A hospital stay is scary. You put your life in the hands of a hospital and its medical staff that you know very little, or nothing, about. Did you know that your choice of hospital could be a life-or-death decision? How do you choose a hospital?
Hospitals vary greatly on things like infection rates, surgical errors, and patient injuries. Certainly, a life-threatening condition dictates a trip to the nearest emergency room. But if you know you need surgery, or you have a long-term medical condition, you likely have the time to evaluate your options.
Do you pick a hospital based on your past experience, advice from your doctor or friends, or the convenience of the location? Are you choosing a hospital with a reputation for providing safe and appropriate care? Or are you inadvertently choosing a hospital with a higher-than-average rate of safety issues?
Read below to learn about the impact of hospital choice as well as tips for choosing a hospital for yourself or a loved one.
Choosing the “right” hospital can improve your health.
A comprehensive study, published in 2016, analyzed over 20 measures of medical outcomes for a variety of health conditions in 22 million hospital admissions. The researchers adjusted the results for factors such as health, age and income to help them identify which hospitals had the best outcomes.
Importantly, the study found that patients at the worst US hospitals were over 2 times more likely to die and over 10 times more likely to have medical complications than if they visited one of the best hospitals.
What factors impact patient outcomes?
Unsurprisingly, this study found that not all hospitals provide the same level of care. Moreover, many factors impact patient outcomes, including the:
- Experience and training of doctors.
- Volume of cases for a particular condition.
- Culture of the hospital.
- Modernity of the machinery for testing and treating patients.
- Nurse staffing levels.
Read a summary of the study in The NY Times.
How should you choose a hospital?
Before I suggest some tips for choosing a hospital, I have a few caveats.
Of course, there are no guarantees in life, including in hospital choice. Although you can find information online that can help you choose a hospital, the data available is somewhat limited. Moreover, picking the “right hospital” does not guarantee a positive outcome.
However, it’s well worth your time to do some research before you select a hospital for yourself or a loved one.
Choose an accredited hospital.
I recommend you use hospitals that have received accreditation from an agency approved by the Centers for Medicare & Medicaid Services (CMS).
The Joint Commission is the oldest and largest standards-setting and accrediting body in healthcare in the US. You can use their Quality Check website to see which hospitals meet their standards for quality care.
Choose a hospital with expertise and experience in your condition.
Whenever possible, choose a hospital where doctors have experience with your health condition. Importantly, hospitals often specialize in particular areas. So, ask how much patients with your health condition are treated at the hospital each year. And find out what the outcomes are for your condition.
Start by asking your doctor(s) to recommend a hospital for your particular condition. Should you look for a specialty hospital or a teaching hospital? Do you need a hospital that conducts research and/or runs clinical trials related to your condition?
Importantly, realize you might need to consider traveling far from home if you have a rare condition. Additionally, understand that a hospital that provides top-notch care for one type of illness might have poor outcomes for other ailments. So don’t jump to conclusions before you do your homework.
Research hospital performance on quality, safety, outcomes, and other criteria.
Having information on outcomes, complication rates, infections and even death rates for specific medical conditions and procedures at hospitals in your area can help you choose a hospital.
The good news is that you can learn valuable information using the websites listed below. However, the bad news is that these sites do not provide detailed information on outcomes for every health condition or procedure.
Additionally, there is no standard methodology used by hospital ratings sites, so use the information with caution. Read the NEJM Catalyst article on “rating the raters” for more information.
Despite any shortcomings, the websites below are excellent sources of information related to a hospital’s record on outcomes and safety related issues.
The Leapfrog Group’s Hospital Safety Grade.
Leapfrog assigns letter grades (A through F) for hospitals based on their ability to protect patients from preventable errors, accidents, injuries, and infections. Search for hospitals by geographic area, or name, to see quality data for information on medication safety, infections and injuries, inpatient care management, and more. Additionally, you can see how your hospital compares on mortality rates of certain high-risk procedures. Looking for a hospital superstar?
