Brain Center | Quality and Safety

The Brain Center is committed to providing the highest quality care to our patients. Through individual department initiatives and institution-wide standards, we are working to improve the patient/family experience and ensure the best possible outcomes.

The following list of department quality and safety initiatives is by no means exhaustive. Please check back frequently for the latest information. 


In the department of Department of Neurology, one of our quality goals is to make access to care easier for you and your child.

We want to listen to your concerns, teach and empower you in caring for your child and create a partnership between you and your neurologist.

  • We are working to improve our teaching materials for patients and their families admitted to the neurology department.  Not only will you understand your child’s condition and how to care for your child once you are home, but with our “Ticket Home” you will understand what things need to happen during the hospitalization to ensure a safe discharge. Your questions will be encouraged at every step in the process.
  • Communication with your care provider will become easier over the next 1-2 years with the introduction of an innovative web based tool that will allow you to complete forms online including medication lists, medical history and other documents required for your visit.  You will be able to submit updates to your physician on a regular basis and/or prior to each appointment.

We are committed to creating a safe environment.

  • We continuously monitor any and all safety events that could potentially occur both in our inpatient and outpatient settings.
  • Our physicians and nurses meet monthly to discuss safety and quality concerns that may arise.


The Department of Neurosurgery at Boston Children's Hospital provides highly integrated care for children with diseases and malformations of the brain, spine and nervous system. Neurological disorders often have broad-reaching effects.

At Children's, we aim to understand and treat all elements of a child's condition.The department also maintains the highest expectations for the quality of care we provide to our patients. The department has a faculty of 6 full time board-certified neurosurgeons (ABNS - American Board of Neurological Surgeons and ABPNS – American Board of Pediatric Neurological Surgeons).

The department also includes 3 Nurse Practitioners (2 full time pediatric neurosurgery and one shared with the Trauma Program/Brain Injury).  We have one clinical  fellow in pediatric neurosurgery (Shillito Staff Associate) and 3-6 residents from the combined Children’s Hospital/Brigham and Women’s Hospital neurosurgery training program and multiple other programs from North America.

The team has the following membership:

  • Physician-leader and director (Liliana Goumnerova, MD)
  • Quality improvement consultant (Marie Lightowler, MPH, CHES)
  • Nursing leader (Mary Pointer Reed, RN, Phdc, CNRN, ANP)
  • Department Administrator (Norman Dean, MSF, CMPE)

The Department of Neurosurgery covers all major areas of pediatric neurosurgery. This includes:

  • Hydrocephalus
  • Congenital anomalies
  • Brain tumors
  • Vascular anomalies
  • Spine
  • Functional neurosurgery (epilepsy, spasticity)
  • Trauma
  • Craniofacial

The Department of Neurosurgery provides care for children as well as adults with “pediatric” problems. The faculty consults with colleagues at Brigham and Women’s Hospital on the care of adults who have transitioned their care to adult institutions.

There are a number of multidisciplinary programs within Children’s Hospital and Dana Farber Cancer Institute for which we are either co-leaders or integral members (Pediatric Neuro-Oncology, Myelodysplasia).

Procedures & Volume

The Department of Neurosurgery provides services both in the in-patient and out-patient settings at the Boston campus. For patients that would prefer to be seen closer to home we have clinics at Boston Children’s Hospital satellite locations in Waltham, Lexington and Peabody.

Each year our neurosurgeons perform close 900 pediatric neurosurgery procedures, including many highly complex procedures:

  • Over 100 Brain Tumor surgeries
  • Over 50 Vascular cases including endovascualar procedures
  • Over 50 Epilepsy cases including hemispherectomy

Our neurosurgery staff is continually working to develop new surgical techniques and approaches that will improve outcomes from surgery. One example is using Combined Endoscopic third ventriculostomy/choroid plexus cauterization to eliminate the need for shunts in infants. Research has shown that ETV/CPC can obviate the need for a shunt in infants with hydrocephalus.

We are internationally-recognized for our surgical innovations in the treatment of children with stroke due to vascular malformations of the brain and for conditions which narrow brain blood vessels (moyamoya).

Because of the installation of the intraoperative MRI unit, and our close relationship with DFCI, we are an international referral center for the treatment of brain tumors.

We are also national leaders in neuroendoscopy, the treatment of hydrocephalus and head trauma, and epilepsy.

Patient Access

The Department of Neurosurgery is dedicated to getting patients requiring care seen as quickly as possible. Most patients will be able to get an appointment with one of our neurosurgeons within 7 days. Conditions requiring immediate attention can be seen within one day.

Results from Outpatient Satisfaction Survey

Patient Satisfaction


The Department of Neurosurgery is dedicated to continually improving our patients and their families experience at Boston Children’s Hospital. The Department participates in the annual Outpatient Satisfaction Survey. We also conduct ongoing surveys for our inpatients and clinics.

Comments Clinic Survey

“It was an excellent experience.  The doctor and her staff were compassionate, kind, thorough, and professional.”

“We are so pleased and grateful for the wonderful care our son received at Children's.  Thank you.”

“Dr. Warf and his staff were absolutely amazing.  It has been refreshing to deal with so many people eager to make my son's surgeries as easy as possible.”

Inpatient Comments

“BCH is the best hospital I've encountered. There is great access to doctors, general care from nursing, facilities and attention to detail."

“I rate my stay here a 10, the team was amazing and everything was really focused about children's care."

“We had great care and the nurses were awesome. The care was conservative, no excessive testing or labs. They did just want needed to be done.”

“Everyone was very informative, helpful and caring.”

Coordinated Care

Our neurosurgeons work collaboratively with many services in the hospital, with specialty clinics and hospital service teams:

  • Neurology (stroke, epilepsy)
  • Oncology (brain tumors)
  • Plastic surgery (craniofacial disorders)
  • Orthopedics (spinal stabilization, spinal cord injury)
  • Otolaryngology (skull base tumors)
  • General Surgery (trauma, Advanced Fetal Care Center)
  • CCS, Orthopedics, Urology (spina bifida)
  • Radiology (Neurointerventional Radiology)


We are working to improve our teaching materials for patients and their families admitted to the neurosurgery service.  Not only will you understand your child’s condition and how to care for your child once you are home, but with our “Ticket Home” you will understand what things need to happen during the hospitalization to ensure a safe discharge. Your questions will be encouraged at every step in the process.

Infection Data

The department maintains databases on all major surgeries conducted within the department. We collect data regarding CSF leaks, wound infections, OR complications and unplanned reoperations. This data is used to reduce laboratory tests and imaging studies.

In August 2010, a standardized procedure for sampling CSF from external ventricular drainage systems was implemented.  Modeled after the successful central venous catheter blood sampling data, the procedure will be taught and followed by all neurosurgery nurse practitioners and rotating house staff to assure consistency with sample collection and will minimize hospital-acquired CSF infections.

In August 2008, a protocol for pre-operative assessment of patients with shunted  hydrocephalus was implemented to insure patient safety while avoiding resource over-utilization.  The algorithm provides a template of recommended imaging studies and a neurosurgery consult based on clinical indications.  The algorithm has decreased unnecessary studies and consults without compromising patient care.

Safety and Quality

There is a commitment to safety and quality that is clearly emphasized to all members of the department. There is a culture of cooperation/discussion and respect amongst the entire department that allows discussion of critical events and opportunity for improvement.

Nursing and physician training programs will incorporate quality and safety curricula and active participation in quality improvement projects. All staff will continue to attend mandatory training programs, competency assessments and reviews geared towards quality goals.

The department is focused on maintaining a professional practice and providing the best care for all patients.