Consumers' CHECKBOOK Logo

Nonprofit Ratings of Local Service
Companies and Health Care Providers

CHECKBOOK is a Unique Rating Service:
Nonprofit & unbiased
Accepts no advertising
Prevents ballot-box stuffing
Price comparisons
Quality comparisons
Expert articles and advice

Only $34 for Two Full years!
(View All Rating Categories)
Hospital Emergency Departments (From CHECKBOOK, Fall 2015/Winter 2016)
Go to Ratings of 67 Bay Area Hospital Emergency Departments

What to Do During a Medical Emergency 

If you believe the case may be an immediate threat to life or future ability to function (must be treated within 30 minutes), immediately call 911

Symptoms requiring immediate emergency department attention: 

  • Spurting blood, massive bleeding 
  • Vomiting blood (often a black coffee ground-like substance), passing black stool, coughing blood 
  • Breathing stopped 
  • Breathing difficult 
  • Blue lips, face, or nail beds 
  • Heart stopped or faint pulse 
  • Extensive burns, especially if skin is white or charred 
  • Eye injuries, or acids or other strong solutions in the eye 
  • Paralysis 
  • Unequal-size pupils 
  • Obvious alteration in consciousness resulting from head injury or without attributable cause 
  • Insect stings, if patient is known to have allergy 
  • Seizure or convulsions 
  • Severe pains in chest, upper abdomen, or down arm plus shortness of breath 
  • Suspected poisoning or overdose 
  • Sudden, severe abdominal pain not attributed to indigestion 
  • Suicidal thoughts or any violent behavior 
  • Patient simply appears to be very sick 

If you believe the case is not immediately life-threatening but requires treatment at a hospital (can wait 30 minutes or more): 

Call patient’s doctor for advice. If you can’t promptly reach the doctor, go to an ER. 

Our ratings of area hospital emergency departments will help you decide where to go. Note that your optimal hospital choice may be different depending on whether the patient needs simple care, complex care, or you don’t know what’s wrong. 

If the case does not require prompt medical attention: 

Go to a primary care doctor. If you need care outside your doctor’s office hours, go to an urgent care clinic. Don’t use a hospital emergency department. Click here for patient ratings of primary care doctors. 

You’re not a doctor. (And, no, you don’t play one on TV.) But chances are that at some point you’ll be forced to make emergency medical judgments for others or yourself. Is it a bump on the head or a concussion? Is it heartburn caused by eating too much fried food or a heart attack? Will the cut heal on its own or does it require stitches? You need to know whom to call, what to say, and where the patient should go. We provide advice on what to do, and, if emergency medical care is needed, much information on the quality of care offered at area hospitals. 

What to Do If There Is Immediate Danger to Life or Ability to Function 

When first confronted with an illness or injury, you must quickly decide whether the case is life-threatening—whether there’s a risk of death or permanent disability if the patient does not receive immediate care (within 30 minutes). If you are faced with what you are sure is a heart attack, your decision is easy; in other cases, you may not be so sure. The rule to live by: If you think the case may require immediate care, assume it does. Making the right decision can be a matter of life and death. In treating heart attacks and serious injuries, even a few minutes can dramatically improve survival rates. 

If a case may be life-threatening, call 911: That’s the best way to get treatment started fast. 

It will likely take longer to get the patient into a car than to wait for an ambulance. In most parts of the area, the average time between calling for an ambulance and the ambulance’s arrival is less than 10 minutes. 

Using an ambulance is also safer: The risk of shock is minimized by allowing the patient to lie down, and an EMS crew can often extricate and transport an injured person without adding to injuries. 

Ambulance crews can begin treating patients during transport to hospitals: In communication with hospital staff, they can start IVs and administer drugs and other treatment. And because ambulance crews communicate with hospital staff during transport, the emergency department can prepare to treat the patient immediately upon arrival. 

Perhaps the greatest virtue of calling an ambulance is that it relieves the frequently panicky patient—and those assisting the patient—of virtually all responsibilities. The ambulance crew decides on preliminary treatment, drives the vehicle, chooses the hospital, calls ahead for instructions. 

In life-threatening—or potentially life-threatening—cases, ambulances take patients to the closest appropriate hospital, given each patient’s specific condition. 

