Riley Children's Health Annual Report 2023 – 2024

Riley Children's Health is a nationally ranked pediatric health system that uses expertise, innovation and the latest advancements to deliver the highest level of patient care to children and families in Indiana and across the nation.

ANNUAL REPORT 2023 – 2024 SPECIALTIES OVERVIEW AND PROGRAM DISTINCTIONS

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RILEY CHILDREN’S HEALTH: A CENTURY OF CARING FOR KIDS In November 1924, Riley Children’s Health opened its doors with a mission to provide preeminent care to children. One hundred years later, our mission remains unchanged. Strengthened by our partnership with the Indiana University School of Medicine, Riley Children’s delivers leading-edge treatment to children in Indiana and beyond. We’re proud to be ranked among the best children’s hospitals in the nation. This year, 11 out of 11 of our pediatric specialties are ranked by U.S. News & World Report , with three programs—Nephrology, Pulmonology and Urology—named among the top 10. Our ability to advance children’s health would not be possible without the ingenuity of our physician-scientists and researchers. Riley Children’s and the IU School of Medicine rank ninth in the nation for pediatric research funded by the National Institutes of Health. * As one of the largest pediatric research hospitals in the Midwest, Riley Children’s is home to the Herman B Wells Center for Pediatric Research, where important breakthroughs take place every year. As we reflect on the past century, we cannot

RESEARCH AND PATIENT CARE HIGHLIGHTS

TABLE OF CONTENTS

LEADERSHIP TEAM Ryan Nagy, MD Interim President D. Wade Clapp, MD Chair, Department of Pediatrics, IU School of Medicine Elaine G. Cox, MD Chief Physician Executive Megan Isley, DNP, MSN, RN Chief Nursing Officer Tyler Leishman Chief Strategy Officer Mara E. Nitu, MD Chief Medical Officer Mark P. Cain, MD, FAAP Surgeon-in-Chief Frank Runion Chief Financial Officer Emily C. Webber, MD Chief Medical Information Officer

Riley Children’s Health: A century of caring for kids Proud to be a nationally ranked children’s hospital About Riley Children’s Health Nursing at Riley Children’s Health Riley Children’s Health quality and safety highlights Pediatric specialties Adolescent Medicine Allergy and Immunology Anesthesiology Cardiology Cardiothoracic Surgery Child Protection

> A century of care: Celebrating 100 years of leadership, compassionate care and innovation in children’s health. > Cardiology: Clinical research on novel treatment aimed at preventing thrombosis in patients with heart disease. > Gastroenterology, Hepatology and Nutrition: One of the first children’s hospitals in the Midwest to use new transnasal esophagoscopy technology. > Research: Ranked ninth in National Institutes of Health-funded pediatric research. > Nephrology: Research on heart disease associated with chronic kidney disease-mineral bone disorder rooted in precision medicine. > Neurology: Magnetoencephalography evaluates seizures in children and adults. > Fetal Center: Multidisciplinary center for high- risk pregnancies engaged in research on complex conditions. > Pediatric Surgery: Riley Children’s focused on extending surgical reach in Indiana and the Midwest. > Pulmonology and Sleep Medicine: Advanced technologies help to clinically validate methods for diagnosing primary ciliary dyskinesia.

Critical Care: Cardiac Critical Care Critical Care: Pediatric Critical Care Dentistry Dermatology Developmental Medicine Diabetes and Endocrinology

Diagnostic Radiology Emergency Medicine

Gastroenterology, Hepatology and Nutrition General Pediatrics and Pediatric Primary Care Hematology, Oncology and Stem Cell Transplant Hospital Medicine Infectious Diseases Interventional Cardiology and Electrophysiology Interventional Radiology Maternal Fetal Medicine Medical and Molecular Genetics Neonatology Nephrology Neurology Neuroradiology Neurosurgery Ophthalmology Orthopedic Surgery Otolaryngology – Head & Neck Surgery Palliative Care Pediatric Surgery Physical Medicine and Rehabilitation Plastic Surgery Psychiatry Pulmonology and Sleep Medicine Rheumatology Transplant Surgery Trauma Services Urology Riley Children’s Health team member directory Refer a patient

overstate the contributions of our team members whose dedication makes exemplary patient care the hallmark of Riley Children’s. To support the care we deliver, our care teams work to achieve and maintain elite recognition from groups such as the American College of Surgeons, the American Nurses Credentialing Center and numerous specialty- specific organizations. While much has changed since our founding, we remain committed to improving not only the lives of the children we treat at Riley Children’s, but also those in need of advanced medical care around the world. With conviction, enthusiasm—and always, with hope—we look forward to continuing the record of excellence at Riley Children’s into our next century.

Elaine G. Cox, MD Chief Physician Executive

Mark P. Cain, MD, FAAP Surgeon-in-Chief

Mara E. Nitu, MD Chief Medical Officer

rileychildrens.org

Annual Report 2023 – 2024

* Federal fiscal year 2023

PROUD TO BE A NATIONALLY RANKED CHILDREN’S HOSPITAL Ranked among the top children’s hospitals by U.S. News & World Report , Riley Children’s Health is ranked in 11 out of 11 pediatric specialties in 2024–25.