Additionally, they create a list of “Top Hospitals” – those that have better systems in place to prevent medication errors, higher quality on maternity care and lower infection rates, and other important qualities. Their Top Hospitals list is divided into 4 categories: teaching, general, rural, and children’s hospitals. View the 2022 list here.
Interestingly, in 2021, Becker’s Hospital Review compiled list of the 27 hospitals that have achieved 19 years of consecutive Leapfrog “A” grades.
Use Kaiser Health News’ tool to find information on Medicare penalties.
The federal government cuts payments to hospitals with high rates of hospital readmissions and to those with the highest numbers of infections and patient injuries. This information can help you determine the safety record of your hospital.
You can use a website created by Kaiser Health News to look up hospitals by name or location to find out if Medicare imposed penalties for either readmissions or hospital-acquired conditions such as infections and patient injuries.
Note that Maryland hospitals are exempted from penalties because they have a separate payment arrangement with Medicare.
Medicare’s Care Compare.
Medicare’s Care Compare website shows their star ratings for hospitals nationwide based on performance. The Centers for Medicare & Medicaid Services (CMS) ratings considers mortality, safety, readmission rates, patient experience, timeliness and effectiveness of care, and the use of medical imaging.
Importantly, the CMS ratings are based on data submitted by hospitals, but having poor quality metrics can lead to a reduction in payments by CMS. Because accurate reporting can cost a hospital money, hospitals have financial incentives to underreport incidents. Therefore, I suggest you use this information cautiously (as you should for all other ratings systems).
Interestingly, you can also find patient survey scores for each hospital. These scores come from patients who completed the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. They randomly sample recently discharged patients about their hospital care experience, asking for information on these factors:
- Communication with doctors.
- Communication with nurses.
- Responsiveness of hospital staff.
- Cleanliness of the hospital.
- Quietness of the hospital.
- Communication about medicines.
- Discharge information.
- Care transition.
- Overall rating of hospital.
- Willingness to recommend hospital.
When using the Care Compare website, you can search by geographic area, or name, to see an overall rating and a patient experience rating. Also, you can find information in 5 quality topics: timely and effective care; complications and deaths; unplanned hospital visits; psychiatric services; and payment and value of care. Ratings include statistics for a variety of health conditions and procedures.
See Becker’s compiled list of the 455 hospitals with 5 stars from CMS in 2021.
U.S. News and World Report.
Their Best Hospitals report includes information on hospitals for 25 adult specialties/conditions and 10 pediatric specialties. See scores for these specialties in the following categories: national ranking, professional recognition, level of staffing, survival rates, patient experience, and patient volume.
Fortune/IBM Watson Health Top Hospitals Program.
Each year, Fortune and IBM Watson Health rank hospitals to determine the US 100 Top Hospitals and 15 Top Health Systems. They analyze a variety of data from Medicare, evaluating over 2,600 hospitals on various performance indicators in 4 categories: clinical outcomes, operational efficiency, patient experience, and financial health.
Additionally, in 2021 they added a new category: how hospitals engaged with the goal of improving the wellbeing of the entire community outside their walls.
See the list of top hospitals in each category of hospitals:
Additionally, their list of the 100 Top Hospitals through the years allows you to find hospitals that consistently made the list.
Interestingly, their research finds that compared to nonwinning hospitals, their 100 Top Hospitals:
- Had lower inpatient mortality, considering patient severity.
- Had fewer patient complications.
- Delivered care that resulted in fewer health-acquired infections.
- Had lower 30-day mortality and 30-day hospital-wide readmission rates.
- Sent patients home sooner.
- Scored higher on patient ratings of their overall hospital experience.
Lown Institute Hospitals Index.
At first glance, it may seem like the more care you receive, the better. However, many doctors over test and over treat their patients, which can lead to health problems and unnecessary spending. And it turns out that doctors at some hospitals are more likely than others to order unneeded tests or treatments.
