volume and outcomes on your
Pediatric and Congenital Cardiology/Cardiothoracic Surgery program for each of the four calendar years
listed below. For relevant volume and mortality questions that follow in this section, the same four calendar
years of 2011, 2012, 2013, and 2014 will be used for all data reporting. If your center is using information
from the STS Congenital Heart Surgery Database reports for volume and mortality, the relevant tables
specified in footnotes 23, 24, 25, and 26 must be submitted to receive credit.
STS CHSD
Other Source
report
of Data
a. Reporting year 1 (2011)
○
○
b. Reporting year 2 (2012)
○
○
c. Reporting year 3 (2013)
○
○
d. Reporting year 4 (2014)
○
○
E18.1 If you participate in the STS Congenital Heart Surgery Database, please provide the name of the
organization you are listed under in the database.
Report based on calendar year 2011 (January 1, 2011 –December 31, 2011); If using the STS Congenital Heart Surgery Database Report, please
submit Tables 6 from the Spring 2012 STS Congenital Heart Surgery Database Feedback Report.
24 Report based on calendar year 2012 (January 1, 2012 –December 31, 2012); If using the STS Congenital Heart Surgery Database Report, please
submit Tables 6 from the Spring 2013 STS Congenital Heart Surgery Database Feedback Report.
25
Report based on calendar year 2013 (January 1, 2013 –December 31, 2013); If using the STS Congenital Heart Surgery Database Report, please
submit Tables 6 from the Spring 2014 STS Congenital Heart Surgery Database Feedback Report.
26
Report based on calendar year 2014 (January 1, 2014 –December 31, 2014); If using the STS Congenital Heart Surgery Database Report please
submit Tables 1, 6, 7, 16, 21, 24, and 27 from the Spring 2015 STS Congenital Heart Surgery Database Feedback Report.
23
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Pediatric Congenital Cardiology & Cardiothoracic Surgery E -8
E18.2 If you will be using data “other” than from the STS Congenital Heart Surgery Database for
reporting (e.g., combination of STS and some other source, another database used to track
cardiothoracic surgeries, or manual review of charts), please indicate the source below for each
reporting year.
E18.3 Does your Pediatric and Congenital Cardiology/Cardiothoracic Surgery program participate in the
STS Public Reporting On-Line program?27
 Yes
 No
E19.
What was the total number of adult cardiac surgical operations listed in Table 7 of your STS Congenital
Heart Surgery Database Report for the four reporting years listed in E18? [For hospitals not reporting STS
data, please exclude all secundum ASD’s (CPT 33641 OR ICD-9-CM 35.51, 35.61, 35.71), any surgery limited to
the mitral or aortic valves, and coronary bypass grafting. Also, you must count each operative encounter as a
single case, even if multiple procedures were performed during the same operative episode.] [If none, please enter
0.]
________ Number of adult cardiac surgical operations
VALIDATE: IF E19 IS NOT A WHOLE NUMBER, DISPLAY: “E19: Please enter a whole number (no
decimals).”
E20. Is your adult congenital heart program listed with the Adult Congenital Heart Association
(www.achaheart.org)?
 Yes
 No
E20.1 What was the total number of neonatal cardiac surgical operations listed in Table 7 of your STS Congenital
Heart Surgery Database Report for the four reporting years listed in E18? [For hospitals not reporting STS
data, how many neonatal cardiac surgical operations were performed on patients <31 days of age (preterm and
full term) (ICD-9-CM procedure code 00.50, 00.51, 00.54, 35.xx, 36.xx, 37.xx, 38.15, 38.35, 38.45, 38.85, 39.21,
39.58, 39.50, 39.56, 39.57, 39.59, 39.61, 77.61, 78.49) in the four reporting years listed in E18? Also you must
count each operative encounter as a single case, even if multiple procedures were performed during the same
operative episode.] [If none, please enter 0.]
_______ Number of neonatal cardiac operations
VALIDATE: IF E20.1 IS NOT A WHOLE NUMBER, DISPLAY: “E20.1: Please enter a whole number (no
decimals).”
E21.
Does your Pediatric and Congenital Cardiology/Cardiothoracic Surgery program have an on-site heart or
heart-lung transplant program recognized by the United Network for Organ Sharing (UNOS)?
 Yes – Go to Question E22
 No – Skip to Question E26
27
To answer yes, the data for your program must appear on the STS website at: http://www.sts.org/quality-research-patient-safety/sts-publicreporting-online
Pediatric Hospital Survey (12/31/2015)
Pediatric Congenital Cardiology & Cardiothoracic Surgery E -9
E22.
How many unique patients (<18 years of age) received heart transplants in your Pediatric and Congenital
Cardiology/Cardiothoracic Surgery program in the four reporting years as indicated in E18? [If none,
please enter 0.]
