Some people are not able to choose their hospital. Sometimes they have a sudden illness, such as a heart attack, or an accident and are taken urgently to the nearest hospital. However, there are some instances when going to the hospital for surgery or to have a baby is planned. In that case, you, as the patient, can take the time to research hospitals and more importantly, think about what is important to you in the hospital.
At ProNobis Health we combine the art of choosing a hospital with the science. While some doctors believe that the quality of care is the only factor that matters in selecting a hospital, others, like us, feel like patients should be able to consider other things that are important to them, in addition to the quality of care, in selecting a hospital. We recognize that choosing the right hospital to have your baby, be treated for cancer, or have a major operation is a big decision. We want to help you in making the decision by exploring what is important to you, connecting you with good information, and explaining what the information means.
Deciding what is important to you in choosing a hospital is the first step. Matching your expectations to the culture of the hospital will help ensure a harmonious relationship and a speedy recovery. For some people, hospital choice is determined either by who their doctor is or what health insurance they have. Even in those situations, if you feel like the hospital that your doctor attends at or that your insurance contracts with is not a good fit for you, ask your doctor or your insurance company if there are other options. Often doctors will have relationships with more than one hospital. The same is true for insurance companies; often the company will contract with more than one hospital, or allow you to go to another hospital that is not their “preferred.” These other hospitals may be further from your home, or you may have to pay a higher fee to go to them, but it is always good to know what your options are, especially when it is something as important as a hospital.
The goal of this section is to help you identify what is important to you in choosing a hospital, beyond the quality considerations. We will discuss where to find the information you need and how to understand it below.
Location: For some people, after quality of care, location is the most important consideration in choosing a hospital. In fact, some patients will accept a lesser quality hospital that is closer to family than a top-notch hospital that is farther away. This is a very personal decision to make, and there is no right answer. Even doctors debate this. Figure out why geography is important to you. Is it so that your family can visit easily and frequently? Is it not to burden your family too much in getting you to and from the hospital? If you are making the decision based on what you think is easiest and best for your family, make sure you talk to them about it. They may have their own feelings on the matter.
Hospital Culture: This is a very important factor that people don’t often talk about. Some hospitals are large and university affiliated. Most of the doctors there also do some form of research. At these hospitals, it may be that a lot of your care is given by residents and interns, including your operation, procedure, birth, or treatment. There are good things and bad things about having residents help take care of you. On the good side, you are contributing to their education. They are often young and enthusiastic. They also may be more available than the attending doctor who is taking care of you. On the downside, they may be very inexperienced. Sometimes, if there are residents, the attending is more hands off in your care. If you don’t want to have residents taking care of you in the hospital, you shouldn’t go to a teaching hospital. It is good to ask about this in advance if it is important to you.
Another aspect of hospital culture that you may want to think about is its size. Again, each has its pros and cons. Larger hospitals typically have more services and specialists available, but they can feel impersonal. Smaller hospitals can have more of a community feel, but may not have as many specialized services to offer.
Culturally Appropriate Care: Don’t underestimate how important this is. If you are a vegan, if your loved one doesn’t speak English, if you refuse the transfusion of blood products, it is very important to be in a place that will recognize the importance of these things to you and make sure that you or your loved one has the things you need. Ask in advance about things like available meals if you have dietary restrictions or preferences. If your loved one will need interpreter services for staff interactions, make sure these are available 24 hours/day. Your family member and the staff may become frustrated, and your loved one may not get the care they need, if they are not able to communicate because of a language barrier. If you have strong cultural or religious beliefs about health care and medicine, it is essential that you are in a hospital that understands your beliefs and will respect you and the things that are important to you.
Religious Considerations: Some hospitals are affiliated with specific religious organizations. These hospitals may have specific guidelines about your care that is consistent with the teachings of the religion. For instance, most Roman Catholic hospitals will not perform tubal ligation after a woman delivers, even if she requests it. On the other hand, it may be very important for you to be in a hospital that you know has religious values consistent with your own. Particularly if you are going to a religiously affiliated hospital for maternal care, be sure to ask how this could affect your care.
