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Best Children’s Hospital
Award Questionnaire
Hospital Address
Information
Name of Children’s Hospital*
Street Address1*
Street Address2
Country*
United States
City*
State*
Select
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Federated States Of Micronesia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Marshall Islands
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Palau
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code*
person Contact
Information
First Name*
Last Name*
Position / Title:*
Email Address*
Phone Number*
Hospital general
Information
Is your children’s hospital part of a general hospital?*
Yes
No
How many beds are dedicated to NICU?*
How many beds are dedicated to PICU?*
How many beds are dedicated to Psychiatric?*
How many beds are dedicated to Burn?*
How many total beds?*
Hospital staff
Information
Does your facility have an emergency department dedicated to the children’s hospital?
Yes
No
Does your children’s hospital offer sleeping/living accommodations for family members?
Yes
No
Does your facility have a pediatric ICU?
Yes
No
Is your children’s hospital a separate building? Floor? Wing?
How many staff are board certified in pediatric anesthesiology?
How many staff are board certified in pediatric radiology?
How many staff are board certified in orthopedic surgery with additional pediatric-specific training?
How many staff are board certified in pediatric cardiology?
How many staff are board certified in pediatric endocrinology?
How many staff are board certified in pediatric pulmonology?
How many staff are board certified in pediatric nephrology?
How many staff are board certified in pediatric gastroenterology?
How many staff are board certified in pediatric urology?
How many staff are board certified in pediatric oncology?
How many staff are board certified in pediatric neurology?
How many staff are board certified in neonatology?
How many staff are board certified in child and adolescent psychiatry?
How many staff are board certified in pediatric emergency medicine?
Apart from the above categories, how many staff are board certified in other pediatric specialties? (examples are rheumatologists, radiologists, ophthalmology, plastic surgeons, infection preventionists etc.)
How many nursing staff hold any of the following credentials?: RN-BC, CPN, PCNS-BC, CPON, CPHON or RNC-NIC, C-NPT, CCRN, CPEN
What is the total nursing staff (FTE)? Please include nursing managers, educators, assistants etc.
How many support staff (social workers, therapists, pharmacists and dieticians) have training specifically for pediatric services?
Hospital facility
Information
Does your facility have a ....
Level II NICU?
Level III?
Level IV?
None?
Does your facility have Child Life specialists and/or Recreation Therapists?
Yes
No
Does your hospital provide in-person interpreters to pediatric patients and their families when medical and surgical discussions are needed?
Yes
No
Does your children’s hospital utilize Telehealth technology?
Yes
No
Does your children’s hospital conduct basic and/or clinical research on diseases that affect children?
Yes
No
In which of the following accreditation programs does your hospital currently participate? (Select one)
The Joint Commission (TJC)
Det Norske Veritas Healthcare-GL (DNV)
The Healthcare Facilities Accreditation Program (HFAP)
Center for Improvement in Healthcare Quality (CIHQ)
Accreditation Association for Hospitals/Health Systems Inc (AAHHS)
None
Don't know
Other
Does the facility have accreditation as a Pediatric Trauma Center?
Yes
No
How does this facility measure patient satisfaction? (SELECT ONE)
Done using nationally recognized measures such as CAHPS, Press-Ganey, or others
Done using measures developed by a non-national organization
Done using measures developed by the center
Not done
What level Pediatric Trauma Center is provided at your hospital? Please select one.
Level 1
Level 2
How did the Pediatric Trauma Center earn its designation? (Select one)
by the American College of Surgeons
by your State Licensing Board
How does this facility measure patient satisfaction? (Select one)
Done using nationally recognized measures such as CAHPS, Press-Ganey, or others
Done using measures developed by a non-national organization
Done using measures developed by the center
Not done
How much does the patient satisfaction results assess the performance of the facility’s staff?
Yes, extensively
Yes, to a limited degree
No
Doesn’t apply (We don’t measure patient satisfaction)
What percent of discharged patients provide patient satisfaction information?
Under 15%
16% - 25%
26% - 50%
> 50%
Doesn’t apply (We don’t measure patient satisfaction)
Which of the following pediatric quality and safety programs does your hospital participate in?
Children’s Hospital Solutions for Patient Safety learning network (CHSPS)
American College of Surgeons (ACS) National Quality Improvement Program (NSQIP)
Children’s Hospital Association sepsis project
None
Other national quality and safety programs.
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