SALT LAKE CITY — Zackery Alexander is an active and lively 2-year-old, so it was odd when he had trouble breathing earlier this year.

"I just thought he had swallowed a toy or something," said his mother, Julie Alexander. A trip to the emergency room ended in a much more severe diagnosis of dilated cardiomyopathy, a genetic condition ultimately requiring a trip to the top of the heart transplant list at Primary Children's Medical Center.

Zack and his mom have since spent three solid months in a patient room at the hospital, awaiting the heart that arrived suddenly on Tuesday, and they both have been glad not to have been stuck anywhere else.

"He really likes the doctors and nurses here. He calls them his friends," Alexander said. "You can see how much they love and care about him, and he can see that, too. They have made it much more comfortable for all of us."

In fact, no expense was spared to make the Lehi family's lengthy and somewhat stressful time at the pediatric hospital as enjoyable as possible. Nurses, Alexander said, would step in whenever they were needed and every effort was made to make Zack feel happy and maintain as much health as he could during the trying time.

"There's just something really amazing about this place," she said. "They're like my medical family."

And the efforts of numerous staff at Primary Children's haven't gone without notice, as the hospital again ranked among the top children's facilities in the country in the latest U.S. News & World Report report card, released Tuesday.

Compared with 179 pediatric facilities nationwide, Primary Children's placed in the top 50 in five of 10 specialties surveyed. It was one of 87 facilities in the country that made the rankings in at least one category, landing 16th in neurology and neurosurgery, 22nd in cardiology and heart surgery, 25th in orthopedics, 37th in gastroenterology and gastro-intestinal surgery, and 48th in urology.

Hospital CEO Katie Welkie said that while the report highlights areas in which the hospital is doing well, it also "helps identify places we can improve."

"We're always working on being better," she said, crediting a formative partnership with the University of Utah College of Medicine, whose professors and fellows make up the majority of physicians working at Primary Children's. Welkie said the staff's focus on quality care, innovation, research and providing the best for patients and their families aligns with the organization's purpose.

"Part of being a high-quality organization, a learning organization, is continually seeking ways to improve care," she said.

The Salt Lake Intermountain Healthcare-owned hospital serves children within a five-state area of more than 450,000 square miles. Its 289-bed facility saw 5,274 impatient and 12,670 outpatient surgeries in the last year, as well as 40,250 emergency room and 311,705 outpatient visits, making it a very busy hospital, Welkie said.

"We want patients who are close to us to come here," she said. "We exist in the community for that purpose."

Alexander thinks she might even go through withdrawals after leaving the hospital.

If all goes well with Tuesday's dramatic surgery, she and her son will spend another six weeks at Primary Children's. It's much better than his original prognosis, which was leaning toward employing an artificial heart — "a big, heavy machine you have to cart around with you everywhere you go," Alexander said.

They're not out of the woods just yet, but she has always trusted that staff at the hospital have her son's best interest in mind.

"They've made it easier to go through all this," she said.

The rankings, based on patient outcomes and other data as well as physician surveys, highlight the top 50 U.S. hospitals in the following specialties: cancer, cardiology and heart surgery, diabetes and endocrinology, gastroenterology and GI surgery, neonatology, nephrology, neurology and neurosurgery, orthopedics, pulmonology and urology.

The reputation of the hospitals makes up a quarter of the ranking score, a smaller percentage than has been used in the past, which somewhat levels the playing ground. But the more competitive hospitals tend to be well-known and in bigger cities, Welkie said.

Survey questions also changed each year, precluding hospitals from anticipating ranking outcomes. But, she said, the objective never changes.

"You do the right thing, and if it benefits you, that's great," Welkie said. "But our absolute priority is providing highest value care."

She said Primary Children's offers a variety of services not necessarily found in adult hospitals, including a number of innovative therapies that inspire creativity and inclusion, as well as foster overall improvement and health.

The hospital fell in the 2013-14 rankings in all but one specialty, but it made significant advances in neurology, or care dealing with the nervous system. The hospital also didn't place in two areas it has in previous years — cancer and nephrology treatment.

It only provides targets to improve upon, Welkie said. "We are proud to have ranked so well in so many categories. It provides an incredible resource to those we serve."

The Children's Hospital of Philadelphia bested the Boston Children's Hospital on the U.S. News' list, placing in the top three among nine of the 10 specialty rankings. A complete listing of the nation's best children's hospitals can be found online, at www.health.usnews.com.

The publication intends to release its annual rankings on adult hospitals July 16.

Email: wleonard@deseretnews.com, Twitter: wendyleonards