Riley Children’s Health, Indiana’s largest and most skilled pediatric health system, provides care in 19 communities across the state. Accreditations and designations ABOUT RILEY CHILDREN’S HEALTH

By the numbers

23,900+ ADMISSIONS AND OBSERVATIONS 475 BEDS 70+ PEDIATRICIANS 580+ SPECIALISTS ACROSS 40+ SPECIALTIES 23,300+ SURGICAL VOLUME 65,200+ EMERGENCY DEPARTMENT VISITS

CANCER

CARDIOLOGY & HEART SURGERY

Level 1 Pediatric Trauma Center verified by the American College of Surgeons (ACS)

DIABETES & ENDOCRINOLOGY

GASTROENTEROLOGY & GI SURGERY

NEONATOLOGY

NEPHROLOGY RANKED 10 TH IN THE NATION

Level 1 Children’s Surgery Center verified by ACS

NEUROLOGY & NEUROSURGERY

Platinum Center of Excellence designated by the Extracorporeal Life Support Organization

ORTHOPEDICS

PULMONOLOGY & LUNG SURGERY RANKED 7 TH IN THE NATION

UROLOGY RANKED 5 TH IN THE NATION

Earned Magnet®status, recognizing excellence in nursing care

PEDIATRIC & ADOLESCENT BEHAVIORAL HEALTH

NEW

AFFILIATED WITH

Leader in research and innovation ■ Ninth-ranked children’s hospital in the nation for research funding ■ One of the largest pediatric research hospitals in the Midwest ■ Home to the Herman B Wells Center for Pediatric Research , the Children’s Clinical Research Center and the Center for Children’s Health Services Research

“The U.S. News & World Report rankings this year are not just a number; they are a testimony to the ongoing excellence in pediatric care that we have cultivated over the last century. It reflects the dedication, compassion and innovation that have been the cornerstone of our legacy.” – Mara E. Nitu, MD Chief Medical Officer, Riley Children’s Health Professor of Clinical Pediatrics, IU School of Medicine > Connect with Dr. Nitu on Doximity.

■ One of the largest medical schools in the U.S. ■ One of the busiest locations for pediatric research funded by the National Institutes of Health and other sponsors

rileychildrens.org

Annual Report 2023 – 2024

Clinical nurses 1,660 Education and specialty certification NURSING AT RILEY CHILDREN’S HEALTH

Riley Children’s Health quality and safety highlights

■ 35% decrease in central line-associated blood stream infections (CLABSIs) compared to 2022 –Central line utilization: 7.5% decrease –Record number of days between CLABSIs in the pediatric hematology/oncology unit ■ 56% decrease in hospital-acquired pressure injuries (HAPIs) compared to 2022 ■ Record high compliance in hand hygiene ■ Equitable outcomes for the first time since 2018 in both CLABSI and HAPI for our patients who speak languages other than English

Bachelor of science in nursing 82%

Associate of science in nursing 12%

Certified RNs 21%

Graduate degree 6%

PROGRAM DISTINCTIONS

RESEARCH HIGHLIGHTS

■ Magnet®designated: Only 10% of U.S. hospitals have earned Magnet status;

Nurses at Riley Children’s are engaged in research related to: ■ Pediatric palliative care education and its impact on nursing awareness and perception of pediatric palliative care ■ Pediatric nurses’ perspectives on suicide screening and prevention ■ Food insecurity ■ Lived experiences of caring for an infant with cleft palate

Riley Children’s is among the 1% of hospitals to earn a fifth designation.

■ Only Entry-to-Practice Nurse Residency

Program in Indiana accredited by the Commission on Collegiate Nursing Education; accreditation received in 2022.

rileychildrens.org

Annual Report 2023 – 2024

“Reflecting on the impact of Riley Children’s over the past 100 years, there is much to celebrate. From our decades- long leadership in pediatric cardiology and infectious diseases to our record as pioneers in family-centered care and diversity, equity and inclusion, we continue to chart a course as a nationally recognized leader in children’s health.”

HISTORYMAKERS Since 1924, Riley Children’s Health

has led vigorous innovation and discovery driven by a steadfast, team-based commitment to advance

Elaine G. Cox, MD Chief Physician Executive, Riley Children’s Health Professor of Clinical Pediatrics, IU School of Medicine > Connect with Dr. Cox on Doximity.

pediatric healthcare for children, adolescents and their families. > WATCH: A Spoken History of the Past 100 Years. Hear directly from patients, caregivers and the skilled team at Riley Children’s as they reflect on the past century.

The adolescent medicine specialists at Riley Children’s Health treat a wide variety of adolescent health issues, including reproductive health, eating disorders and gender health. Our fellowship-trained physicians routinely work with specialists in cardiology, hematology/ oncology, child development, psychiatry, endocrinology, and obstetrics and gynecology to provide patient-centered, comprehensive care for young people up to age 25. ADOLESCENT MEDICINE

RESEARCH HIGHLIGHTS

Adolescent medicine specialists at Riley Children’s lead research in multiple areas: ■ Human papillomavirus (HPV) ■ HPV vaccines ■ Sexually transmitted infections ■ Healthcare access for youth ■ Eating disorders ■ Teen pregnancy prevention ■ Gender health ■ Long-term effects of illness and recovery on youth 4 new research grants in 2023

DIVISION CHIEF Rachel A. Katzenellenbogen, MD Professor of Pediatrics, IU School of Medicine > Connect with Dr. Katzenellenbogen on Doximity.

PROGRAM DISTINCTIONS

Specialized programs Adolescent Medicine Consultation Program

We offer evaluation and treatment for any adolescent health issue requiring more specialized treatment than is typical for primary care. Common referrals include: ■ Mental health and behavioral issues, including anxiety and depression and disordered attention ■ Nutritional concerns, including eating disorders ■ Co-management of chronic illness ■ Evaluation for chronic symptoms that lack a diagnosis Adolescent Gynecology and Reproductive Health Our physicians evaluate and treat a variety of gynecological conditions, including delayed puberty, abnormal uterine bleeding, polycystic ovary syndrome, chronic pelvic pain and dysmenorrhea. We offer specialized gynecology and reproductive healthcare, including long-acting reversible contraceptive options. Our specialists have extensive experience consulting patients and families about fertility preservation in complex illness, including heart transplants and congenital heart conditions, childhood cancer, cystic fibrosis, and sickle cell disease.

■ One of the largest divisions of its kind in the nation with high-volume clinical care, prolific grant- funded research and a robust training program ■ One of only nine nationally recognized Leadership Education in Adolescent Health (LEAH) programs; provides interdisciplinary training in the needs of adolescent and marginalized populations ■ Home to the Charis Center, Indiana’s most comprehensive eating disorders treatment program

9 board certified physicians

>

See full team member list

Our physicians lead subspecialty training through a three-year Adolescent Medicine Fellowship . Fellows provide clinical care, conduct research, direct resident education and can earn a master’s degree in public health.