Unique
Patients
a. Reporting year 1 (2011)
________
b. Reporting year 2 (2012)
________
c. Reporting year 3 (2013)
________
d. Reporting year 4 (2014)
________
VALIDATE: IF E22x IS NOT A WHOLE NUMBER, DISPLAY: “E22x: Please enter a whole number (no
decimals).”
E22.1 How many of the unique patients in E22 were <1 year of age when they received heart transplants in your
Pediatric and Congenital Cardiology/Cardiothoracic Surgery program in the four reporting years as
indicated in E18 (2011-2014)? [If none, please enter 0.]
Unique
Patients
a. Reporting year 1 (2011)
________
b. Reporting year 2 (2012)
________
c. Reporting year 3 (2013)
________
d. Reporting year 4 (2014)
________
VALIDATE: IF E22.1x IS NOT A WHOLE NUMBER, DISPLAY: “E22.1x: Please enter a whole number (no
decimals).”
E23. Please report your program’s Pediatric (<18) 1-year heart transplant patient survival statistics from Table
C15D in your December SRTR report, which includes transplants performed between 7/1/12 and 12/31/14.
[Please refer to tables C15D and C16D of the PDF version of the December 2015 SRTR report for your center for
the requested values.]
a.
b.
c.
d.
e.
f.
g.
h.
1-year SRTR Measure
Number of transplants evaluated
Estimated probability of surviving at 1 year (unadjusted)
Expected probability of surviving at 1 year (adjusted)
Number of observed deaths during the first year after transplant
Number of expected deaths during the first year after transplant
Estimated hazard ratio
95% credible interval (low value)
95% credible interval (high value)
Pediatric Hospital Survey (12/31/2015)
Table C15D Value
______________
_____________%
_____________%
______________
______________
______________
______________
______________
Pediatric Congenital Cardiology & Cardiothoracic Surgery E -10
E24.
Please report your program’s Pediatric (<18) 3-year heart transplant patient survival statistics from Table
C16D in your December SRTR report, which includes transplants performed between 1/1/10 and 6/30/12.
a.
b.
c.
d.
e.
f.
g.
h.
3-year SRTR Measure
Number of transplants evaluated
Estimated probability of surviving at 3 years (unadjusted)
Expected probability of surviving at 3 years (adjusted)
Number of observed deaths during the first 3 years after transplant
Number of expected deaths during the first 3 years after transplant
Estimated hazard ratio
95% credible interval (low value)
95% credible interval (high value)
Table C16D Value
______________
_____________%
_____________%
______________
______________
______________
______________
______________
E24.1 Please list the name your hospital reports under to SRTR. Also, please note that we will verify28 the values
reported with the SRTR/UNOS reports for your hospital. If the SRTR/UNOS values differ from the values
reported here, please provide an explanation:
E25.
Please answer the following question about the heart transplants offered by your Pediatric and Congenital
Cardiology/Cardiothoracic Surgery program?
Yes
No
a. Has your pediatric heart transplant program performed cardiac transplantation in a
○
○
recipient with high (≥ 10%) panel reactive antibody (PRA)?
b. Does your pediatric heart transplant program have a written protocol for the
○
○
management of recipients with high (≥ 10%) panel reactive antibody (PRA)?
c. Has your pediatric heart transplant program performed an ABO incompatible heart
○
○
transplant?
d. Does your pediatric heart transplant program have a written protocol for the
○
○
management of ABO incompatible recipients?
E26.
How many unique patients in the following age groups were treated with a Berlin heart or other VAD
(excluding ECMO) in the last 4 calendar years (2011-2014)? [ICD-9-CM Codes 37.60, 37.65, and 37.66 OR
CPT 33975, 33976 and 33979.] [If none, please enter 0.]
________ Unique patients (< 1 years of age)
________ Unique patients (>1 and < 3 years of age)
________ Unique patients (≥3 and <10 years of age)
________ Unique patients (≥10 and ≤18 years of age)
________ Unique patients (>18 years of age with congenital heart disease29)
VALIDATE: IF E26x IS NOT A WHOLE NUMBER, DISPLAY: “E26x: Please enter a whole number (no
decimals).”
28
Verification reports are available here: http://www.srtr.org/csr/current/Centers/TransplantCenters.aspx?organcode=LI. If your reports do not match
the values that are publically available, please provide an explanation.
29
This may include adult patients (over 18) in recognition that many pediatric heart programs continue to treat patients with certain congenital
conditions into adulthood.
Pediatric Hospital Survey (12/31/2015)
Pediatric Congenital Cardiology & Cardiothoracic Surgery E -11
E27.