In cases where injuries or illness are not immediately life-threatening, most ambulances routinely transport patients to the closest hospital. That practice might be one disadvantage of calling an ambulance: The patient might not be able to choose the best available hospital. But in many areas, ambulance squads will honor a patient’s request to go to a more distant hospital if the additional travel time will not endanger the patient—or other patients by depleting the area’s ambulance coverage. 

On balance, we recommend calling an ambulance, even if doing so limits your choice of hospital. You can be reasonably sure that the hospital emergency department staff at the hospital chosen by the ambulance squad can provide at least the relatively basic treatment needed immediately to stabilize a life-threatening case—opening a blocked breathing passage, stopping massive bleeding, restoring blood loss. When stabilized, the patient can be transferred to a more sophisticated facility. 

When you call the ambulance, be calm and clear with the person who answers your call. State the address or location carefully, and ask the operator to repeat it—especially if you are using a cell phone. Easily made errors have produced some tragic outcomes. 

After you have called an ambulance, administer what first aid you can to the patient, follow any directions the 911 operator gives you, and call the patient’s doctor, if he or she has one. Calling the doctor is important because the doctor might come to the emergency department to work with the staff (although very few do this anymore); the doctor might call and instruct the emergency department staff to bring in a particular specialist whom the doctor trusts; or the doctor might alert the emergency department staff to important facts about the patient’s history. 

What to Do If the Case Is Not Immediately Life-Threatening but Requires Treatment at a Hospital 

The most difficult decisions involve cases in which you feel safe waiting 30 minutes or more to receive care, but still require treatment at a hospital, rather than at an urgent care clinic or doctor’s office. In these cases, you can generally do without an ambulance; a car or taxi will suffice. But you may prefer an ambulance if— 

  • The patient and those assisting him or her are too upset to drive; using an ambulance is comparatively easy. 
  • Medical skill may be needed to move the patient (for example, if there is a possible fracture). 

On the other hand, there are good reasons not to use an ambulance— 

  • By providing your own transportation, you control the choice of hospital. In an ambulance, even if the ambulance squad considers a patient’s preference, hospital choices likely will be limited to the two or three closest hospitals. 
  • You ensure that the emergency department will not turn you away. Concerns about legal liability make it difficult for hospitals to turn individuals away at the door. In contrast, ambulances are easily turned away. The emergency department simply claims to be overcrowded and asks that ambulances be put on “reroute.” Thus, in an ambulance you may be shunted to a more distant hospital, which has a more responsible policy on keeping its emergency department open but is equally overburdened. 
  • Ambulances often charge fees. Even if you have insurance coverage, you might have to pay all or a portion of the fee. 

Assuming you do provide your own transportation, or your ambulance service allows you to choose a hospital, you have the opportunity—and the burden—of making that choice. A good strategy is to have the patient’s doctor choose for you. There is usually time to call the doctor, who probably has a general sense of the medical capabilities of different emergency departments and knows which are easiest to communicate with on follow-up. 

A call to the patient’s doctor also makes sense for other reasons: 

  • The doctor will be able to tell you whether to call an ambulance and what first aid to administer. 
  • The doctor may call the emergency department and smooth the way for your arrival. This may eliminate a lot of red tape because tests can be ordered right away, without having to wait to see an emergency department physician. The doctor may also specify conditions under which a specialist should be called in—and perhaps who that specialist should be. 
  • The patient’s doctor may be able to tell you not to bother with the emergency department—to wait for a regular office visit or to visit an urgent care clinic. 

If you can’t reach the patient’s doctor, or he or she doesn’t have one, or if you want to have a role along with the doctor in emergency department selection, our Ratings Tables provides information that will help. 

The right choice in an urgent but not life-threatening case depends mainly on the complexity of the case. Let us (somewhat arbitrarily) divide cases into three categories: 

  • Simple cases. You know what is wrong and know that the treatment is simple—for instance, a laceration that may require stitches (other than on the face). 
  • Complex cases. You know what is wrong and know that treatment will require considerable skill—for instance, severely crushed fingers or a badly lacerated face. 
  • Cases in which you don’t know. You aren’t sure what is wrong or how complex the problem is—for instance, an unusual abdominal pain that has become increasingly severe over a period of a few hours, or the patient experiencing shortness of breath following several days with a cold. 

