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? 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. So, how do you choose a hospital? 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 a hospital with expertise and experience in your condition.
Whenever possible, choose a hospital where doctors have experience with your health condition. How much patients with your health condition are treated at the hospital each year? What are the outcomes?
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.
Even so, these websites 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? See Becker’s 2021 compiled list of the 27 hospitals that have achieved 19 years of consecutive Leapfrog “A” grades.
Medicare’s Care Compare.
Medicare’s Care Compare website shows their star ratings for hospitals nationwide based on their performance across five quality categories. 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 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 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. 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 visit and/or stay overnight.
For more information, read The Dangers of Missed Bedside Alarms.
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.
- How to Avoid Medication Errors in the Hospital and at Home.
- Tips for Hospital Discharges.
- Is Your Hospital Safe?