Amenities: While hospitals are not hotels, it is very important that you know some basic things, such as whether rooms are private or shared, if there is a place in your room for your family member, and if there is a cafeteria (and when it is open). If you are expecting a private room, you don’t want to come out of surgery and be taken to your room only to discover that you are sharing it with three other people.
Discharge Planning and Social Work: As medicine is practiced today, hospitals focus a lot of effort on getting people discharged. Length of stay (LOS) is a major issue that hospitals look at, and the goal will be to get you home as safely and quickly as possible. For some people, this may be perfectly aligned with their own goal of getting out of the hospital as soon as possible. Other people may feel rushed or pushed out of the hospital. Particularly for planned procedures, operations, births, and treatments, it is very important to talk about discharge planning before you ever get to the hospital. For instance, if you are having a joint replacement operation, and you anticipate home physical therapy (PT) after surgery, make sure this has been arranged prior to surgery. The same is true if any home nursing needs are anticipated after you leave the hospital. Make sure these have been arranged. If you wait until you are going home to make these arrangements, there may be several days between going home and getting the home care that you need.
LGBTQ: Regardless of where you are, as an LGBTQ individual, you should expect to be treated with respect and understanding. Particularly if your LGBTQ status is highlighted as part of your stay in the hospital, such as two dads or two moms having a baby, someone having gender corrective surgery, or a wife making end-of-life decisions about the woman she loves, you as a person and your relationships should be respected. Some LGBTQ individuals may feel particular hesitation about a religiously affiliated hospital. Ask about the staff’s familiarity with LGBTQ issues. Make sure your relationship will be respected. If there are potential legal considerations, talk with an attorney and have any issues addressed before you go into the hospital. You don’t want to get there only to find that at that hospital, your LGBTQ identity precludes you from receiving the care and respect you expect to receive.
Reputation: While it is important to ask people if they have had experience with the hospitals you are considering, you have to take what you hear with a grain of salt. Hospitals are difficult, complicated places where people may experience some of the greatest joys and sorrows of their lives. As such, consider this when you are asking for opinions about a hospital.
Information About the Quality of Hospital Care
For many people, the quality of care is among the most important considerations when choosing a hospital. Fortunately, with increased focus on health care quality and outcomes, and in order to stay competitive in the market, most hospitals provide quality care. That is particularly true for commonly performed procedures and treatments. When it comes to more specialized operations or treatments that are less commonly performed, it is very important to know how many are performed at your hospital and what their complication rate is. For many procedures, research has shown that if a hospital performs fewer than a certain number, the outcomes are worse. These hospitals are sometimes called “High Volume Centers” or “Centers of Excellence.” It is an important consideration when deciding which hospital to go to for a procedure. On the other hand, if some procedures, such as cesarean birth or episiotomy, are performed too frequently, that may be a sign that the hospital is not as good as it could be.
Two highly reliable organizations gather information from hospitals about the quality of their care and make it available on their websites. Each has as part of its goal to inform you, the health care consumer, and help you make good decisions about your care. These organizations also strive to help hospitals deliver excellent care.
The Leapfrog Group is a nonprofit watchdog organization that helps health care purchasers, such as large corporations, make sure that the care they are paying for is high quality. Leapfrog advocates for health care transparency so that purchasers and patients can make informed decisions. By promoting transparency in information, Leapfrog influences hospitals to perform better and deliver excellent care. Leapfrog has two sites: Leapfrog Compare Hospitals and Leapfrog Hospital Safety Grade, which is dedicated to patient safety.
Centers for Medicare & Medicaid Services (CMS) Hospital Compare. CMS pays hospitals to deliver quality care and keep patients from getting sicker or worse while in the hospital; CMS wants to make sure hospitals are doing a good job. Hospital Compare gives hospitals an overall score (5 stars is the best) and then a rating on different aspects of care.
Both CMS and Leapfrog collect a lot of data that you can search on their sites. The data they collect can be divided between general information and specific information. General information includes how satisfied patients were with their stay in the hospital, how many patients developed infections while they were in the hospital, and how many patients had to be readmitted to the hospital within 30 days of being discharged. The other information applies to specific treatments, procedures, or operations.
