SECTION K: PEDIATRIC UROLOGY
K1.
Do you have a Pediatric Urology program?
 Yes
 No – Skip to Final Review and Data Submission
REQUIRED: IF K1=BLANK, DISPLAY: “K1: 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, your hospital must consult with the chief of service (or equivalent) of
your Pediatric Urology 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 Urology 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 (12/17/2015)
Pediatric Urology
K-1
K2.
Please indicate the current total number of attending/on-staff physicians1 who are currently members of the
medical staff in your Pediatric Urology 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.]
a.
b.
Pediatric urologists (board-certified/board-eligible by the
American Board of Urology with subspecialty
certification/eligibility in pediatric urology3)
Other attending/on-staff physicians (include all other
attending/on-staff physicians who are not certified/eligible in
pediatric urology)
Total Physicians
Clinical FTEs
________
________
________
________
VALIDATE: IF K2x1 IS NOT A WHOLE NUMBER, DISPLAY: “BKx (Total Physicians): Please enter a whole
number (no decimals).”
Questions 1 and 2 are used to determine eligibility for Pediatric Urology. If you leave any part of these questions
blank, your hospital will be considered ineligible for the rankings in Pediatric Urology.
K3.
Please indicate the total number of nurse practitioners and physician assistants who work in or directly
support your Pediatric Urology program. For each category, please indicate the total number of full-time
equivalents (FTEs)4 devoted to clinical care. [If none, please enter 0.]
Total Staff
Clinical FTEs
a. Nurse practitioners
________
________
b. Physician assistants
________
________
VALIDATE: IF K3x1 IS NOT A WHOLE NUMBER, DISPLAY: “K3x (Total Staff): Please enter a whole
number (no decimals).”
K4.
Please indicate the number of clinical nurse (RN) FTEs5 who work in or directly support your Pediatric
Urology program. [Do not include any nurse practitioners counted in K3.] [If none, please enter 0.]
________ FTE RNs
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 Pediatric urology certificate of added qualification (CAQ) was initiated by the American Board of Urology starting in 2008. Any attending
physician who has this board certification should automatically be counted here. Other urologists who are eligible for this board after completion of
an accredited fellowship program may also be counted here.
4 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).
5 Calculate nurse (RN) clinical FTEs based on total paid hours for the period of review divided by 2080.
Pediatric Hospital Survey (12/17/2015)
Pediatric Urology
K-2
K5.
Is your Pediatric Urology program currently engaged in any of the following activities?
a.
b.
c.
d.
e.
Implemented a formal plan for program review and improvement
Determined appropriate data-based performance metrics for the program
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
Presented results of your program’s clinical quality performance metrics to your
clinical staff on a regular basis
Participated in one or more quality-of-care or improvement initiatives specific to
pediatric urology care
Yes
○
○
No
○
○
○
○
○
○
○
○
K5.1. If “yes” to any part of K5, 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:
K6.
Does your Pediatric Urology (Urology) program provide the following? [Do not include activities related to
review and improvement of the quality of the program covered in K5 above]
a.
b.
Regular morbidity and mortality conferences to discuss pediatric urology
patients
Regular case conferences to discuss surgical management of complex cases
Yes
No
○
○
○
○
K7.
Does your hospital provide the following diagnostic, treatment, or training technology either on-site or
through a formal contractual relationship with another facility?
Yes
No
a. Dedicated laparoscopic skills lab for faculty and trainees
○
○
b. Video pediatric urodynamic fluoroscopy
○
○
c. Surgical robot (for urology surgery)
○
○
K8.
What was the total number of outpatient visits and unique outpatients6 that were seen in your Pediatric
Urology program in the last two calendar years? [If none, please enter 0.]
________ Total outpatient visits, past 2 calendar years
________ Unique outpatients seen, past 2 calendar years
VALIDATE: IF K8x IS NOT A WHOLE NUMBER, DISPLAY: “K8x: Please enter a whole number (no
decimals).”
IF K8b > K8a, DISPLAY: “K8: Unique outpatients cannot be greater than outpatient visits.”
6
Count may include both new and ongoing outpatients being seen for follow-up.
Pediatric Hospital Survey (12/17/2015)
Pediatric Urology
K-3
K9.
What were the total number of surgical cases7 operated on by pediatric urologists in your Pediatric
Urology program in the last two calendar years, excluding circumcisions and circumcision revisions (CPT
codes 54150, 54160, 54161, 54162, 54163, and 54450)? [Note that if multiple procedures were performed
during a trip to the OR, this only counts as a single case.] [If none, please enter 0.]
