Impact of an advanced practice provider–directed plagiocephaly clinic for neurosurgical practices

Restricted access


In recent years, the Weill Cornell neurosurgical team noticed an increase in referrals for plagiocephaly, likely due to increased infant back-sleeping and awareness. A plagiocephaly clinic staffed by a nurse practitioner and a physician assistant was established in 2016 to meet this demand, and to decrease the nonsurgical case burden on neurosurgeons. The purpose of this study was to examine the impact of a clinic directed by advanced nonphysician practice providers (NPPs) on parental satisfaction and nonsurgical work hours for staff neurosurgeons.


Over a 1.5-year period (from January 1, 2016, to June 20, 2017), Likert scale–based surveys were administered to parents before and after their child’s visit to the NPP-staffed clinic. Clinic hours were tracked to assess impact on the neurosurgeon’s workload.


All 185 patients seen in the plagiocephaly clinic over the 1.5-year period completed pre- and postvisit surveys. Parents all reported a significant reduction in their level of concern for their child’s diagnosis after the evaluation, and 95.5% were “very likely” to recommend the clinic. All parents felt that there was an increase in their knowledge base after an appointment with an NPP. Additionally, over 1 year in the study, 170 visits to the NPP plagiocephaly clinic were recorded, resulting in 85 hours that neurosurgeons normally would have spent in the clinic that they now were able to spend in the operating room.


This research provides evidence that an NPP-directed clinic can positively impact parental satisfaction and decrease nonsurgical case burden on neurosurgeons.

ABBREVIATIONS NPP = nonphysician practice provider.

Article Information

Correspondence Caitlin Hoffman: NewYork-Presbyterian Hospital, New York, NY.

INCLUDE WHEN CITING Published online March 29, 2019; DOI: 10.3171/2019.1.PEDS18385.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.



  • View in gallery

    Consult hours by NPPs and surgeons were compared based on the yearly quarters (Q) in which patients were seen during the study. Figure is available in color online only.


  • 1

    Argenta LCDavid LRWilson JABell WO: An increase in infant cranial deformity with supine sleeping position. J Craniofac Surg 7:5111996

  • 2

    Bruneteau RJMulliken JB: Frontal plagiocephaly: synostotic, compensational, or deformational. Plast Reconstr Surg 89:21331992

  • 3

    Cartwright CC: Assessing asymmetrical infant head shapes. Nurse Pract 27:33392002

  • 4

    Evangelista JAConnor JAPintz CSaia TO’Connell CFulton DR: Paediatric nurse practitioner managed cardiology clinics: patient satisfaction and appointment access. J Adv Nurs 68:216521742012

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5

    Hutchison BLHutchison LAThompson JMMitchell EA: Plagiocephaly and brachycephaly in the first two years of life: a prospective cohort study. Pediatrics 114:9709802004

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6

    Kane AAMitchell LECraven KPMarsh JL: Observations on a recent increase in plagiocephaly without synostosis. Pediatrics 97:8778851996

  • 7

    Kuang AABergquist CCrupi LOliverio MSelden NR: Effectiveness and safety of independent pediatric nurse practitioners in evaluating plagiocephaly. Plast Reconstr Surg 132:4144182013

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8

    Moon RY: SIDS and other sleep-related infant deaths: evidence base for 2016 updated recommendations for a safe infant sleeping environment. Pediatrics 138:201629402016

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 9

    Moss SD: Nonsurgical, nonorthotic treatment of occipital plagiocephaly: what is the natural history of the misshapen neonatal head? J Neurosurg 87:6676701997

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    Sarro ARampersaud YRLewis S: Nurse practitioner-led surgical spine consultation clinic. J Adv Nurs 66:267126762010




All Time Past Year Past 30 Days
Abstract Views 57 57 57
Full Text Views 16 16 16
PDF Downloads 21 21 21
EPUB Downloads 0 0 0


Google Scholar