Does your Pediatric and Congenital Cardiology/Cardiothoracic Surgery program offer the following:
Yes
No
a. Multidisciplinary morbidity and mortality conferences which occurs at least
monthly and includes cardiology, cardiac surgery, and critical care specialists in
○
○
intensive care units (e.g., NICU, PICU, CICU, or other ICU) who care for heart
and heart surgery patients
b. Multidisciplinary maternal/fetal medicine conference where fetuses with
congenital heart disease are discussed, which occurs at least monthly and
○
○
includes maternal/fetal medicine, cardiology, cardiac surgery, neonatology,
radiology, and palliative care specialists, as appropriate.
c. Active home surveillance program30 for infants after single ventricle palliation
○
○
for hypoplastic left heart syndrome
d. A follow-up program for children with complex congenital heart disease at risk
○
○
for adverse neurodevelopmental outcomes31
e. Patient planning conference which occurs at least weekly and includes
cardiologist, cardiac surgeons, cardiac anesthesiologists and critical care
○
○
specialists to discuss upcoming surgical cases, interventional catheterizations
and complex case planning.
f.
Support groups for patients and families with congenital heart conditions (e.g.,
○
○
Mended Little Hearts)
g. Multidisciplinary management program for complex congenital heart disease
○
○
patients who experience long-term change to physical or cognitive functioning
E28.
Has your Pediatric and Congenital Cardiology/Cardiothoracic Surgery program currently engaged in any
of the following activities?
Yes
No
a. Implemented a formal plan for program review and 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 cardiology/cardiothoracic surgery care
E28.1 If “yes” to any part of E28, 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:
30
This program tracks patients in their home environment, trains parents to assist in care, and establishes protocols for emergencies.
This program tracks children at risk for adverse neurodevelopmental problems following diagnosis and/or treatment of a pediatric cardiac
condition.
31
Pediatric Hospital Survey (12/31/2015)
Pediatric Congenital Cardiology & Cardiothoracic Surgery E -12
E29.
Does your Pediatric and Congenital Cardiology/Cardiothoracic Surgery program currently participate and
contribute data (if applicable) to any of the following?
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
Society of Thoracic Surgeons (STS) Congenital Heart Surgery Database [Credit
will only be given if a mortality report (see E18) is submitted in this survey]
Congenital Heart Surgeons’ Society data center and submit data for at least one
study
National Pediatric Cardiology – Quality Improvement Collaborative (NPC-QIC)
Congenital Cardiac Anesthesia Society database (participation only)
National Cardiovascular Disease Registry – Improving Pediatric and Adult
Congenital Treatment (NCDR-IMPACT)
Extracorporeal Life Support Organization (ELSO) registry
Pediatric Cardiac Critical Care Consortium (PC4) or Virtual pediatric ICU
System (VPS)
Pediatric Heart Transplant Study (PHTS)
Radiation reduction with either the Reducing Radiation Risk Quality Initiative of
NCDR-IMPACT or the Congenital Cardiac Catheterization Project (C3PO-QI)
Other externally audited, national quality-improvement initiative
Yes
No
○
○
○
○
○
○
○
○
○
○
○
○
○
○
○
○
○
○
E29.1 If “yes” to E29j, please list:
E30.
Does your heart or heart surgery program currently participate in one or more the following types of
investigative work? [To answer yes to any of the following, your program must have had at least one patient
enrolled in calendar year 2015, or subjects enrolled prior to 2015 who were in the follow-up phase during 2015.]
a.
b.
c.
d.
e.
E31.
b.
c.
33
Yes
○
○
○
○
○
No
○
○
○
○
○
Prior to cardiac surgical procedures, does your Pediatric and Congenital Cardiology/Cardiothoracic
Surgery program, engage in the following surgical site infection prevention procedures?
a.
32
Single institution retrospective studies
Multi-institutional retrospective studies
Basic science, with extramural funding
Prospective clinical studies or trials32, with industry funding
Prospective clinical studies or trials33, with competitive extramural funding
Pre-operative bath (bathing with soap and water, chlorhexidine-containing
solution, or wiping with chlorhexidine-impregnated cloth prior to surgery)
No use of a razor for hair removal (clipper or other non-traumatic method allowed)
Preparation of skin at surgical site with alcohol containing agent (if no
contraindications)
Yes
No
○
○
○
○
○
○
To answer yes, single center or multicenter prospective studies must be listed at ClinicalTrials.gov.
To answer yes, single center or multicenter prospective studies must be listed at ClinicalTrials.gov.
Pediatric Hospital Survey (12/31/2015)
Pediatric Congenital Cardiology & Cardiothoracic Surgery E -13
E32.
Does your Pediatric and Congenital Cardiology/Cardiothoracic Surgery program have an ongoing
program to monitor compliance with preoperative antibiotic prophylaxis timing for cardiothoracic
surgeries34? The ongoing program should capture all surgeries, or at a minimum capture a monthly
sampling of cases based on standard (e.g., Joint Commission) sampling recommendations.