________ Surgical cases, past 2 calendar years
VALIDATE: IF K9 IS NOT A WHOLE NUMBER, DISPLAY: “K9: Please enter a whole number (no
decimals).”
K10.
Does your hospital offer any of the following specialized programs? If so, how many unique patients were
seen by a pediatric urologist in each of the programs in the last calendar year?
Unique
Yes No
Patients
a. Spina bifida program8
________
○
○
b. Voiding dysfunction program9
________
○
○
c. Comprehensive stone program10
________
○
○
d. Prenatal program11
________
○
○
e
Disorders of sexual differentiation program12
________
○
○
13
f
Exstrophy/cloaca/GU sinus program
________
○
○
WARNING:
IF K10x1=“Yes” AND K10x2=(0 OR BLANK), DISPLAY: “K10x: Please check your responses.
You indicated that you have the program but did not report any patients.”
VALIDATE: IF K10x2 IS NOT A WHOLE NUMBER, DISPLAY: “K10x (Unique Patients): Please enter a
whole number (no decimals).”
7
Surgical procedures do not have to be performed in the operating room (OR). You may count surgical procedures performed in the office or a clinic
setting as well. Note that surgical cases count only as one case regardless of the number of procedures (individual CPT codes) performed during that
case.
8 This program brings together specialists to deliver optimal care for pediatric patients with spina bifida. To answer “Yes,” the program must have a
designated medical director; a nursing coordinator; and access to urology, neurosurgery, physiatry, and orthopedics in one location. Note that this
question may include patients older than 18 seen by a pediatric urologist in your program.
9 This program brings together specialists to deliver optimal care for pediatric patients with voiding dysfunction. To answer “Yes,” the program must
have a designated medical director (who is a pediatric urologist or nephrologist), a nursing coordinator, pediatric biofeedback, and access to
urodynamics in one location. Hospitals may count patients seen by a pediatric urologist as well as other specialists in the program such as nurse
practitioners, physician assistants, or other physicians not boarded in pediatric urology who provide care as part of the voiding dysfunction program.
10 This program brings together specialists to deliver optimal care for pediatric patients with urinary and kidney stones. To answer “Yes,” the
program must have a designated medical director (who is a pediatric urologist or nephrologist), a nursing coordinator and pediatric endoscopic
equipment in one location.
11 This program brings together specialists to diagnose and treat prenatal urological dysfunction. To answer “Yes,” the program must have a
designated medical director; a nursing coordinator; and access to specialists in perinatal medicine, in one location. Note that this question may
include patients older than 18 seen by a pediatric urologist in your program.
12 This program brings together specialists to diagnose and treat disorders of sexual differentiation. Typical conditions treated by this program
include Disorders of Gonadal Differentiation (Klinefelter syndrome, 46 XX male, syndromes of gonadal dysgenesis), Ovotesticular DSD (true
hermaphroditism), 46 XX DSD (congenital adrenal hyperplasia), 46 XY DSD (disorders of testosterone biosynthesis, Leydig cell agenesis, disorders
of androgen dependent target tissue, proximal hypospadias, persistent mullerian duct syndrome). To answer “Yes,” the program must have a
designated medical director (who is a pediatric urologist or endocrinologist), a nursing coordinator; and access to specialists in endocrinology and
genetic counseling in one location. Note that this question may include patients older than 18 seen by a pediatric urologist in your program.
13 This program brings together specialists to deliver optimal care for pediatric patients with bladder exstrophy or persistent cloaca or GU sinus
requiring reconstructive surgery. To answer “Yes,” the program must have a designated medical director (who is a pediatric urologist); a nursing
coordinator; and access to specialists in endocrinology in one location. Note that this question may include patients older than 18 seen by a pediatric
urologist in your program.
Pediatric Hospital Survey (12/17/2015)
Pediatric Urology
K-4
K11.
Does your Pediatric Urology program offer any of the following treatment modalities to pediatric patients?
If so, how many unique patients received the therapy from a pediatric urologist in the last calendar year?
[For questions exclusively defined by CPT codes, include only cases assigned using the CPT encoder.
Assignment of CPT codes via a crosswalk with ICD-9 codes may not identify all cases properly.]