NOTABLE PUBLICATIONS

JAMA Pediatrics: January 2024 What Health Systems Can Do Now to Improve Human Papillomavirus Vaccination LGBT Health: February – March 2024 The Impact of Gender Affirming Medical Care During Adolescence on Adult Health Outcomes Among Transgender and Gender Diverse

Individuals in the United States: The Role of State-Level Policy Stigma

32 research publications in 2023

20th anniversary in 2023

Through more than 10,000 outpatient visits annually, the center provides medical, psychological, group therapy, nutritional and parental support.

Charis Center for Eating Disorders The Charis Center provides multidisciplinary medical, psychological and family services for patients with eating disorders. Inpatient and outpatient treatment options are offered. Riley Gender Health Program

■ One of the few programs regionally that serves the unique needs of gender- diverse patients and their families

Riley Children’s is committed to advocating for families of adolescents and young adults in Indiana and across the nation, with the goal of improving their health and wellness.

Now caring for patients up to age 25, our interdisciplinary program delivers comprehensive support to patients and their families who are experiencing gender dysphoria and seek supportive, holistic and affirmative care.

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Annual Report 2023 – 2024

317.274.8812

Allergy and immunology specialists at Riley Children’s Health are expertly trained in the management and treatment of pediatric allergy, asthma and immunology issues. Our board certified physicians offer the latest diagnostic methods and treatments delivered in a safe and comfortable manner to children dealing with the challenges of allergic conditions. ALLERGY AND IMMUNOLOGY

RESEARCH HIGHLIGHTS

■ Riley Children’s participates in five clinical trials and multiple studies investigating the role of the airway microbiome in the development of allergic disease. ■ Our program participates in PARK (Preventing Asthma in High Risk Kids), a multicenter clinical study led by the National Institute of Allergy and Infectious Diseases to investigate the impact of omalizumab to prevent severe asthma and new allergies in preschool-age children. ■ Riley Children’s is one of the leading U.S. sites involved in the study of a proprietary probiotic to prevent the development of allergic conditions in infants.

DIRECTOR Girish V. Vitalpur, MD, FAAP, FAAAAI Associate Professor of Clinical Pediatrics, IU School of Medicine > Connect with Dr. Vitalpur on Doximity.

PROGRAM DISTINCTIONS

Specialized programs High-Risk Asthma Program

■ Recognized for distinction in clinical care by Food Allergy Research and Education (FARE); performs more food challenges than any other program in Indiana ■ Member of the Jeffrey Modell Centers Network for treatment and research related to primary immunodeficiency diseases ■ Indiana’s only multidisciplinary program for eosinophilic gastrointestinal diseases ■ Partners with the Indiana Department of Health to analyze all abnormal newborn screenings for severe combined immune deficiencies (SCIDs)

This collaborative program addresses the medical and social needs of children and families with severe asthma. > READ more about the program. Immunogenetics Program Children with complex immune disorders receive the latest guidance from an immunologist, a geneticist and a genetic counselor. Gastrointestinal Eosinophilic Digestive Diseases Program Our multidisciplinary program allows children to see a pediatric allergist, gastroenterologist and dietitian during the same visit. Immune Dysregulation Program This multidisciplinary program combines experts from rheumatology, immunology, hematology and infectious diseases to guide children with complex immune disorders.

6 board certified physicians

>

See full team member list

NOTABLE PUBLICATIONS

Annals of Allergy, Asthma and Immunology: June 2023 Body Mass Index in Relation to

Symptom Presentation on Diagnosis of Eosinophilic Esophagitis in Children Pediatric Pulmonology: July 2023 Nonsteroidal Anti-Inflammatory Drug Hypersensitivity in a Pediatric Severe Asthmatic Population The Journal of Allergy and Clinical Immunology: August 2023 Childhood Respiratory Viral Infections and the Microbiome Blood Advances: February 2024 Clinical, Immunological Features, Treatments and Outcomes of Autoimmune Hemolytic Anemia in Patients with RAG Deficiency

Professional organization affiliations American Academy of Pediatrics – Section on Allergy and Immunology Girish V. Vitalpur, MD, FAAP, FAAAAI American Academy of Allergy, Asthma & Immunology Jay J. Jin, MD, PhD, FAAAAI Simran K. Jutla, MD Kirsten M. Kloepfer, MD, MS, FAAAAI Nurcicek Padem, MD, MS Craig D. Sewell, DO Girish V. Vitalpur, MD, FAAP, FAAAAI

The inpatient penicillin allergy de-labeling protocol at Riley Children’s is used in hospitals across Indiana.

New Patient Volume: 2021 – 2023

Allergy

Immunology

Food Challenges Conducted: 2020 – 2023

2,534

181

389

2021

Clinical Immunology Society Jay J. Jin, MD, PhD, FAAAAI Nurcicek Padem, MD, MS

336

262 293

2,989

282

2022

Riley Children’s is a core member of the Severe Pediatric Asthma Consortium, a group focused on developing best practice guidelines and cultivating research initiatives.

3,325

323

2023

2020

2021

2022

2023

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Annual Report 2023 – 2024

317.948.7208

ANESTHESIOLOGY

Grants are currently funding research related to: ■ Translating science into clinical practice to improve safety and efficacy of opioids in neonates, children and nursing mothers ■ Personalized perioperative analgesia platform for pediatric spine fusion surgery RESEARCH HIGHLIGHTS

Watch how Riley Children’s contributed to advancements in pediatric anesthesiology. VIDEO SERIES >

The expert anesthesiologists at Riley Children’s Health deliver safe, evidence- based and compassionate care to pediatric patients in all areas of anesthesia, perioperative medicine, and acute and chronic pain management. In addition, our specialists are committed to leading innovative perioperative care research, providing high-quality clinical education and improving health outcomes.

DIVISION CHIEF Rania K. Abbasi, MD, FASA Associate Professor of Clinical Anesthesia, IU School of Medicine > Connect with Dr. Abbasi on Doximity.