 Yes, we monitor for ALL cardiothoracic surgeries – Go to Question E33
 Yes, we have an ongoing monthly program (12 months a year) that monitors timing for a sample of cases –
Go to Question E33
 Yes, we have a program, but monitor less frequently than every month – Go to Question E33
 No – Skip to Question E34
E33.
Of the cases monitored and reviewed, 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) for cardiothoracic surgeries35 in the last calendar year? [Calculate as
follows: (1) Determine the number of pediatric cardiothoracic surgeries in which preoperative 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 pediatric cardiothoracic surgeries sampled. (3) Multiply by
100. (4) Insert the results of steps 1-3 below.]
________ Number of cases compliant
________ Number of cases reviewed
________ Percent compliant
VALIDATE: IF E32=YES AND E33b=(0 OR BLANK), DISPLAY: “E33 (cases reviewed): Please provide a value
greater than 0 or answer No to E32.”
IF E33a/b IS NOT A WHOLE NUMBER, DISPLAY: “E33a/b: Please enter a whole number (no
decimals).”
IF E33a > E33b, DISPLAY: “E33: Please check your responses. Number of cases compliant cannot
be greater than number of cases reviewed.”
AUTOCALC: E23c = [(E23a / E23b) *1000]
E34.
Does your Pediatric and Congenital Cardiology/Cardiothoracic Surgery program have an established
surveillance system to monitor surgical site infections (SSI) for major cardiothoracic procedures?
 Yes – Go to Question E34.1
 No – Skip to Question E35
E34.1 If “yes” 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).
34
Include all of the following ICD-9-CM procedures (00.50, 00.51, 00.54, 35.xx, 36.xx, 37.xx, 38.15, 38.35, 38.45, 38.85, 39.21-39.23, 39.0, 39.56,
39.61) that were performed in an operating room and meet NHSN definitions for a surgical procedure
(http://www.cdc.gov/nhsn/pdfs/pscmanual/9pscssicurrent.pdf). These codes may be used in conjunction with each other for one surgical session.
Each surgical session should be counted once. Do not count the occurrence of these codes as separate surgical sessions.
35 These procedures may be performed in an OR or catheterization laboratory depending on the nature of the procedure. You may include surgeries
performed by cardiac surgeons with a pediatric interventionalist. All of the following ICD-9-CM procedures are eligible to be counted as
cardiothoracic surgeries: ICD-9-CM procedure code 00.50, 00.51, 00.54, 35.xx, 36.xx, 37.xx, 38.15, 38.35, 38.45, 38.85, 39.21-39.23, 39.0, 39.56,
39.61. These codes may be used in conjunction with each other for one surgical session. Each surgical session should be counted once. Do not count
the occurrence of these codes as separate surgical sessions.
Pediatric Hospital Survey (12/31/2015)
Pediatric Congenital Cardiology & Cardiothoracic Surgery E -14
E35.
Prior to cardiac surgical procedures, does your Pediatric and Congenital Cardiology/Cardiothoracic
Surgery program, engage in the following surgical safety procedures?
a.
b.
c.
d.
Conventional pre-procedural “time-out” (including the identification of patient,
operative site, procedure and history of any allergies.)
Pre-procedural briefing (surgeon reviews with all members of the operating room
team the essential elements of the operative plan; including diagnosis, planned
procedure, outline of essentials of anesthesia and bypass strategies, anticipated or
planned implants or device applications, and anticipated challenges).
Post-procedural debriefing (prior to the patient leaving the operating suite, the
surgeon briefly reviews with all members of the operating room team the essential
elements of the operative plan, identifying key outcomes).
Hand-off protocol /briefing which includes a checklist (occurs at the time of
transfer (arrival) to the Intensive Care Unit after the end of the operation, involving
the anesthesiologist, surgeon, physician staff of the Intensive Care Unit and
nursing).
Yes
No
○
○
○
○
○
○
○
○
E35.1 Prior to cardiac catheterization procedures, does your Pediatric and Congenital Cardiology/Cardiothoracic
Surgery program, engage in the following surgical safety procedures?
a.
b.
c.
E36.
Conventional pre-procedural “time-out” (including the identification of patient,
operative site, procedure and history of any allergies.)
Pre-procedural briefing (surgeon reviews with all members of the operating room
team the essential elements of the operative plan; including diagnosis, planned
procedure, outline of essentials of anesthesia and bypass strategies, anticipated or
planned implants or device applications, and anticipated challenges).
Hand-off protocol/briefing which includes a checklist (occurs at the time of
transfer (arrival) to the Intensive Care Unit after the end of the operation, involving
the anesthesiologist, surgeon, physician staff of the Intensive Care Unit and
nursing).
Yes
No
○
○
○
○
○
○
Does your Pediatric and Congenital Cardiology/Cardiothoracic Surgery program use Clinical Practice
Guidelines36 for peri-operative and post-operative care for the following patient groups/care?
a.
b.
c.
d.
e.