Some of the information on these sites can be difficult to find unless you know what you are looking for. That is where ProNobis Health can help. Below you will find an overview of the sites to help you find the information that is most important for you whether you are having a baby, undergoing cancer surgery, or having a hip replacement.
Leapfrog Compare Hospitals
For each measure shown below, the hospital receives a score of 0-4 bars, with 4 bars meaning that the hospital fully meets the standards set by Leapfrog.
- Inpatient Care Management
- Steps to Avoid Harm
- Never Events Management
- Appropriate Use of Antibiotics in Hospitals
- Specially Trained Doctors Care for ICU Patients
- Medication Safety
- Doctors Order Medications Through a Computer
- Safe Medication Administration
- Medication Reconciliation
- Infection in the Blood
- Infection in the Urinary Tract
- MRSA Infections
- C. difficile Infection
- Surgical Site Infection After Colon Surgery
- High-Risk Surgery
- Bariatric Surgery for Weight Loss
- Carotid Artery Surgery
- Mitral Valve Repair and Replacement
- Open Aortic Procedures
- Cancer Surgery
- Lung Resection for Cancer
- Esophageal Resection for Cancer
- Pancreatic Resection for Cancer
- Rectal Cancer Surgery
- Maternity Care
- Early Elective Deliveries
- Cesarean Sections
- Maternity Care Processes
- High-Risk Deliveries
- Pediatric Care
- Experience of Children and their Parents
- Radiation Dose for Head Scans
- Radiation Dose for Abdomen/Pelvis Scans
Leapfrog Hospital Safety Grade
For each hospital, there is an overall grade for safety, with a letter grade of A being the best.
For each measure below, there is the hospital’s score, the best hospital’s score, the average hospital’s score, and the worst hospital’s score. This allows you to judge how well your hospital performs relative to other hospitals.
- Infection in the blood
- Infection in the urinary tract
- MRSA infections
- C. difficile infection
- Surgical site infection after colon surgery
- Problems with Surgery
- Dangerous object left in the patient’s body
- Surgical wound splits open
- Death from serious treatable complications
- Collapsed lung
- Serious breathing problem
- Dangerous blood clot
- Accidental cuts and tears
- Practices to Prevent Errors
- Doctors order medications through a computer
- Safe medication administration
- Communication about medicines
- Communication about discharge
- Staff work together to prevent errors
- Safety Problems
- Dangerous bed sores
- Patient falls and injuries
- Air or gas bubble in the blood
- Track and reduce risks to patients
- Doctors, Nurses, and Hospital Staff
- Effective leadership to prevent errors
- Enough qualified nurses
- Specially trained doctors care for ICU patients
- Communication with doctors
- Communication with nurses
- Responsiveness of hospital staff
CMS Hospital Compare
For each hospital, CMS gives an overall star rating of 1-5 stars, with 5 stars being the best score. Clicking on the hospital name will take you to specific information about that hospital. Examples of information available, how it is organized, and how to interpret it can be found below.
Survey of patients’ experiences
There is an overall star rating of 1-5 for patients’ experiences, with 5 stars being the best.
Each of the individual measures below has a score for the hospital that is compared with the individual state and national averages.
- Communication with doctors and nurses
- Receiving help as soon as they wanted
- Bathrooms clean
- Hospital quiet at night
- Percent of patients rating the hospital 9 or 10 on a scale of 0-10, where 10 is the best
- Percentage of patients who reported YES, they would definitely recommend the hospital
Timely and effective care
Each of the individual measures below has a score for the hospital that is compared with the individual state and national averages.
- Sepsis care
- Cataract surgery outcome
- Colonoscopy follow-up
- Heart attack care
- Emergency department care
- Preventive care
- Cancer care
- Pregnancy and delivery care
- Use of medical imaging
Complications and deaths
Each of the individual measures below compares the hospital’s performance with the national benchmark or the national rate.
- Surgical complications (rate for the hospital compared to national rate)
- Rate of complications for hip/knee replacement patients
- Serious complications