PROGRAM DISTINCTIONS

Specialized programs Chronic Pain Management Program Harnessing the expertise of pain physicians,

■ Subspecialty anesthesia care for complex cardiac, neurosurgical and transplant surgeries, as well as acute and chronic pain management services ■ Nationally recognized in pediatric anesthesia and pain medicine research ■ Leader in the use of infant spinal anesthesia to minimize the need for general anesthesia

psychologists, and physical and occupational therapists, this multidisciplinary program provides psychological and procedural support for pediatric patients with chronic pain. Our Chronic Pain Management Program treated more than 1,000 patients in 2023. Acute Pain Management Program Skilled anesthesiologists provide leading-edge pain management for inpatient and outpatient procedures; use regional anesthesia and pain management protocols to enhance recovery and mitigate unwanted side effects. Cardiac Anesthesia Program The congenital cardiac anesthesia team delivers specialized care to children and adults with congenital and acquired cardiac disease who are undergoing diagnostic, interventional and surgical procedures. Transplant Anesthesia Program Providing 24/7 coverage for complex transplant cases, our physicians specialize in anesthesia care for children undergoing intra-abdominal and multivisceral transplants. Leading-edge technologies in cardiac anesthesia TEG 6S, a new point-of-care diagnostic modality, allows real-time assessment and treatment of bleeding disorders during cardiac surgery.

35 board certified physicians

>

See full team member list

NOTABLE PUBLICATIONS Pharmacogenomics: March 2023 Effects of Oxycodone Pharmacogenetics on Postoperative Analgesia and Related Clinical Outcomes in Children: A Pilot Prospective Study Paediatric Anaesthesia: May 2023 Antifibrinolytic Agents and Seizure Risk in Neonates Undergoing Cardiac Surgery Journal of Anesthesiology, Liposomal Bupivacaine Reduces Opioid Requirements Following Ravitch Repair for Pectus Excavatum Paediatric Anaesthesia: June 2023 Intraoperative Fluid Administration Volumes During Pediatric Liver Transplantation and Postoperative Outcomes: A Multicenter Analysis Clinical Pharmacology: July – September 2023

Committed to quality and safety Riley anesthesiology team members are actively involved in the statewide IU Health controlled substance stewardship and steering committees to enhance and guide safe opioid prescribing practices for all pediatric patients. In 2023, the Riley Children’s Opioid Stewardship Program partnered with the Indiana Department of Health to host a public service outreach program at the Indiana State Fair. Information about safe medication storage and disposal and free medication disposal kits were provided to the public.

Anesthesia Encounters: 2021 – 2023

2021

2022

2023

Riley Hospital for Children Main OR

15,818

17,000 *

17,000 *

Riley Outpatient Center

5,077

5,473

5,573

Riley Children’s Health at IU Health North

1,717

2,327

3,448

Total

22,612

24,800

26,021

* Estimated total for Main OR

Annual Report 2023 – 2024

Home to a high-volume, nationally ranked pediatric cardiology program, Riley Children’s Health delivers the full continuum of cardiac care from fetuses and premature infants to adults with congenital heart disease. Achieving exceptional patient outcomes, the Riley Heart Center has experienced significant growth in recent years. In addition to offering specialists in every clinical area of cardiology, we are active in research to address unmet needs in pediatric cardiology. CARDIOLOGY

RESEARCH HIGHLIGHTS

National Institutes of Health (NIH)-funded studies R01: Novel Molecular and Cardiac Imaging Paradigms for Precision Medicine in Aortopathy R21: An Integrated and Automated Tool for Quantification of Biomechanics in Fetal and Neonatal Echocardiography Larry W. Markham, MD , is a principal investigator of a $3.6 million NIH grant to improve the detection of heart disease in children with Duchenne muscular dystrophy. Investigators aim to integrate statistical modeling based on advanced imaging to improve the prediction of cardiomyopathy. Major study funded by the Additional Ventures Foundation Metabolic Profiles Identify Circulating Biomarkers Associated With Heart Failure in Young Single Ventricle Patients National program affiliations and accreditations ■ Pediatric cardiac catheterization and ECHO labs accredited by the Intersocietal Accreditation Commission ■ Member of the Cardiac Neurodevelopmental Outcome Collaborative ■ Accredited by the Adult Congenital Heart Association 42 research publications in 2023

DIVISION CHIEF Larry W. Markham, MD, FAAP, FACC Phillip Murray Professor of Pediatric Cardiology; Professor, Departments of Pediatrics and Medicine, IU School of Medicine > Connect with Dr. Markham on Doximity. >

PROGRAM DISTINCTIONS

Specialized programs Fetal Cardiology Program Partners in the Fetal Center, our cardiologists offer in-depth diagnostic imaging, evaluation and consultation during pregnancy to develop a

■ Ranked among the leading pediatric heart programs in the nation by U.S. News & World Report

26 board certified physicians

See full team member list

comprehensive treatment plan. Cardiovascular Genetics Program

■ National leader in patient outcomes with mortality rates below benchmark*

Fully integrated CV genetics program provides testing, evaluation and consultation for the full spectrum of heritable heart conditions: ■ Aortopathy ■ Cardiomyopathy ■ Inherited arrhythmia ■ Pulmonary hypertension ■ Familial lipid disorders ■ Congenital heart disease/syndromes > READ about genetic testing for newborns with congenital heart defects. Preventive Cardiology Program Cardiologists with expertise in preventive cardiology diagnose and manage both inherited and acquired dyslipidemia and pediatric hypertension (arrange for ambulatory blood pressure monitoring); provide lifestyle modification guidance in collaboration with a specially trained dietitian. Pediatric Cardiac Psychology Program New inpatient and outpatient program offers assessment and psychotherapeutic intervention for patients coping with acute or chronic heart conditions, procedures, and emergent events/trauma; assist adolescents in developing self-management skills in preparation for role as an adult patient.