Single ventricle/shunt management (e.g. – Norwood, BTS, Glenn, Fontan)
Two ventricle repairs (e.g. - VSD, TOF, d-TGA/ASO)
Infant feeding (may be part of a. or b.)
Anticoagulation
Sedation and pain management
Yes
○
○
○
○
○
No
○
○
○
○
○
36
To answer yes, Guidelines should be on a form (paper or electronic), approved for local use, posted in each patients chart to which they apply, and
compliance with the Guidelines should be tracked in the form of a checklist or other mechanism. Hospitals may include another well-defined and
tracked technique to reduce practice variation such as the Standardized Clinical Assessment and Management Plan.
Pediatric Hospital Survey (12/31/2015)
Pediatric Congenital Cardiology & Cardiothoracic Surgery E -15
E37.
Does your Pediatric and Congenital Cardiology/Cardiothoracic Surgery program routinely track and
submit EVERY occurrence of the following surgical admission outcomes parameters to the STS Congenital
Heart Database? (DO NOT answer YES unless the data for all operations are submitted to STS.)
a.
b.
c.
d.
Unplanned reoperation during the same hospital admission as the primary surgery
Re-exploration for bleeding
Deep sternal wound infection/mediastinitis requiring debridement
Atrioventricular block requiring placement of a permanent pacemaker (STS
Version 2.50), arrhythmia necessitating pacemaker, or permanent pacemaker (STS
Version 3.0 and 3.22)
Yes
○
○
○
No
○
○
○
○
○
E37.1. Does your Pediatric and Congenital Cardiology/Cardiothoracic Surgery program routinely track
and submit to IMPACT every unplanned cardiothoracic surgical or vascular surgical procedure
due to a catheterization complication (Lines 1226 and 1227 on the Quarterly IMPACT Outcome
Report)?37
 Yes
 No
SKIP LOGIC: IF E37a=Yes, GO TO E37.2; ELSE SKIP TO E37.4.
E37.2. What was the total number (cumulative incidence) of patients who underwent Tetralogy of Fallot
(TOF) repair surgeries and the total number of these patients the required an unplanned cardiac
reoperation following TOF? [Please refer to and submit Table 24 (Tetralogy of Fallot Repair, Last 4
Years (Jan 2011 - Dec 2014)) from the STS Congenital Heart Surgery Database Spring 2015 Feedback
Report]. [If none, please enter 0.]
________Total number of patients who underwent TOF repair surgeries (sum of incidence of No
ventriculotomy” + “Ventriculotomy” + “Ventriculotomy, Transannular patch” + “RV-PA
conduit”)
________Total number of patients that required an Unplanned Cardiac Reoperation following TOF repair
surgeries (sum of Unplanned Cardiac Reoperation” for “No ventriculotomy” +
“Ventriculotomy” + “Ventriculotomy, Transannular patch” + “RV-PA conduit”)
VALIDATE: IF E37.2x IS NOT A WHOLE NUMBER, DISPLAY: “E37.2x: Please enter a whole
number (no decimals).”
If E37.2b>E37.2a, DISPLAY, “E37.2: Please check your responses. Number of
patients that required an unplanned cardiac reoperation cannot be greater than the
number of patients who underwent TOF repair.”
E37.3. What was the total number (cumulative incidence) of patients who underwent Arterial Switch
Operations for Transposition of the Great Arteries with intact ventricular septum (TGA, IVS) and
the total number of these patients who were managed with postoperative Mechanical Circulatory
Support following Arterial Switch Operations for TGA, IVS? [Please refer to and submit Table 27
(Transposition of the Great Arteries, Last 4 Years (Jan 2011 - Dec 2014)) from the STS Congenital Heart
Surgery Database Spring 2015 Feedback Report]. [If none, please enter 0.]
________Total number of patients who underwent Arterial Switch Operations for Transposition of the
Great Arteries with intact ventricular septum (sum of TGA, IVS + Switch)
________Total number of patients managed with postoperative Mechanical Circulatory Support
following Transposition of the Great Arteries with intact ventricular septum (sum of TGA, IVS
+ Switch)
37
To answer yes, all catheterizations must be submitted to IMPACT.
Pediatric Hospital Survey (12/31/2015)
Pediatric Congenital Cardiology & Cardiothoracic Surgery E -16
VALIDATE: IF E37.3x IS NOT A WHOLE NUMBER, DISPLAY: “E37.3x: Please enter a whole
number (no decimals).”
If E37.3b>E37.3a, DISPLAY, “E37.3: Please check your responses. Number of
patients with postoperative support cannot be greater than the number of patients
who underwent arterial switch operations.”
SKIP LOGIC: IF E37d=Yes, GO TO E37.4; ELSE SKIP TO E38.
