When Is a Hospital Bad for You? Choosing the Right Hospital for Your Needs
The U.S. News Best Hospitals report, as well as other sources such as ratemds.com, can be useful tools to help steer you towards the best hospitals. However, one often overlooked aspect of finding the “best” hospitals and doctors in the nation, is that not every one is the “best” for your individual needs. Certainly, most hospitals can perform routine care without any trouble. But sometimes a particular hospital can be the right choice for you and the wrong choice for others—read on to find out why.
- 1. Low hospital volume: a hospital that sees a regular flow of patients with similar problems to your own is likely to have a well-oiled system in place to handle special procedures and medical conditions. Seek out the hospital’s volume figures for the most recent year, along with the death and complication rates. The LeapFrog Group, a business-sponsored organization that evaluates hospital performance, has suggested volume levels for particular procedures. A hospital with a much lower volume number could still perform well, but you might want to ask your doctor about an alternative source of care.
- 2. Low surgeon volume: even high-volume hospitals can have surgeons that perform a low number of surgeries. For some operations, it is particularly important that surgeons keep their skills sharp. In fact, various studies have found that surgeons can be more of a factor in determining complications and the length of hospital stays than the hospital itself. Ask your surgeon to provide their latest yearly total and rates of death and complications before undergoing a procedure. If he or she bristles at the request, you might want to talk to your primary care doctor about seeing a different surgeon.
- 3. No intensivists: studies show that deaths drop by about 25 percent or more when patients in ICUS were under the care of intensivists, or specialists in critical care who spend most of their time inside of the ICU. Alternatively, surgeons and other physicians perform most of their work in the OR, which makes them less experienced than intensivists who spend all of their time dealing with high-stress, critical cases. However, not all hospitals are able to carry an intensivist on staff, but those with 250 or more beds should have at least one available during the day who can get to the ICU within five minutes of being paged.
- 4. Not enough nurses: sometimes it is difficult to decipher when a patient is shivering from the chilly OR or when they are going into shock. It is even more difficult to determine what subtle signs indicate if you’re a nurse who can’t spend much time at the bedside of each patient because of a heavy patient load. A 2002 study in the Journal of the American Medical Association found that a patient’s risk of dying increased in hospitals where nurses had eight or more patients during an average shift when compared to nurses with four or fewer patients. Similarly, nurses with four-year degrees also had a lower rate of surgery-related deaths when compared to nurses with two-year degrees.
- 5. Too many readmissions: this is a clear indicator that a hospital is unable to coordinate care of their patients after discharge. Unfortunately, readmission rates at hospitals across the U.S. tend to be fairly similar, so you might want to compare the rates of one hospital you might choose with other hospitals that you might also choose to see if one is radically worse than the others.