NOTABLE PUBLICATIONS Journal of the American Heart Association: September 2023 A Multicenter Analysis of Abnormal Chromosomal Microarray Findings in Congenital Heart Disease Journal of the American College of Cardiology: April 2023 MEK Inhibition Improves Cardiomyopathy in Costello Syndrome Journal of the American College of Cardiology: March 2023 Risk of Sudden Death in Patients With RASopathy Hypertrophic Cardiomyopathy Pediatric Cardiology: January 2023 Impact of Home Monitoring Program and Early Gastrostomy Tube on Interstage Outcomes Following Stage 1 Norwood Palliation American Heart Journal: April 2023 Design of a Multi-Institutional Neurocognitive Discovery Study in Adult Congenital Heart Disease (MINDS-ACHD) Digestive and Liver Disease: January 2024 Biomarkers of Fibrosis and Portal Hypertension of Fontan-Associated Liver Disease in Children and Adults

■ Integrated care model with subspecialty care coordination and novel approaches to cardiac intensive care, inpatient navigation and home monitoring ■ Only formalized comprehensive adult congenital heart disease program in Indiana; program accredited by the Adult Congenital Heart Association

Echocardiogram Interpretations: 2019 – 2023 Our program serves more than 40 Indiana hospitals and achieves record volume.

Fetal Echocardiogram Volume: 2019 – 2023

Performed at eight locations across Indiana

24,371

22,726

2,764

21,177

2,569

2,307

17,938 17,887

1,927

1,670

2019

2020

2021

2022

2023

2019

2020

2021

2022

2023

* Source: Society of Thoracic Surgeons (STS) Table 16, Harvest Report, published January 2024 for period ending June 30, 2023

Refer a patient online

Annual Report 2023 – 2024

317.944.8906

“What sets apixaban apart is its convenience and potential benefits over current treatments. With the study’s implications, this could signify an incredibly positive turning point for pediatric cardiology.”

INVESTIGATORS Clinical research at Riley Children’s Health is delivering novel insights into preventing thrombosis in children with congenital or acquired heart disease. SAXOPHONE (Safety of Apixaban on Pediatric Heart Disease On the Prevention of Embolism) explores the safety and efficacy of apixaban—an alternative to standard treatment that offers hope in preventing blood clots in pediatric patients. READ about the study published in the Journal of the American College of Cardiology. >

Ronald M. Payne, MD, FAAP, FACC Cardiology Lead SAXOPHONE Investigator Professor of Pediatrics, IU School of Medicine > Connect with Dr. Payne on Doximity.

NEW TREATMENTS FOR FRIEDREICH’S ATAXIA > R EAD about Dr. Payne’s other major study that aims to uncover new potential treatments for the genetic disorder characterized by the loss of the frataxin protein in mitochondria.

The cardiovascular surgeons at Riley Children’s Health treat and manage the full spectrum of heart defects—from the most common to the most rare and complex. Practicing at the highest level of board certification, our heart surgeons offer a degree of expertise found only in the most advanced pediatric hospitals. CARDIOTHORACIC SURGERY

Mark D. Rodefeld, MD, has received multiple National Institutes of Health grants for his work to develop a blood pump designed to provide cavopulmonary assist in a univentricular Fontan circulation. RESEARCH HIGHLIGHTS

30-day Survival: 2021 – 2023

Index operations **

All operations

DIVISION CHIEF Mark W. Turrentine, MD John W. Brown Professor of Cardiothoracic Surgery, IU School of Medicine United Network for Organ Sharing primary surgeon > Connect with Dr. Turrentine on Doximity.

PROGRAM DISTINCTIONS

Specialized programs ■ Pediatric Heart Failure/Transplant Program (only program in Indiana) ■ Cardiovascular Genetics Program ■ Aortopathy Program ■ Adult Congenital Heart Program ■ Single Ventricle Home Monitoring Program ■ Ventricular Assist Device (VAD) Home Monitoring Program ■ Fontan Program ■ Cardiac Rehabilitation Program

98%

94%

2021

97% 99%

93% 96%

2022

■ Ranked among the leading pediatric heart programs in the nation by U.S. News & World Report ■ Treats more infants, children and teenagers with heart conditions than any other institution in Indiana ■ Only pediatric and adult congenital transplant program in Indiana; program accredited by the Adult Congenital Heart Association

2023

3 board certified physicians

>

Postoperative Overall Complications The Society of Thoracic Surgeons (STS) Participant Dashboard for period July 1, 2019 – June 30, 2023 No complications identified Riley Children’s 67.37% STS overall 60.38%

See full team member list

One or more complications identified

NOTABLE PUBLICATIONS Pediatric Cardiology: January 2023 Impact of Home Monitoring Program and Early Gastrostomy Tube on Interstage Outcomes following Stage 1 Norwood Palliation Pediatric Cardiology: August 2023 QRS Duration After Pulmonary Valve Replacement in Adults with Repaired Tetralogy of Fallot: Association with Ventricular Arrhythmia and Correlation with Right Ventricular Size The American Journal of Cardiology: January 2023 Serial Magnetic Resonance Imaging for Aortic Dilation in Tetralogy of Fallot With Pulmonary Stenosis VAD SIMULATION LAUNCHED IN 2023 Training on VAD in a dedicated simulation lab in the Riley Heart Center helps ensure team members are prepared for patient care situations with the goal of improving clinical processes and outcomes.

Riley Children’s 32.54% STS overall 36.80%

VIDEO SERIES

■ One of the nation’s most experienced centers for the Ross procedure

Median CPB and Cross Clamp Time for Select Procedures (in minutes) ***

Riley Children’s achieves less time on bypass than the national average.

