Need a good hospital in your community? Want more to go on than your doctor's recommendation? Conduct your own online checkup first. Death rates, adherence to accepted safety practices, and patient satisfaction are among the kinds of information you may be able to tap. Then you should talk over your findings with your referring physician; the data can be revealing but may need interpreting or may have limitations that are not obvious.
Here's a recent example: A study reported in this week's Journal of the American Medical Association found no correlation between how well hospitals scored on a 13-item set of quality and safety measures (from the Leapfrog Hospital Survey, described below) and death rates, adjusted for severity, of patients admitted to the hospitals. Does that suggest complications such as infections following surgery and diligent handwashing don't mean anything? Of course not—the study didn't look at rates of complications.
We've started you off with a list of hospitals that did well in our latest America's Best Hospitals results even though they aren't part of an academic medical center and, in fact, aren't involved in teaching students or residents to any significant degree. Here are a few useful online resources to help you refine your hospital choices:America's Best Hospitals, a set of rankings in various specialties that U.S . News has generated since 1990, assesses a hospital's ability to handle very serious or complex cases—in fact, everyday procedures are specifically excluded. The Best Hospitals rankings are based on a hospital's reputation among board-certified physicians in each of the specialties, death rates, and care-related factors such as procedure volume and nurse staffing. More details can be reviewed here.Hospital Compare, hosted by the federal Centers for Medicare and Medicaid Services, focuses on how often hospitals give heart attack patients aspirin within 30 minutes of their arrival at the ED, give surgery patients the correct antibiotic at the right time prior to the procedure, and otherwise do the right thing in 23 "process measures." Some are relative lightweights. Most hospitals show great success, for example, at giving smoking-cessation advice to heart patients who smoke. (Nurse: "I see you're a smoker, Mr. Smith. You know it doesn't help your heart condition, don't you?" Mr. Smith: "Yes, I do." Nurse marks box on discharge form.) Other measures, such as the rate of getting a tube into heart-attack patients within 90 minutes to administer a clotbuster, are telling.
Hospital Compare also indicates whether a hospital's death rates in heart attack, heart failure, and pneumonia patients is better, no different, or worse than the U.S. average. That might seem useful, but the average is so broadly defined that only about 2 percent of hospitals are "better" or "worse." Clicking on the graph or table view of the page will reveal the actual death rates, as well as average state and national rates. Last year, the site began offering patient satisfaction data gleaned from surveys, such as the percentages of patients who reported their nurses always communicated well and of those who said they would definitely recommend the hospital. Look, but take with a grain of salt. Studies show that individuals whose medical care was successful tend to be more satisfied with a hospital in other ways.HealthGrades gives hospitals one, three, or five stars for 26 commonplace procedures and conditions, such as hip replacement and respiratory failure, based on death and complication rates. As with Hospital Compare, delving more deeply into the star ratings will reveal specific data, including the hospital's procedure volume. It's a good information resource if you need routine care or surgery.The Leapfrog Group is a nonprofit business coalition that allows consumers to compare hospital safety and quality ratings based on results of a voluntary survey. Hospitals are rated on their ability to satisfy two sets of safety standards. One set, such as appropriate ICU staffing and a program to reduce bedsores, applies to the entire hospital. The other set reflects quality of care and cost for 10 specific procedures and conditions, including repairing an abdominal aortic aneurism and treating pneumonia. Hospitals can be compared directly. You may not be able to find yours, however. Roughly 1,300 hospitals out of more than 5,000 in the nation—two out of 16 in Baltimore, for example—responded to the most recent Leapfrog survey.