Simple Cases 

The fact that a case is simple does not mean it can’t be very uncomfortable. And choosing the wrong hospital (or the right hospital on the wrong day) can make the experience miserable. Your major considerations for these cases are convenience and pleasantness. 

Other patients are an excellent source of guidance when choosing an emergency department for simple cases. Our Ratings Tables show how area consumers (primarily CHECKBOOK and Consumer Reports subscribers) rated hospital emergency departments they had used on the following criteria: “overall quality of care,” “speed of service,” “staff pleasantness,” “effort to relieve patient’s discomfort and anxiety,” “listening to/communicating with patient,” and “helpfulness in arranging follow-up care.” Click here for more information on our customer survey and other research methods. 

Our Ratings Tables also report results of a survey in which physicians told us which hospital emergency departments they considered “most desirable” and which they considered “least desirable” “for emergency treatment of minor injuries.” The Ratings Tables show, among the physicians who mentioned each hospital, what percentage considered it “most desirable.” 

If your case is simple, you want to obtain treatment and go home as quickly as possible. In addition to the ratings from patients on “speed of service,” our Ratings Tables report data on hospital emergency departments from the federal government’s Hospital Compare website, which includes six measures related to the speed of service: 

  • Average number of minutes patients waited to be seen by a healthcare professional 
  • Average number of minutes patients spent in ER before decision was made to admit them 
  • Average number of minutes patients waited to get to their rooms after decision to admit was made 
  • Average number of minutes it took ER to treat patients and send them home, if not admitted 
  • Average number of minutes patients with broken bones waited to receive pain medication 
  • Percent of hospitals’ patients who left the ER without being seen 

For simple cases, you can call various emergency departments to ask about wait times before making a choice. Some hospitals now post average wait times on their websites. Keep in mind the estimates provided on websites usually take into account how long patients wait to see a doctor, physician’s assistant, or nurse who provides care, but usually don’t indicate how long it will take the hospital to treat you and get you out the door. 

Complex Cases 

Your best choice of facility might be quite different in cases that require complex treatment. 

An Overall Quality Indicator 

Our Ratings Tables show results from our surveys of area physicians who were asked which area hospitals they considered “most desirable” and which they considered “least desirable” for “emergency treatment of major injuries.” We believe this is a useful overall measure. 

Frontline Capabilities 

Although in complex cases you’re likely to get most of your care from a specialist who will be called in, the emergency department staff itself is also important. The emergency department doctors who see you first will be the ones who decide, or advise you, whether a specialist is needed. Also, they can sometimes influence which specific specialist is called in, and are likely to begin diagnostic procedures, preparation, and treatment. In addition, they can do a lot to make you more comfortable while you wait for a specialist. 

One indicator of quality is always having on duty a physician who is board-certified in emergency medicine—someone who has completed training and passed exams to become certified in the field. Treating a large volume of cases also suggests that the hospital is serious about maintaining a major emergency service capability. These data are reported on our Ratings Tables for each hospital. 

Another indicator of an emergency department’s capabilities is the trauma care designation it has achieved. California has adopted guidelines based on recommendations of the American College of Surgeons (ACS) that designate hospitals as Level I, II, III, or IV trauma centers. These designations guide EMS crews in deciding to which hospital they should take a patient, and determine how the hospitals will work together to manage trauma care. Patients with complex or severe injuries either are taken by an EMS crew directly to the hospital that has staffing and facilities appropriate for the case, or are taken to a hospital that will stabilize the patient and then transfer him or her to a facility with proper capabilities. 

Level I trauma facilities can provide comprehensive care for any type of injury. These facilities are expected to conduct trauma research and be the trauma system’s leaders in education, prevention, and outreach. 

Like Level I trauma facilities, Level II facilities must also be able to provide comprehensive care for any type of injury. But Level II facilities are usually smaller than their Level I counterparts and aren’t required to be research or teaching centers. 

Facilities with Level III trauma designations have to be able to at least treat initially any type of injury, but patients with severe traumas are usually stabilized and then transferred to a Level I or Level II center. 

Level IV trauma facilities are usually rural clinics that usually stabilize severe traumas and then transfer these patients to a Level I or Level II facility for further treatment. 

