When a Hospital Is Bad for You

It could be right for most patients but the wrong place for you. Here's how you can tell.

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The U.S. News Best Hospitals rankings and other resources can help steer you to a top-notch hospital when a procedure or condition requires exceptional skill. For routine care, such as repairing a torn rotator cuff or inserting a heart stent, most hospitals will do a fine job. Still, "most" is not "all." Sometimes a particular hospital can be the right choice for some patients but the wrong one for you.

There aren't many hospitals so terrible that they're lethal. A 50 percent death rate or other glaring red flag would prompt padlocks on the doors. But you don't want a place that has little experience with your surgical or medical needs—or is less alert than it should be for anything that could go wrong. 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, says John Birkmeyer, a professor of surgery at the University of Michigan Medical School and the study's coauthor. Mortality rates at some hospitals in the study were almost twice as high as at others. A good hospital, says Birkmeyer, catches problems and responds quickly. What follows are five signs that you might want to think twice about the hospital you have chosen.

Low hospital volume. A hospital that sees a regular flow of patients like you is more likely than a low-volume center to have a well-oiled system in place for their procedures and medical conditions. The hospital should be able to provide volume figures for the most recent year, along with death and complication rates. Recommended volumes have been set for a handful of procedures. The Leapfrog Group, a business-sponsored organization that evaluates hospital performance, suggests 450 a year for heart bypass surgery, 400 for coronary angioplasty and stenting, 125 for weight-loss surgery, 120 for aortic valve replacement, 50 for repair of an abdominal aortic aneurism (a weakened portion of the lower part of the aorta), and 13 and 11 for removing a cancerous portion of the esophagus and pancreas respectively. A hospital with much lower figures could still perform well, but you might ask your doctor about an alternative source of care.

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Low surgeon volume. Even high-volume hospitals can have low-volume surgeons, and the difficulty of some operations, such as aortic valve replacement, demands practice to keep the required skills sharp. Various studies have found that for some procedures, the surgeon is more of a factor than the hospital in determining complications and length of stay. In a study involving men whose cancerous prostates were removed, for example, complications were significantly lower and length of stay shorter with surgeons who did 60 or more prostatectomies a year than for surgeons who did fewer than 60. The surgeon to whom you were referred should freely provide the latest yearly total and rates of death and complications. If she bristles or says the information isn't readily available, that, too, suggests a conversation with your doctor about a different surgeon.

No intensivist. Traditionally, surgeons or other physicians were in charge of patients they sent to the intensive care unit. But studies show that deaths drop by 25 percent or more in ICUs where patients are under the care of intensivists. These specialists in critical care spend most of their time inside the ICU, while surgeons do most of their work in the OR and other medical specialists appear only intermittently. Small hospitals might not be able to carry an intensivist on staff, but those with 250 beds or more should have at least one intensivist available during the day who can get to the ICU within five minutes of being paged. In an "open" ICU, the surgeon or other doctor still has the final say over care. A "closed" ICU, in which an intensivist is completely responsible for care, is better because of the physician's daily familiarity with the patients.