VPS’s Star Ranking System (SRS) uses the clinical richness of VPS’s high quality data base to build a visual report of a unit’s performance in each of the following domains: Clinical Outcomes, Severity of Illness, Resource Utilization, Quality, and Services Offered. This choice of domains is based on data availability and has been approved by the VPS PICU Advisory Group (VPS PAG). Each one of these domains overlaps with one or more of the six dimensions of care published by the Institute of Medicine [1] (IOM). While VPS does not collect data on all six dimensions, it is, by case volume, the largest PICU registry in the world, to address several of the IOM dimensions.