E37.4. If yes to E37d, what was the total number (cumulative incidence) of patients who underwent VSD
repair and total number of these patients that developed “Arrhythmia req. Permanent Pacemaker”
following VSD repair? [Please refer to and submit Table 21 (Ventricular Septal Defect, Last 4 Years
(Jan 2011 - Dec 2014)) from the STS Congenital Heart Surgery Database Spring 2015 Feedback Report].
[If none, please enter 0.]
________Total number of patients who underwent VSD repair (sum of incidence of VSD Type 1 + VSD
Type 2 + VSD Type 3 + VSD Type 4)
________Total number of patients that developed “Arrhythmia req. Permanent Pacemaker” following
VSD repair (sum of Arrhythmia req. Permanent Pacemaker” for VSD Type 1 + VSD Type 2 +
VSD Type 3 + VSD Type 4)
VALIDATE: IF E37.4x IS NOT A WHOLE NUMBER, DISPLAY: “E37.4x: Please enter a whole
number (no decimals).”
If E37.4b>E37.4a, DISPLAY, “E37.4: Please check your responses. Number of
patients that developed arrhythmia cannot be greater than the number of patients
who underwent VSD repair.”
E38.
How many cardiac surgeries38 were performed by a pediatric cardiac surgeon in your pediatric cardiac
surgical operating room(s) or catheterization lab during the calendar years 2011-2014? [If reporting STS
data, use the “Operations in Analysis” row from Table 1 in the STS Congenital Heart Surgery Database Spring
2015 Feedback report for calendar years 2011-2014. If not reporting STS data, use the ICD-9 or CPT procedure
definitions specified in the footnotes below.] [If none, please enter 0.]
Surgeries
a. Reporting year 1 (2011)
________
b. Reporting year 2 (2012)
________
c. Reporting year 3 (2013)
________
d. Reporting year 4 (2014)
________
VALIDATE: IF E38x IS NOT A WHOLE NUMBER, DISPLAY: “E38x: Please enter a whole number (no
decimals).”
38
These procedures may be performed in an OR or catheterization laboratory depending on the nature of the procedure. You may include surgeries
performed by cardiac surgeons or pediatric interventionalists. Whether you are using ICD-9 or CPT codes hospital should identify surgical cases
rather than listing all procedures so that cases are not double counted; if a patient has multiple procedures in the same day they should be counted as a
single case, while patients that received procedures on different days may be counted more than once. Include the following ICD-9-CM procedure
codes in your count of surgeries performed: 00.50, 00.51, 00.54, 35.xx (excluding 35.96), 36.xx, 37.xx (excluding 37.0, 37.21, 37.22, 37.23, 37.25,
37.26 and 37.34), 38.15, 38.35, 38.45, 38.85, 39.0, 39.21, 39.22, 39.23, 39.61. The range of equivalent CPT codes includes the following: 21627,
21750, 32852, 32853, 32854, 33010, 33020, 33025, 33030, 33031, 33050, 33120, 33206, 33207, 33208, 33233, 33234, 33235, 33236, 33237, 33238,
33240, 33243, 33250, 33251, 33254, , 33256, 33261, 33310, 33400, 33401, 33403, 33404, 33405, 33406, 33410, 33411, 33412, 33413, 33414,
33415, 33416, 33417, 33422, 33425, 33426, 33427, 33430, 33460, 33463, 33464, 33465, 33468, 33472, 33474, 33475, 33476, 33478, 33500, 33501,
33502, 33504, 33505, 33506, 33507, 33542, 33600, 33602, 33606, 33608, 33610, 33611, 33612, 33615, 33617, 33619, 33641, 33645, 33647, 33660,
33665, 33670, 33675, 33681, 33684, 33688, 33690, 33692, 33694, 33697, 33720, 33722, 33730, 33732, 33735, 33736, 33737, 33750, 33755, 33762,
33764, 33766, 33767, 33770, 33771, 33774, 33775, 33776, 33777, 33778, 33780, 33786, 33788, 33800, 33802, 33803, 33813, 33814, 33820, 33822,
33824, 33840, 33845, 33851, 33852, 33853, 33860, 33863, 33864, 33870, 33875, 33910, 33915, 33916, 33917, 33920, 33922, 33935, 33924, 33925,
33926, 33945, 33999, 34502, 35189, 35820, 38381,.
Pediatric Hospital Survey (12/31/2015)
Pediatric Congenital Cardiology & Cardiothoracic Surgery E -17
E39.
How many of the current attending/on-staff congenital heart surgeons in your Pediatric and Congenital
Cardiology/ Cardiothoracic Surgery program performed 75 or more of the operations listed in question
E38 during calendar year 2015?39 [If none, please enter 0.]