Our Ratings Tables report the trauma designation, if any, each hospital has achieved with the ACS. 

How Often Hospitals Followed Best Treatment Guidelines for Stroke and Heart Attack Patients 

On our Ratings Tables, we report the overall percentage of instances in which the hospitals performed the proper tests or procedures for stroke and heart attack cases. These scores are derived from data published on the federal government’s Hospital Compare website

To collect these data, the federal government examined patient records for each hospital and assessed how often hospitals performed recommended tests or treatments known to produce the best results for patients with certain medical conditions. This analysis examines, for example, how often hospitals gave heart-attack patients aspirin upon arrival and how often hospitals gave stroke patients medicine to break up blood clots within three hours. 

Our Ratings Tables list aggregate scores calculated across all measures for heart attack and stroke. (In other words, we added up all of the instances where a given hospital performed the proper tests and/or treatments across all reported measures, and then divided that total by the number of times the hospital had an opportunity to perform the proper tests and/or treatments.) 

One limitation in these data is that the recommended care may not always be the best treatment for everyone. For example, someone who has recently had a heart attack should be given aspirin as soon as possible upon arrival at the hospital—but not, of course, if that patient is allergic to aspirin. Unfortunately, the federally reported data do not always take into account patients who should not have received generally recommended care. 

Quality of the Backup Services 

Since there’s a good chance in a complex case that you’ll need a range of services from the hospital, and that you’ll be admitted to the hospital as an inpatient, you want a hospital that has high-quality backup services—such as laboratory and imaging services—and that provides high-quality care to its inpatients. Our ratings of more than 4,000 acute-care hospitals in the U.S. for inpatient care includes a trove of data related to the care patients receive during overnight stays. Our Ratings Tables for area hospital emergency departments also reports some key measures of inpatient care for each hospital: 

  • Whether the hospital received our top rating for inpatient hospital care. Hospitals that received our top rating scored high on an overall score calculated across a range of measures. 
  • Adjusted death rates. For relatively high-risk cases, these are the percentages of each hospital’s patients who died within 90 days of hospital admission. The adjusted death rates are based on analysis of records of hospital stays of Medicare patients admitted to hospitals during a three-year period (fiscal years 2010—12) for medical cases and a four-year period (fiscal years 2009—12) for surgical cases. These rates are adjusted—to the extent possible—for differences in how sick and frail each hospital’s patients were. 
  • Patients’ overall ratings for inpatient care. These ratings come from federally sponsored surveys, using a standardized questionnaire and survey procedure. The survey asked a random sample of recently discharged patients about important aspects of their hospital experience. 
  • Doctors’ ratings for high-risk surgery. These are the percentages of physicians who rated each hospital “very good” or “excellent” for “surgery on adults in cases where the risk of complications is high” in our surveys of area doctors. We also show the number of doctors who rated each hospital on this question. 
  • The Leapfrog Group , an organization that tracks and encourages hospitals’ efforts to improve patient safety, calculates its Hospital Safety Score for more than 2,500 hospitals in the U.S.; scores shown on our Ratings Table were reported by Leapfrog in August 2015. The Leapfrog Hospital Safety Score program grades hospitals on their overall performance in keeping patients safe from preventable harm and medical errors. For more information, visit

When You Don’t Know What’s Wrong or How Complex It Is 

Selecting the right emergency department is most important when you don’t know what is wrong or what treatment will be required—for instance, in a case of severe abdominal pain. Such pain might result from any of many causes—including an aneurysm, which is immediately life-threatening and requires sophisticated treatment; appendicitis, for which the treatment is much less complex; or gastroenteritis, which can often be treated with medication. 

In such undiagnosed cases, the relevant indicators of quality are the same as in complex cases where you do know what’s wrong. But in undiagnosed cases, the emphasis is different: You’ll want to put somewhat more weight on the expertise of the frontline emergency department staff as opposed to the hospital’s inpatient backup capabilities. 

Using an emergency department with a strong staff of its own is important because its emergency department physicians will be able to make many diagnoses and provide successful treatment on their own. A good emergency department physician might, for instance, spot an unusual strain of pneumonia that a less capable physician (or resident) might never recognize and never bring to the attention of specialists. 