Fortunately, the Lown Institute Hospitals Index ranks US hospitals based on overuse criteria to rate their success at avoiding tests and procedures that offer little to no benefit to patients. Check out their lists of the worst 50 and best 50 hospitals ranked by how frequently their patients had any of 12 procedures largely regarded as unnecessary.
Read The Dangers of Too Many Tests and Treatments for more information.
Don’t overlook patient experience factors.
Patient experience encompasses the range of interactions patients have with the healthcare system. This includes factors that can impact the quality of care received, such as ease of getting appointments, ease of access to health information, and the quality of communication with healthcare providers.
A positive patient experience can improve the quality of care and outcomes, as it can lead to improved adherence to medical advice, better outcomes, and improved patient safety.
Therefore, it’s great if you can choose a hospital that focuses on patient experience. Use this list of hospitals for each state that are top-rated hospitals for patient experience to look up hospitals in your area.
Don’t forget about your insurance coverage.
To avoid unexpected bills, check with your insurance carrier to determine your coverage at any hospital you consider. And don’t forget to ask if you need pre-approval, or if there are any exclusions to your coverage.
Consider the convenience of hospitals in your area. It’s important to have visitors – not only do they provide much needed company, but they can also act as a second set of ears, participate in conversations with doctors, provide comfort care, notify staff if important bedside alarms go unnoticed, and more. (For more information, read The Dangers of Missed Bedside Alarms.)
Additionally, visitors who stay overnight can stay on top of your comfort and care, an important benefit for patients who cannot speak for themselves due to their medical condition or cognitive abilities. Therefore, make sure the hospital location and visitor policies will not make it hard for your loved ones to regularly visit and/or stay overnight.
Are you or your loved one over 65?
Unfortunately, as we age, we face more risks during and after hospital stays. Many factors can cause a rapid decline in health for hospitalized seniors, including:
- Seniors are susceptible to adverse drug reactions.
- Hospitalizations can lead to an increase in the number of medications taken.
- Falls among seniors are common and dangerous.
- Limited physical activity leads to deterioration.
- Hospitalizations increase the risk of dangerous blood clots.
- Seniors are more susceptible to pressure sores.
- Seniors are particularly impacted by sleep loss.
- Dementia patients face more complications and worse outcomes.
Try to use a hospital is designated as an “Age-Friendly Health System”. These hospitals commit to providing appropriate, evidence-based care for seniors, and to causing no harm. Also, these hospitals consider the desires of seniors and their families. Visit the IHI website to see the list of the thousands of hospital systems deemed friendly to seniors. Additionally, you can search online with the term “acute care for elders” and the name of your city or hospital to learn about programs and policies regarding senior care.
Furthermore, choose an emergency department that has received Geriatric Emergency Department Accreditation (GEDA) from the American College of Emergency Physicians. Visit the GEDA website and download a list of GEDA hospitals by clicking on the small bar towards the top of the page.
Research potential doctors.
In addition to evaluating potential hospitals, it’s a good idea to evaluate potential doctors. Firstly, ask potential doctors specific questions about their training – their level of experience with your condition is important. And ask about the outcomes for their patients, not just for general outcomes for patients with your condition.
Additionally, try to get second, even third opinions, and ask each doctor these same questions. Although it can be intimidating to ask doctors questions about their abilities, find the courage. Your life may depend on it.
Read How Do You Find a New Doctor You Can Trust? for more information.
For more information on how to choose a hospital, read:
- Wondering How to Choose the “Best” Hospital? Find out How Doctors Would Choose a Hospital for Their Own Care.
- How to Choose a Hospital for Cancer Treatment.
Additionally, in any hospital, the risk of harm, ranging from errors to infections, is real. However, you can reduce your risks. For tips, read these blogs:
- Germs in Hospitals and Doctor Offices – Watch Out!
- The Benefits of Participating in Hospital Rounds.
- Medication Errors in Hospitals – How Can You Protect Yourself?
- Tips for Hospital Discharges.
- What’s Your Hospital’s Safety Record? Is Your Hospital Safe?
NOTE: I updated this post on 5-31-22.