Watch how Riley Children’s has contributed to the field of pediatric heart surgery. Watch how a Riley surgeon and patient led the way in an FDA-approved treatment for children with heart failure. >

RILEY CHILDREN’S

CPB TIME

STS

% DIFFERENCE

■ Seven decades of experience with right ventricular outflow tract reconstruction

AV Canal Partial

25.00% 28.77% 26.85% 22.58%

64 73

80 94

>

Intermediate

108

137

Complete

Operative and Adjusted Operative Mortality*

62

76

VSD

85.71%

56

104

Valvuloplasty

NEONATES/INFANTS/ CHILDREN/ADULTS All STAT Mortality Categories STAT Category 1 (Least risk)

# DEATHS/ELIGIBLE RILEY CHILDREN’S

OBSERVED MORTALITY RILEY CHILDREN’S

EXPECTED MORTALITY RILEY CHILDREN’S

STS OVERALL

9.06%

149 162.5

Norwood

RILEY CHILDREN’S

47/1,477

3.18%

3.41%

2.66%

CROSS CLAMP TIME

STS

% DIFFERENCE

AV Canal Partial

5/751

0.67%

0.68%

0.65%

44.74% 45.65% 37.33% 40.00%

38 46 75 35

55 67

Intermediate

5/300

1.67%

2.04%

1.94%

STAT Category 2

103

Complete

3/125

2.40%

4.31%

3.34%

STAT Category 3

49

VSD

15/236

6.36%

9.41%

7.83%

STAT Category 4

108.57%

35

73

Valvuloplasty

STAT Category 5 (Most risk)

19/65

29.23%

17.92%

14.97%

47.92%

48

71

Norwood

* Source: Society of Thoracic Surgeons (STS) Table 16, Harvest Report, published January 2024 for period ending June 30, 2023 ** The first cardiac operation of a hospitalization *** Source: Society of Thoracic Surgeons (STS) Harvest Report, published January 2024 for period ending June 30, 2023

Refer a patient online

Annual Report 2023 – 2024

317.944.7150

Child Protection at Riley Children’s Health offers multidisciplinary clinical services and education to improve the evaluation and care of maltreated children. Our team of board certified physicians provides evidence-based consultation in cases of suspected child maltreatment. These consultations are objective assessments to help determine the extent of injury and whether medical cause or accidental mechanism accounts for the injury pattern. CHILD PROTECTION

RESEARCH HIGHLIGHTS

Our physicians are currently engaged in research related to: ■ Evaluation of physical abuse when domestic violence occurs ■ Disparities in evaluation and reporting of drug ingestions by children ■ Caregiver understanding of adverse childhood experiences (ACEs) ■ Radiography use in assessing possible child maltreatment – Use of postmortem body CT scans to evaluate occult injuries – Spinal fractures in children evaluated for nonaccidental trauma ■ Analysis of demographics in child maltreatment evaluation using skeletal surveys as a proxy and employing multicenter trauma databases ■ Spatial distributions of child trauma and fatalities in Marion County, Indiana

DIVISION CHIEF Shannon L. Thompson, MD, FAAP Associate Professor of Clinical Pediatrics, IU School of Medicine > Connect with Dr. Thompson on Doximity.

PROGRAM DISTINCTIONS

Specialized programs Child Abuse Consultation Service

■ Extensive history of collaboration and care coordination with healthcare providers, child protection case managers, law enforcement and the judicial system ■ Consults with the Indiana Department of Child Services (DCS) on more than 6,000 cases of suspected child maltreatment each year ■ Home to one of only 31 ACGME- accredited child abuse pediatrics fellowship programs in the nation

Child protection specialists facilitate comprehensive medical evaluations for children alleged to have been physically abused or neglected. Foster Care Bridge Program Riley Children’s offers a multidisciplinary clinic to serve as a bridge—providing comprehensive healthcare and acquiring appropriate resources for children entering and making transitions within the foster care system until a permanent medical home is identified. Pediatric Center of Hope Riley specialists in child abuse pediatrics provide comprehensive medical evaluation for children alleged to have been sexually abused. Crisis Counseling Services These services bridge the gap from the time a child is identified as a possible child sexual abuse victim to when formal ongoing counseling may become available. Docs InCASE Program Our team, collaborating with 15 pediatric practices in Indiana, facilitates pediatric care and coordination in advancing the medical role in child protection.

5 board certified physicians

>

See full team member list

NOTABLE PUBLICATION

Physical, Developmental and Behavioral Needs of Youth in Foster Care, a chapter within Child and Family- Serving Systems: A Compendium of Policy and Practice Volume II: Approaches to Child and Family Protection: Core Opportunities and Challenges in Family-Serving Systems

Foster Care Bridge Program Encounters: 2020 – 2023

246 234

222

Children Served: 2023 Child abuse consults 5,456 Pediatric Center of Hope consults 808

Child protection specialists at Riley Children’s are active in national and local organizations, including: ■ American Academy of Pediatrics Council on Child Abuse and Neglect ■ American Academy of Pediatrics Trauma Informed Care Champion ■ American Academy of Pediatrics Council on Foster Care Adoption and Kinship Care ■ U.S. Department of Health and Human Services Children’s Justice Act Task Force ■ USA Gymnastics Safe Sport Committee ■ Ray E. Helfer Society ■ Local and state child fatality review teams and child advocacy centers

2020–21

2021–22

2022–23

Physical and Sexual Abuse Consultations by Year: 2019 – 2023

6,264

Crisis counseling 738 DCS consults 6,264

5,572 5,355 5,483

The child protection team led 52 community education programs in 2023.

2019–20

2020–21

2021–22

2022–23

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Annual Report 2023 – 2024

317.274.2617

CARDIAC CRITICAL CARE CRITICAL CARE

RESEARCH HIGHLIGHTS

■ Founding member and coordinating center: Collaborative Research in Pediatric Cardiac Intensive Care (CoRe- PCICS) network; 34 active U.S. sites participating in several ongoing research projects ■ Riley Children’s is part of the Pediatric Cardiac Critical Care Consortium (PC4), which uses registry data from more than 60 congenital heart programs to evaluate best practices and drive improvements. ■ We are actively enrolling in several prospective observational cohort studies and clinical trials—some funded by the National Institutes of Health and the Centers for Disease Control and Prevention. Our CVICU team remains active in studies focused on aspects of multiorgan dysfunction, including ARDS, sepsis, renal failure and extracorporeal membrane oxygenation (ECMO) support.

The expert cardiac critical care physicians at Riley Children’s Health provide specialized care for critically ill newborns, infants, children and adolescents with congenital and acquired heart disease. Our high-acuity, high-volume CVICU includes 23 beds for CVICU patients and an eight-bed specialized neonatal ICU.

