Why Your Choice of Hospital Matters
Last updated July 2016
Choosing a good hospital can be a life and death decision, as our ratings of hospitals for inpatient care reveal. For the selected high-risk cases we looked at, there are some hospitals where more than 15 out of every 100 patients die within 90 days of admission while there are others where fewer than 11 per 100 die. That’s four more of these patients dying per 100 with one hospital than with another.
Does that get your attention? What if we told you that four out of every 100 guests who stay for a week at Hotel A will die within 90 days and, as you would expect, no one who stays at Hotel B will die in that time? That is, going to Hotel A means you will have a four in 100 chance of dying within 90 days. That wouldn’t just keep you out of the hotel; it would be the lead story in every news broadcast and newspaper in the country.
Going to a high-death-rate hospital if yours is one of the high-risk types of cases we looked at (which include congestive heart failure, kidney failure, pneumonia, heart by-pass surgery, and various other types of cases) adds just as much to your risk of death as going to Hotel A would. Yet many people give less attention to choice of hospital than to choosing a hotel.
And that’s not the whole story. There are also dramatic differences in complication rates—not leading to death but responsible for extra-long, often painful hospital stays and possibly pain and disability for years to come.
Amazing things happen at hospitals. They can transplant whole organs; can look at tissues deep inside a patient’s body without ever making a cut; have machines to take over when organs fail; in short, can do what only a few decades ago would have been considered impossible.
But hospitals remain today, as they always have been, dangerous places. Where else do you allow someone to cut deep into your body, inject potent chemicals into your veins, feed you strong drugs, and intervene in your life in so many other ways? In the operation of such powerful forces, at a time when you are sick and vulnerable, a single mistake can have catastrophic consequences.
And mistakes do occur: Infections passed among patients; missed diagnoses due to inaccurate lab or X-ray results; administration of unprescribed medications or medications that interact in life-threatening ways; too-slow responses in emergencies; heart attacks caused by feeding the wrong solutions into IV hookups; operations on the wrong patient or the wrong organ; unintended lacerations of healthy organs; patients falling down or falling out of bed while under sedation; chokings from vomiting of meals improperly given before surgery; and many more.
In fact, some authoritative studies have concluded that preventable medical errors may kill more than 200,000 patients each year in the U.S., making it the third leading cause of death. That’s more deaths than from auto accidents and anything else save cancer and heart disease. And there are also many thousands of other cases where hospital or physician negligence, while not causing death, slows recovery or leads to short-term or long-term disability.
What you want for your care is a hospital that will keep mistakes to a minimum and that will help you quickly improve your medical condition and your ability to function; limit your discomfort; improve, or at least maintain, your morale; and make your stay reasonably pleasant.
Whether you will get such care depends heavily on which hospital you choose. There are big hospital-to-hospital differences in how astute medical staffs are at spotting changes in patients’ conditions, how adept nursing staffs are at instilling optimism in their patients, how good a facility’s entire staff is at maintaining sanitary conditions, and myriad other aspects of hospital performance.
Our guide to hospitals will help you find the best. For nearly every acute care hospital in the U.S., we give you important information on what has actually happened to patients: estimates of the percent of patients with various types of cases who have died or experienced adverse outcomes, including complications. In addition, we give you ratings from patients who have used the hospitals and other key facts that relate to quality.
Much of the responsibility for choosing the right hospital for you rests with your doctor. But you too must play an important role.
Your choice of hospital will generally be rather narrow if your primary care doctor proposes admitting you to a hospital under his or her own care. Most doctors have arranged privileges for themselves to admit patients only at a few hospitals, or a single hospital.
If your primary care doctor will be referring you to a specialist who will be the one arranging your admission to a hospital, you can consider hospital affiliation as one basis for selecting the specialist you will use. Your primary care doctor will probably favor a specialist who practices at one of his or her own hospitals. These are usually the specialists your doctor knows best. Also, your primary care doctor may want to see you in the hospital and work with the specialist. But the choices need not be limited to your doctor’s hospitals. You will want your primary care doctor to remain involved in your case, to advise you and ensure that all aspects of your care are coordinated, but the doctor might not have to have privileges at the hospital where you will be admitted in order to play this role. Discuss this issue with your primary care doctor. Ask your doctor if he or she can arrange to keep up-to-date on your care by communicating with the doctor or doctors who will be responsible for you in the hospital.
All this presumes that you have a primary care doctor. But there is another point at which comparison of hospitals is important: when you are first choosing a doctor or health insurance plan. There are two reasons to look for a doctor or health plan that uses high-quality hospitals. First, this will enhance your chances of being admitted to such a hospital in the future if the need arises. Second, it enhances your chances that your doctor will be a top-quality professional: good hospitals can be expected to attract good physicians.
A comparison of hospitals is especially important if you are considering a health maintenance organization (HMO) or a preferred provider organization (PPO) with a narrow network. If an HMO or PPO uses high-quality hospitals, that suggests its overall medical care standards are high.