U.S. News & World Report recently issued its ranking of Best Hospitals in the United States as well as a host of interpretive articles to help people refine their understanding of what constitutes “best” and how to locate the “best” hospital in your area.
The article “When a Hospital is Bad for You” explains that a facility offering excellent treatment for someone seeking treatment for, say, a broken leg can be less than the best place for someone who needs her aortic valve replaced.
Because the U.S. is a developed nation with regulatory oversight, few hospitals offer truly abysmal care. Such incompetence is rewarded with the withdrawal of credentials and a shuttered physical plant.
But there are important differences, and when it comes to your health, you can’t be too careful about separating the merely good from the superior. As the magazine says, “Rates of postsurgical complications such as bleeding, infection, and sudden kidney failure vary surprisingly little, according to a recent study of nearly 200 hospitals across the country. What does differ are deaths from such complications,” said John Birkmeyer, M.D., and the study’s co-author.
Here, according U.S. News, are five signs that should prompt you to continue shopping for a hospital that meets your medical needs:
- 1. Low volume. This falls under the “practice makes perfect” category. A hospital should be able to provide figures for the most recent year, along with death and complication rates, and you should ask for them. If it doesn’t have much experience with the procedure you need, go elsewhere. According to the Leapfrog Group, a business-sponsored organization that evaluates hospital performance, these are acceptable numbers, per year, for some common procedures:
bypass surgery– 450;
coronary angioplasty and stenting–400;
aortic valve replacement–120;
repair of abdominal aortic aneurism–50;
removal of cancerous portions of esophagus and pancreas, respectively–13 and 11.
If these numbers are low, ask your doctor about options.
- 2. Low surgeon volume. A hospital can register high-volume numbers for procedures, but individual surgeons might be low-volume practitioners. Some operations, such as aortic valve replacement, require lots of practice to maintain sharp skills. Your surgeon should be willing to supply the latest yearly total as well as rates of death and complications for your procedure. If not, or if he or she seems indignant at the request, seek alternatives.
- 3. No intensivist. Hospitals that employ specialists to care for patients in intensive care, versus the traditional practice of surgeons or other physicians taking charge of their intensive care patients show a decrease of deaths of 25% or more. Specializing in critical care, intensivists work primarily inside the ICU; surgeons, in contrast, spend most of their time in the OR. Hospitals with more than 250 beds should be able to summon an intensivist to the ICU within five minutes of being paged.
- 4. Not enough nurses. A study in the Journal of the American Medical Association found that a patient’s risk of dying was much higher where nurses on surgery floors had more than seven patients during an average shift; the ideal number is four or fewer. Also, a nursing corps that holds four-year RN degrees versus two-year RN degrees notched a lower rate of surgery-related deaths. Patients should contact a hospital’s director of nursing to find out its nurse-to-patient ratio.
- 5. Too many readmissions. This is a relative figure, so you must compare several hospitals to determine which has the lowest rate. The higher the rate of readmission, the greater the likelihood that a hospital struggles to coordinate care after discharge.
For more tips and practical websites for research, check out our firm’s patient safety newsletter, which devoted an issue to finding the right hospital.