DIRECTOR Riad Lutfi, MD Associate Professor of Clinical Pediatrics, IU School of Medicine > Connect with Dr. Lutfi on Doximity.

PROGRAM DISTINCTIONS

Advanced technologies ■ Ventricular assist devices (VAD) – We offer a wide range of circulatory support devices to support patients in bridge-to-transplant or bridge-to-recovery circumstances. ■ Continuous renal replacement therapy (CRRT) – In addition to a multidisciplinary CRRT program, Riley Children’s offers aquapheresis to remove excess fluid accumulation in critically ill neonates and children. ■ Etiometry software – All CVICU rooms are equipped with this FDA-approved software visualization application to collect, store and present ICU data in near real-time.

■ Ranked among the leading pediatric heart programs in the nation by U.S. News & World Report ■ Only program in Indiana to offer pediatric heart transplantation and mechanical circulatory support capability ■ Indiana’s only pediatric hospital with a formal extracorporeal cardiopulmonary resuscitation (ECPR) program

9 board certified physicians (plus multiple board certified neonatologists and physicians in other specialties)

>

See full team member list

NOTABLE PUBLICATIONS Pediatric Critical Care Medicine: January 2023 Inter-Rater Reliability of Delirium Screening of Infants in the Cardiac ICU: A Prospective, Observational Study American Journal of Respiratory and Critical Care Medicine: January 2023 Executive Summary: International Clinical Practice Guidelines for Pediatric Ventilator Liberation, A Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network Document Chest: May 2023 Operational Definitions Related to Pediatric Ventilator Liberation Pediatrics: August 2023 Factors Associated With Improved Pediatric Resuscitative Care in General Emergency Departments

High-volume pediatric ECMO center ■ 55 patients treated with ECMO in 2023. ■ Over the past five years, our overall survival rate for ECMO patients is nearly 60% (above the national average).

Risk-adjusted CVICU Surgical Mortality * 3.79% 2.22%

Risk-adjusted CVICU Medical Mortality *

Cardiac Arrest in the CVICU

3.97%

Our ECMO program is designated a Platinum Level Center of Excellence by the

2.96% 3.2%

2.92%

Extracorporeal Life Support Organization. To date, we have treated more than 1,200 patients with ECMO.

Riley Children’s All PC4 ** facilities

Riley Children’s All PC4 ** facilities

Riley Children’s All PC4 ** facilities

Additional 2023 outcome measures

Postoperative Severity – Adjusted CVICU Length of Stay

Major Complications – Unadjusted

ALTERNATIVE COMPLICATIONS

CASES

OUT OF

RILEY CHILDREN’S

ALL PC4 ** FACILITIES

CLABSI per 1,000 line days (central line-associated bloodstream infection)

0.44 per 1,000

2

4,596

1.21 per 1,000

23.5

19

11 days

CAUTI per 1,000 catheter days (catheter-associated urinary tract infection)

0.65 per 1,000

9.53 days

1

1,540

0.95 per 1,000

Unplanned extubation per 100 ventilator days

0.45 per 100

13

2,893

0.29 per 100

Riley Children’s All PC4 ** facilities

Riley Children’s All PC4 ** facilities

SSI per 100 surgical procedures (surgical site infection)

0 per 100

0

720

1.5 per 100

* Risk adjustment is a methodological approach incorporating unique patient characteristics that impact patient outcomes and are unrelated to the quality of care delivered by the care team or hospital. ** Pediatric Cardiac Critical Care Consortium | Charts reflect July 1, 2022 – June 30, 2023 , outcomes.

Annual Report 2023 – 2024

877.247.1177 IU Health 24/7 Transfer Center

PEDIATRIC CRITICAL CARE CRITICAL CARE

RESEARCH HIGHLIGHTS

■ 20 clinical trials and observational studies underway in critical care at Riley Children’s, including 14 funded by the National Institutes of Health and three funded by the Centers for Disease Control and Prevention ■ Active in studies focused on data science, global health and aspects of multiorgan dysfunction, including ARDS, sepsis, renal failure and ECMO support

The 37-bed PICU at Riley Children’s Health provides skilled care to critically ill infants, children and adolescents. According to The Children’s Hospital Association, the PICU located at Riley Hospital for Children in downtown Indianapolis is one of the highest acuity centers in the United States. With all pediatric medical and surgical subspecialties represented, the PICU delivers a collaborative model for the care of a large volume of high-acuity diseases and injuries.

DIVISION CHIEF Adnan Bhutta, MD, FAAP, FCCM Professor of Pediatrics, IU School of Medicine > Connect with Dr. Bhutta on Doximity.

PROGRAM DISTINCTIONS

Specialized programs Procedural Sedation Team

■ Platinum Level ECMO Center of Excellence designated by the Extracorporeal Life Support Organization

■ Averaging nearly 120 procedural sedations per month, our team provided care to 1,427 patients in 2023. Advanced technologies ■ Etiometry ■ High-frequency oscillatory ventilation ■ Inhaled nitric oxide ■ Kinetic therapy rotational bed ■ Continuous renal replacement therapy (CRRT) ■ Aquapheresis Committed to quality and safety ■ Reduced hospital-acquired harm -- The Riley PICU has significantly reduced the number of central line infections, pressure injuries and catheter-associated urinary tract infections. In 2023, our central line infection rate was 0.73 per 1,000 line days -- markedly lower than the national benchmark of 1.29. ■ CRRT support -- 53 patients were supported with CRRT in 2023. Additionally, the Riley PICU provided postoperative care for 20 children undergoing solid organ transplants. ■ Improved communication -- Nursing-integrated rounds and a standardized approach to communicating with families are being used to improve team collaboration and family experience during critical illness.