Unique
Yes
No
Patients
a. Stone treatment including shock wave lithotripsy ( CPT code
50590), ureteroscopy (CPT codes 52352, 52353), and percutaneous
○
○
nephrolithotripsy or nephrolithotomy (CPT codes 50080, or 50081)
________
b. Laparoscopic orchiopexy/orchidectomy (CPT codes 54692 or
○
○
54690)
________
c. Robotic-assisted laparoscopic pediatric surgery (ICD-9 procedure
○
○
code 17.42, or HCPC S2900)
________
d. Laparoscopic surgery including cyst ablation, pyeloplasty,
nephrectomy, and partial nephrectomy (CPT 50541, 50542, 50543,
○
○
50544, 50545, 50546, 50548, 50549)
________
WARNING:
IF K11x1=“Yes” AND K11x2=(0 OR BLANK), DISPLAY: “K11x: Please check your responses.
You indicated that you have the program but did not report any patients.”
VALIDATE: IF K11x2 IS NOT A WHOLE NUMBER, DISPLAY: “K11x (Unique Patients): Please enter a
whole number (no decimals).”
K12.
How many of the following surgical procedures were performed on pediatric patients by a pediatric
urologist14 in the last calendar year? [For questions exclusively defined by CPT codes, include only cases
assigned using the CPT encoder. Assignment of CPT codes via a crosswalk with ICD-9 codes may not identify all
cases properly.] [If none, please enter 0.]
Surgeries
Performed
a. Open Pyeloplasty performed in children under age 24 months of age (CPT codes
50400 and 50405)
________
b. Radical or partial nephrectomy for malignancies (ICD-9 diagnostic code 189.0,
and CPT codes 50220, 50225, 50230, 50234, 50236, 50240 for Open or 50543,
50545, 50546, 50548 for Laparoscopic)
________
c. Open heminephrectomy, ureteral reimplantation, or ureteroureterostomy
for patients with duplication anomalies of the kidney (CPT code in 50240,
50660, 50740, 50782, 50783)
________
d. Laparoscopic heminephrectomy, ureteral reimplantation, or
ureteroureterostomy for patients with duplication anomalies of the kidney
(CPT code in 50543, 50549, 50947, 50948, 50949)
________
VALIDATE: IF K12x IS NOT A WHOLE NUMBER, DISPLAY: “K12x: Please enter a whole number (no
decimals).”
14
Include only physicians board certified/eligible by the American Board of Urology with a subspecialty certification in pediatric urology.
Pediatric Hospital Survey (12/17/2015)
Pediatric Urology
K-5
K13.
How many unique pediatric patients received the following surgical procedures performed by pediatric
urologists15 in the last calendar year? [For questions exclusively defined by CPT codes, include only cases
assigned using the CPT encoder. Assignment of CPT codes via a crosswalk with ICD-9 codes may not identify all
cases properly.] [If none, please enter 0.]
Unique
Patients
a. Exstrophy closures (CPT code 51865,51940, or 54390)
________
b. Reconstructive procedures for incontinence or hostile bladder—open (CPT code in
50810, 50815, 50820, 50825, 50830, 50845, 51800, 51820, 51840, 51841, 51845,
51960, 51990, 51992, 53400, 53405, 53410, 53430, 53442, 53449, 53500, 53415,
________
53420, 53425,57287, 57288, 53431, 53440, 53445, 53444, 53447, 53448)
c. Endoscopic procedures for incontinence or hostile bladder (i.e., injection of a bulking
________
agent such as DeFlux or BOTOX into the bladder) (CPT code 51715 or 52287)
d. Posterior urethral valve ablation (OR CPT code in 52400)
________
e. Proximal urethroplasty or complex revision for hypospadias (CPT codes in 54304,
54308, 54312, 54316, 54318, 54332, 54336, 54352 or 54348)
________
f. Female reconstructive procedures (CPT code in 46744, 46746, 46748, 53430, 53431,
56800, 56805, 57335, 57291, 57292)
________
VALIDATE: IF K13x IS NOT A WHOLE NUMBER, DISPLAY: “K13x: Please enter a whole number (no
decimals).”
K13.1 For the complex reconstructive procedures for incontinence or hostile bladder described in K13b,
does your Pediatric Urology Program monitor for the following operative complications?
a.
b.
c.
d.
e.
K14.
Post-augment bladder capacity based on either VCUG or Urodynamic
study (CPT code V43.5)
Compliance based on urodynamic study
Continence (no leaking for 3 hours post surgery)
Absence of reflux (ICD-9-CM 593.70, 593.71, 593.72, or 593.73)
Stomal complications (ICD-9-CM 596.82)
Yes
No
○
○
○
○
○
○
○
○
○
○
How many of each of the following surgical procedures were performed by the pediatric urologists16 in
2015? [If none, please enter 0.]