________ Surgeons with 75 or more surgical cases
VALIDATE: IF E39x IS NOT A WHOLE NUMBER, DISPLAY: “E39x: Please enter a whole number (no
decimals).”
E40.
How many patients40 meeting the following criteria—single ventricle physiology as verified by a single
ventricle management strategy through 1 year of age; inadequate systemic outflow tract requiring
Norwood41 at Stage 1 or Stage 2; aortic arch obstruction requiring intervention, and for whom there was
intention to treat with an intervention at either your institution or a transfer center—were managed at
your institution as neonates in each of the following categories for each reporting year? [If reporting based
on STS, refer to Table 6 from the 2011, 2012, 2013 and 2014 reports (Columns: "Overall, N", Rows: "Norwood
Procedure" and “Hybrid Approach Stage 1, Stent placement in arterial duct (PDA) + application of RPA & LPA
bands” and “Hybrid Approach "Stage 1", Application of RPA & LPA bands”). Note that patients may only be
counted once; if a patient undergoes more than one of these procedures, please count the patient only once using
the first procedure.] [If none, please enter 0.]
Died prior to
Received
Transferred to
surgical
Hybrid Stage
Received Norwood
another center
intervention
1
Stage 1
a. Reporting year 1 (2011)
________
________
________
________
b. Reporting year 2 (2012)
________
________
________
________
c. Reporting year 3 (2013)
________
________
________
________
d. Reporting year 4 (2014)
________
________
________
________
VALIDATE: IF E40x IS NOT A WHOLE NUMBER, DISPLAY: “E40x: Please enter a whole number (no
decimals).”
SKIP LOGIC: IF SUM (E40a2, E40a3, E40b2, E40b3, E40c2, E40c3, E40d2, E40d3) > 0, GO TO E40.1; ELSE
SKIP TO E42.
E40.1 Of the patients you identified in E40 as receiving either a Hybrid Stage 1 or a Norwood Stage 1
procedure, how many unique patients were alive without a heart transplant at 1 year of age?42 [If
none, please enter 0.]
Hybrid Stage 1
Norwood Stage 1
Patients Alive
Patients Alive
a. Unique patients alive, reporting year 1 (2011)
________
________
b. Unique patients alive, reporting year 2 (2012)
________
________
c. Unique patients alive, reporting year 3 (2013)
________
________
d. Unique patients alive, reporting year 4 (2014)
________
________
39
May include cases from more than one institution, and may average the cases from 2014 and 2015 if an institutional change occurred during 2015
for any of the attending/on-staff physicians.
40
Note that patients for whom “comfort care” is planned prior to any intervention, surgical or catheter based, should not be counted; to be removed
from the count, the strategy of “comfort care” must be adopted within 72 hours from the time of admission at your center.
41
Norwood is equivalent to Damus-Kaye-Stansel plus arch reconstruction.
42
Note that vital status at one year cannot be assumed, but must be verified by one of the following methods: 1) Your medical records document a
visit/admission to your health system at >= 1 year of age, or an outpatient visit to your health system at > 9 months of age in a patient who has
completed a total cavopulmonary anastomosis and was otherwise generally well at the time of the visit; 2) Your medical records document a
visit/admission to a referring health system at >= 1 year of age, or an outpatient visit a referring health system at > 9 months of age in a patient who
has completed a total cavopulmonary anastomosis and was otherwise generally well at the time of the visit; 3) Direct communication from a health
worker at a referring institution in a written/electronic (letter, e-mail, text message) form documents #2 above; or 4) Direct communication with the
family in a written/ electronic (letter, e-mail, text message) or verbal form documents the vital status at >= 1 year of age.
Pediatric Hospital Survey (12/31/2015)
Pediatric Congenital Cardiology & Cardiothoracic Surgery E -18
VALIDATE: IF E40.1x IS NOT A WHOLE NUMBER, DISPLAY: “E40.1x: Please enter a whole number (no
decimals).”
IF E40.1x1 > E40x3, DISPLAY: “Number of Hybrid patients alive (E40.1x) cannot be greater the
number of patients that received Hybrid surgery (E40x).”
IF E40.1x2 > E40x4, DISPLAY: “Number of Norwood patients alive (E40.1x) cannot be greater the
number of patients that received Norwood surgery (E40x).”
SKIP LOGIC: IF SUM (E40.1a2, E40.1a3, E40.1b2, E40.1b3, E40.1c2, E40.1c3, E40.1d2, E40.1d3) > 0, GO TO
E40.2; ELSE SKIP TO E42.
E40.2 Of the patients you identified in E40.1 who were alive at 1 year of age, how many had a
neurodevelopmental evaluation prior to 24 months of age? [If none, please enter 0.]