20 board certified physicians

>

See full team member list

■ Serves the critical care needs of Indiana’s largest pediatric trauma program

NOTABLE PUBLICATIONS Pediatrics: August 2023 Factors Associated With Improved Pediatric Resuscitative Care in General Emergency Departments Pediatric Critical Care Medicine: January 2023 Executive Summary of the Second International Guidelines for the Diagnosis and Management of Pediatric Acute Respiratory Distress Syndrome (PALICC-2) American Journal of Respiratory and Critical Care Medicine: January 2023 Executive Summary: International Clinical Practice Guidelines for Pediatric Ventilator Liberation, A Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network Document Pediatric Critical Care Medicine: December 2023 Evaluation of the Resources and Inequities Among Pediatric Critical Care Facilities in Pakistan

■ The state’s only pediatric hospital with a dedicated burn ICU

Professional organization affiliations EDUCATION COMMITTEE World Federation of Pediatric Intensive Care Societies Riad Lutfi, MD CHAIR, HEMATOPOIETIC STEM CELL TRANSPLANTATION AND CELLULAR THERAPY SUBGROUP Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Courtney M. Rowan, MD, MS EXECUTIVE COMMITTEE, PEDIATRIC RESPIRATORY AND VENTILATION GROUP Pediatric Acute Lung Injury and Sepsis Investigators (PALISI)

■ Center of Excellence in Pediatric Sedation; designated by the Society for Pediatric Sedation

PICU Annual Admissions: 2020 – 2023

2,872

2,752

2,425

1,992

Average daily census of 34.96

Samer M. Abu-Sultaneh, MD, FAAP, FCCM CHAIR, SCIENTIFIC OVERSIGHT COMMITTEE Extracorporeal Life Support Organization Matthew L. Friedman, MD CHAIR, INTERNATIONAL COMMITTEE Pediatric Cardiac Intensive Care Society Adnan Bhutta, MD, FAAP, FCCM SCIENTIFIC OVERSIGHT COMMITTEE OF PEDIATRIC ECMO SUBGROUP Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Matthew L. Friedman, MD

2020

2021

2022

2023

106 research publications in 2023

Annual Report 2023 – 2024

877.247.1177 IU Health 24/7 Transfer Center

Faculty members of Indiana University School of Dentistry, the pediatric dentists at Riley Children’s Health are skilled in providing comprehensive dental care to children of all ages. Our dentists have extensive experience in treating children with complex medical issues. These conditions include physical disabilities, craniofacial anomalies, genetic disorders, liver and kidney disease, bleeding disorders, and congenital and acquired heart problems. Our team works closely with Riley specialists to optimize health outcomes for these medically compromised patients. DENTISTRY

Five-year grant from the Health Resources & Services Administration (HRSA) to improve children’s access to dental care and provide preventive and restorative services, while working with the medical community to educate future primary care providers. RESEARCH HIGHLIGHT

DIVISION CHIEF Brian J. Sanders, DDS, MS Chair of Pediatric Dentistry, IU School of Dentistry > Connect with Dr. Sanders on Doximity.

PROGRAM DISTINCTIONS

Advanced technologies ■ With iTero,®the newest digital scanner, we are able to expand the diagnostic and orthodontic services available to patients. ■ Riley Children’s is one of the few craniofacial centers in the Midwest to provide presurgical orthopedics using DynaCleft®tape to help align soft tissues and bones.

Professional organization affiliations COMMITTEE ON SPECIAL NEEDS American Academy of Pediatric Dentistry LaQuia A. Vinson, DDS, MPH CLINICAL REFERENCE COMMITTEE American Academy of Pediatric Dentistry Brian J. Sanders, DDS, MS COUNCIL ON SCIENTIFIC AFFAIRS American Academy of Pediatric Dentistry Allison C. Scully, DDS, MS DIRECTOR American Board of Oral Medicine Juan F. Yepes, DDS, MD, MPH, MS, DrPH COMMITTEE ON PEDIATRIC DENTAL SEDATION American Academy of Pediatrics James E. Jones, DMD, MSD, EdD, PhD Brian J. Sanders, DDS, MS COMMITTEE ON DIVERSITY, EQUITY AND INCLUSION American Cleft Palate and Craniofacial Association LaQuia A. Vinson, DDS, MPH EXAMINATION COMMITTEE American Board of Pediatric Dentistry LaQuia A. Vinson, DDS, MPH ASSOCIATE EDITOR Journal of the American Dental Association Juan F. Yepes, DDS, MD, MPH, MS, DrPH SITE VISITOR Commission on Dental Accreditation LaQuia A. Vinson, DDS, MPH Juan F. Yepes, DDS, MD, MPH, MS, DrPH

5 board certified pediatric dentists

■ Nationally recognized faculty with diverse expertise in dental care of children with special medical, emotional and psychological needs ■ Team includes dentists board certified in oral radiology, oral medicine, pediatric dentistry and orthodontics

See full team member list >

NOTABLE PUBLICATIONS

Journal of the American Dental Association: July 2023 Topical Fluoride Impact in Future Restorative Dental Procedures Journal of the American Dental Association: August 2023 Amalgam or Composite in Pediatric Dentistry and Analysis of Private Insurance Claims Data Journal of Anesthesia Progress: March 2023 Comparison of Oropharyngeal Oxygen Pooling and Suctioning During Intubated and Non-Intubated Dental Office-Based Anesthesia Journal of Pediatric Dentistry: January 2023 Evaluation of Claim Reports for Potential Impact of COVID-19 on Pediatric Dental Procedures Journal of Dentistry for Children: January 2023 Pediatric Phantom Dosimetry Evaluation of a New Rectangular Collimator

Dentistry for the Child and Adolescent , the longest-running international textbook in pediatric dentistry, was written by dentistry faculty at Riley Children’s and medical colleagues at

■ Indiana’s only pediatric dental residency program

IU School of Medicine. Originally published in 1963, the textbook has been translated into eight languages. The 11th edition was released in 2021.

Riley Dentistry Volume: 2023

14,453

Patient visits

2,692

New patients

845

Dental OR surgeries

The Riley Dental Center, a high- volume practice, has 5 full-time faculty and 14 residents on staff.

Our team sees as many as 130 patients a day.

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Annual Report 2023 – 2024

317.944.3865

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