Procedures
performed
2015
a.
Distal hypospadias (Repair surgeries CPT codes in 54322, 54324, 54326, 54328;
________
Revision surgeries CPT codes 54340, 54344, 54348)
b.
Proximal hypospadias (Repair surgeries CPT codes in 54304, 54308, 54312, 54316,
54318, 54332, and 54336; Revision surgeries CPT codes 54340, 54344, 54348,
________
54352).
c.
Pyeloplasty (Repair surgeries CPT codes 50400, 50405, 50544, or 50750; Revision
________
surgeries CPT codes 50405, 50544, or 50750).
VALIDATE: IF K14x IS NOT A WHOLE NUMBER, DISPLAY: “K14x: Please enter a whole number (no
decimals).”
15
16
Include only physicians board certified/eligible by the American Board of Urology with a subspecialty certification in pediatric urology.
Include only physicians board certified/eligible by the American Board of Urology with a subspecialty certification in pediatric urology.
Pediatric Hospital Survey (12/17/2015)
Pediatric Urology
K-6
K15.
How many of each of the following surgical procedures were performed by the pediatric urologists17 in
your program in the calendar year 2013? Of these procedures, how many required a revision surgery in
the last 3 years (2013, 2014 or 2015) for the same problem or a related complication?18 [If none, please enter
0.]
Surgical
Revision
Procedures
Surgeries
Performed
Performed
2013
2013-2015
a. Distal hypospadias (Repair surgeries CPT codes in 54322, 54324,
________
________
54326, 54328; Revision surgeries CPT codes 54340, 54344,
_R_1_1)
_R_1_2)
54348)
b. Proximal hypospadias (Repair surgeries CPT codes in 54304,
________
________
54308, 54312, 54316, 54318, 54332, and 54336; Revision
_R_2_1)
_R_2_2)
surgeries CPT codes 54340, 54344, 54348, 54352).
c. Pyeloplasty (Repair surgeries CPT codes 50400, 50405, 50544, or
________
________
_R_3_1)
_R_3_2)
50750; Revision surgeries CPT codes 50405, 50544, or 50750).
VALIDATE: IF K15x IS NOT A WHOLE NUMBER, DISPLAY: “K15x: Please enter a whole number (no
decimals).”
IF K15x2 > K15x1, DISPLAY: “K15x: Please check your response. The total number of revision
surgeries should not be greater than the total number of surgical procedures.”
K16.
Of both major and minor19 surgical procedures performed by a pediatric urologist20 in your program, what
percentage resulted in the following unplanned issues? [Calculate percentage as the number of issues divided
by the number of major/minor cases performed in the last calendar year, multiplied by 100. If multiple major
surgeries were performed during 1 OR visit, count that as 1 major surgical case.]
Major
Minor
Procedures Procedures
Percentage Percentage
a. Unplanned hospital admissions for a urologic issue21 within 30 days of
________% ________%
inpatient urological surgery
_R_1_1
_R_1_2
b. Unplanned hospital admissions for a urologic issue within 30 days after a
________% ________%
scheduled ambulatory urological surgical procedure
_R_2_1
_R_2_2
c. Unplanned reoperation for a urologic issue within 48 hours of urological
________% ________%
surgery
_R_3_1
_R_3_2
WARNING:
If K16a2 > K16a1, DISPLAY: “It is unlikely that there were more unplanned issues for minor
procedures than major procedures. Please verify your responses are correct before submitting.”
VALIDATE: 0 ≤ K16x ≤ 100. ELSE DISPLAY: “K16x: Please enter a numeric value between 0 and 100.”
K17.
This question was removed from the survey.
17
Include only physicians board certified/eligible by the American Board of Urology with a subspecialty certification in pediatric urology.
Hospitals should count both revisions surgeries done in-house and those referred out to other urology surgery programs for the revision surgery.
19
Major urological surgical procedures are defined as: pyeloplasty – open or minimally invasive surgery (MIS), Nephrectomy – total or partial (open
or MIS), ureteral reimplantation (open or MIS), Ureterocele excision, uretero-ureterostomy, bladder augmentation, mitrofanoff, partial cystectomy or
bladder diverticulectomy, correction of a perineal hypospadias, bladder exstrophy, and epispadias. Minor procedures are defined as all other
urological surgical procedures.
20 Include only physicians who are board certified/eligible by the American Board of Urology with a subspecialty certification in pediatric urology.