In undiagnosed cases, the availability of in-house physicians is also relatively important. In-house physicians are likely to be consulted in diagnosing your case. While an emergency department physician might be quite reluctant to ask an on-call physician to come to the hospital just to consult on a diagnosis, asking an in-house specialist to come to the emergency department is easy. 

On the other hand, relying on in-house specialists has some disadvantages. Since they are usually residents still in training, they have less diagnostic experience than top-quality on-call attending physicians might have. They also have less treatment experience. Yet there is a chance one will end up operating on you or providing whatever other treatment you require. You can offset this disadvantage by insisting that an attending physician be called in if you are not entirely satisfied with the soundness of a resident’s diagnosis, or if you require anything other than the most straightforward treatment. 

In general, we have found that the top-scoring emergency departments for complex cases also tend to get top scores for dealing with cases in which patients don’t know what is wrong. 

Cases that Do Not Require Prompt Medical Attention 

Many cases are not urgent, of course. These cases could await a visit to an urgent care clinic or a family doctor during regular hours. They include small lacerations, sore backs, mild sore throats, painful bruises, and chronic complaints. They constitute a large portion of all cases handled at many hospital emergency departments. 

If you feel confident your case is not urgent, avoid an emergency department. Use a family doctor; if you don’t have a family doctor, take this opportunity to try one out. Click here for patient ratings of area primary care doctors. 

The main reason to use a family doctor rather than an emergency department, or even an urgent care clinic, is that the family doctor will provide better “continuity of care.” Doctors often say about 80 percent of diagnosis is in the patient’s history, but the emergency department won’t know you and your medical history as well as your doctor does. An emergency department might, for instance, diagnose acute appendicitis when your doctor would tie stomach pains to a previously diagnosed disorder. Also, since emergency departments ordinarily don’t schedule follow-up visits, when you visit your own doctor for follow-up he or she will not have first-hand knowledge of what symptoms you had at the time of the emergency visit, what treatment was given, or what assumptions were made about aftercare. 

Another reason to consult a family doctor in non-urgent cases is cost. Emergency departments must maintain staff even at hours when there are no patients—simply to be prepared. Patients pay for that staff. Similarly, emergency services must maintain sophisticated equipment—for instance, to resuscitate heart attack victims. Patients help pay for that. It all adds up to much higher fees at emergency departments—sometimes five times higher—than at doctors’ offices. 

Not only is the base price more, but an emergency department will also impose additional special charges. It will perform lab tests and X-rays because it must find out in one visit everything a family doctor knows from past visits or could expect to find out on a future visit. All these tests are important to the diagnosis and protect the emergency department doctor against malpractice suits. 

And extra costs don’t end at the time of the emergency visit. When you go to your doctor for a follow-up visit after being treated in the emergency department, the doctor will have to remove dressings, duplicate tests, and waste time on the phone getting reports on the emergency department’s studies. This is expensive. 

Of course, this higher cost factor makes no difference to you if your insurance policy pays for ER visits. But deductibles and other obstacles force many patients to bear the full cost of either an emergency department or doctor’s office visit, and you may feel a social responsibility to keep medical costs down—even if the charges don’t come out of your own pocket. 

How to Deal with an Emergency Department 

  • Ask your doctor to call the hospital. 
  • Make sure to mention your doctor’s name if the doctor practices at the hospital. 
  • Before treatment begins, explain that you want all records sent to your doctor. 
  • If you don’t have a doctor to call for you, if possible call ahead yourself to inform the staff you are coming and what your problem is; this will help them prepare the equipment and assemble needed staff. If the case is not life-threatening, ask if the facility is unusually crowded. If it is, go somewhere else. 
  • Ask whether the physician treating you is a resident. If so, and if you have any doubts about the diagnosis or treatment plan, ask to discuss your case with the attending physician along with the resident. 
  • Show evidence of ability to pay. An insurance card is ideal, but don’t worry if you have no insurance: Any hospital will treat an emergency first and worry about payment later. 
  • Be polite; it relieves staff tension and helps you communicate your medical needs. 
  • If you did not call your doctor before visiting the emergency department, make sure your doctor is informed as soon as possible about your emergency department visit. 
  • Check with your health insurance plan as soon as possible to determine all requirements for plan notifications and pre-approvals. 

Go to Ratings of 67 Bay Area Hospital Emergency Departments Back to top