________ Unique patients, reporting year 1 (2011)
________ Unique patients, reporting year 2 (2012)
________ Unique patients, reporting year 3 (2013)
________ Unique patients, reporting year 4 (2014)
VALIDATE: IF E40.2x IS NOT A WHOLE NUMBER, DISPLAY: “E40.2x: Please enter a whole number (no
decimals).”
IF E40.2x > (E40.1x1 +E40.1x2), DISPLAY: “Number of patients alive who had an evaluation
(E40.2x) cannot be greater than the number of patients alive (E40.1x).”
E41.
Of the patients in E40.1, how many received a referral for early intervention program43 by 24 months of
age through a standardized program within or outside your center? [If none, please enter 0.]
________ Unique patients referred, reporting year 1 (2011)
________ Unique patients referred, reporting year 2 (2012)
________ Unique patients referred, reporting year 3 (2013)
________ Unique patients referred, reporting year 4 (2014)
VALIDATE: IF E41x IS NOT A WHOLE NUMBER, DISPLAY: “E41x: Please enter a whole number (no
decimals).”
IF E41x > (E40.1x1 +E40.1x2), DISPLAY: “Number of patients referred for early intervention
(E41x) cannot be greater than the number of patients alive (E40.1x).”
E42.
How many unique patient admissions in the four reporting years from Question E38 received surgical
procedures in the following Society of Thoracic Surgery & European Association for Cardio-Thoracic
Surgery Congenital Heart Surgery (STAT) Mortality Categories? Of those patients, how many experienced
Operative Mortality? [If reporting based on STS, refer to Table 1 from the STS Congenital Heart Surgery
Database Spring 2015 Feedback Report (Columns for each calendar year 2011-2014: Rows: "Number of
Mortalities" and "Number Eligible" for each STAT Category). For hospitals not participating in STS, count the
volume and deaths according to the STAT definitions.44] [If none, please enter 0.]
a.
b.
c.
d.
e.
Reporting year 1 (2011)
STAT Level 1
STAT Level 2
STAT Level 3
STAT Level 4
STAT Level 5
Reporting year 2 (2012)
Unique Patients
________
________
________
________
________
Unique Patients
Deaths
________
________
________
________
________
Deaths
43
A comprehensive early intervention program will involve a developmental pediatrician, a pediatric physiatrist, and representation of treatment staff
from physical therapy, occupational therapy, and speech therapy depending on the needs of the patient.
44 For information on classifying cardiac surgical procedures into STAT categories, see: Table 1 in J Thoracic and Cardiovascular Surgery, 2009;
138: 1139-1153 at http://jtcs.ctsnetjournals.org, or use the STAT Table included with this survey.
Pediatric Hospital Survey (12/31/2015)
Pediatric Congenital Cardiology & Cardiothoracic Surgery E -19
f.
g.
h.
i.
j.
STAT Level 1
STAT Level 2
STAT Level 3
STAT Level 4
STAT Levels 5
________
________
________
________
________
________
________
________
________
________
k.
l.
m.
n.
o.
Reporting year 3 (2013)
STAT Level 1
STAT Level 2
STAT Level 3
STAT Level 4
STAT Levels 5
Unique Patients
________
________
________
________
________
Deaths
________
________
________
________
________
p.
q.
r.
s.
t.
Reporting year 4 (2014)
STAT Level 1
STAT Level 2
STAT Level 3
STAT Level 4
STAT Levels 5
Unique Patients
________
________
________
________
________
Deaths
________
________
________
________
________
VALIDATE: IF E42x IS NOT A WHOLE NUMBER, DISPLAY: “E42x: Please enter a whole number (no
decimals).”
If E42x2 > E42x1, DISPLAY: “E42x: Please check your responses. The number of patient deaths
cannot be greater than the number of patients.”
E43.
What was the 4-year combined Risk-Adjusted Operative Mortality for your Pediatric and Congenital
Cardiology and Cardiothoracic Surgery program? [Please refer to Table 16 from the STS Congenital Heart
Surgery Database Spring 2015 Feedback Report. For the combined four reporting years, as indicated in E18,
please provide adjusted mortality rate (AMR) from the row “Neonates + Infants + Children + Adults, All STAT
Mortality Categories.” Please leave this question blank if your program did not receive an adjusted mortality rate
in Table 16.]
________ 4-year combined adjust mortality rate
E44.
For Pediatric and Congenital Cardiology/Cardiothoracic Surgery, what was the primary time period used
for reporting patient volume on questions with ICD-9 codes?
 Calendar year (January 1, 2015-December 31, 2015)
 Fiscal year (October 1, 2014-September 30, 2015)
 Some other timeframe [Specify below]
E45.
If you selected “some other timeframe,” please provide the timeframe used for reporting patient volume on
questions with ICD-9 codes.
COMMENTS FOR SECTION E:
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.
Pediatric Hospital Survey (12/31/2015)
Pediatric Congenital Cardiology & Cardiothoracic Surgery E -20