21 Urological issues are complications related to urological surgery which a pediatric patient received at your institution.
18
Pediatric Hospital Survey (12/17/2015)
Pediatric Urology
K-7
K18.
Did your Pediatric Urology program participate in any of the following types of prospective research22
activities in the past calendar year? If yes, how many IRB-approved trials, studies, or databases did you
participate in during this period?
Number of
trials, studies,
Yes
No
and databases
a. Prospective randomized clinical trial23
○
○
________
b. Prospective observational studies
○
○
________
c. Prospective clinical database on patient care
○
○
________
WARNING:
IF K18x1=Yes AND BK18x2=(0 OR BLANK), DISPLAY: “K18x: Please check your responses.
You reported that you participated in this research, but did not report any activities.”
VALIDATE: IF K18x IS NOT A WHOLE NUMBER, DISPLAY: “K18x: Please enter a whole number (no
decimals).”
K19.
For patients seen in the Emergency Department for Torsion of testis (ICD-9-CM 608.20 or 608.22) in the
last calendar year, what percentage received care (i.e., OR start time) within 4 hours, 4-7 hours, or longer
following their registration for care in the ED or outpatient clinic – that is, from the time they were
registered for care anywhere in your institution? [Any patient that has been documented to be symptomatic for
>24 hours prior to arrival to hospital (i.e., delayed torsion) should be excluded.]
________% OR start time < 4 hours
________% OR start time in 4-7 hours
________% OR start time in >7 hours
VALIDATE: 0 ≤ K19x ≤ 100. ELSE DISPLAY: “K19x: Please enter a numeric value between 0 and 100.”
IF K19a + K19b + K19c + K19d ≠100, DISPLAY: “K19: Please check your responses. Values for
the 3 start times should sum to 100%.
K20.
What is the average “third next available” appointment time24 for new patients in your Pediatric Urology
Program to receive an appointment for an outpatient office visit in the last calendar year? [Calculate using
the IHI definition (http://www.ihi.org/resources/pages/measures/thirdnextavailableappointment.aspx) and average
over the entire reporting period.]
________ Average days to “third next available” appointment
K21.
Does your Pediatric Urology Program offer the following weekend and afterhours outpatient clinics for
elective care?
Yes
No
a. Scheduled (non-emergency) weekday evening clinic appointments (after 5pm)
○
○
b. Scheduled (non-emergency) weekend surgical appointments
○
○
c. Scheduled (non-emergency) weekend clinic appointments
○
○
K22.
Which of the following does your Pediatric Urology Program have in place at the present time?
22
Prospective studies follow patients over time to evaluate how different factors affect outcomes.
These may include grant, hospital, society or industry-sponsored trials.
24 Average length of time in days between the day a patient makes a request for an appointment with a physician and the third available appointment
for a new patient physical or routine exam. The "third next available" appointment is used rather than the "next available" appointment since it is a
more sensitive reflection of true appointment availability. If not already tracked by your hospital, detailed instructions can be found at:
http://www.ihi.org/knowledge/Pages/Measures/ThirdNextAvailableAppointment.aspx
23
Pediatric Hospital Survey (12/17/2015)
Pediatric Urology
K-8
a.
b.
c.
d.
e.
f.
g.
h.
K23.
Protocol for preparing and assisting in the transition of patients from pediatric to
adult urology (URO_PROTOCOL_TRANS)
Protocol for teaching home intermittent catheterization
Radiation reduction/safety protocols for urology patients (e.g., Retrograde
pyelogram protocol, Ureteroscopy protocol)
Standardized clinical pathway for children presenting with acute stone pain to the
Emergency Department
Standardized clinical pathways for postoperative patients (i.e. post-op care plan by
diagnosis)
Educational materials for patients and families on urological conditions that are
updated on a regular basis
Child life specialists for perioperative care in the operating room and for office
procedures
Sedation services for VCUG/ noxious procedures
Yes
No
○
○
○
○
○
○
○
○
○
○
○
○
○
○
○
○
Does your Pediatric Urology Program make use of a patient portal to enable families to access electronic
medical records and communicate with their physicians and medical staff members?
 Yes
 No
 Does not apply, we do not have a patient portal
K24.
For Pediatric Urology, 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]
K25.
If you selected “some other timeframe,” please provide the timeframe used for reporting patient volume on
questions with ICD-9 codes.
COMMENTS FOR SECTION K:
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 (12/17/2015)
Pediatric Urology
K-9