Hospital 'Matchmaking': Finding the Right One for You

From the WebMD Archives

Feb. 29, 2000 (New York) -- Choosing a hospital can be one of the most important decisions you can make, and according to some studies, it could actually save your life. Experts tell WebMD that certain steps should be taken and questions asked to assure you're going to the absolute best hospital for your particular condition.

Most hospitals are accredited by an organization called the Joint Commission on Accreditation of Healthcare Organizations, but this is a bare minimum accreditation, not necessarily a certificate of expertise to competency. "There is no Good Housekeeping seal of approval for hospitals, which is, to some extent, unfortunate, because some hospitals are better than others and have better outcomes," David R. Theimann, MD, assistant professor of medicine at Johns Hopkins Medical Institutions in Baltimore, tells WebMD. "Some states, including New York and Pennsylvania, do offer rankings, but for the vast majority of states there is nothing like that," he adds.

Theimann is also the lead researcher of a landmark study showing that heart attack patients were 17% more likely to survive if they were taken to a high-volume hospital, a medical center that sees a large number of such patients, rather than a low-volume hospital. And younger heart attack patients were 30% more likely to survive a heart attack if they were treated in a high-volume hospital.

The quest to find the perfect hospital for your needs "starts with a conversation with the doctor who knows you and your family best and can help you make decisions ahead of time, because he or she may have insights on what type of treatment you need or may potentially need down the road," Rick Wade, senior vice president of the American Hospital Association in Washington, tells WebMD. For example, if you have a family history of heart disease and a personal history of high blood cholesterol levels, your doctor may point you toward a hospital with a strong heart disease program.

However, Wade explains, "it's important to remember that your choices may be limited by insurance plans and the community in which you live. The notion of choice is rapidly disappearing from our portfolio of hospital choices, just like it did from our choice of physicians." That said, "Make sure to find out which hospitals your current doctor has privileges to practice, [also called] admitting privileges," Wade suggests.

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"It's important to consider whether you need a teaching hospital or a general community hospital," he says. People with a highly unusual or difficult-to-treat medical problem may require a teaching hospital. Teaching hospitals are basically training sites that are affiliated with a medical school and may be better at treating complex medical problems. If your physician does not have admitting privileges in such a hospital, it may be worth finding a new physician who does, Wade notes.

"Once the doctor answers your questions, you can contact the hospital[s] to find out specifics," Wade says. When making your choice in advance, it's also important to inquire about follow-up services such as home-care, rehabilitation, patient education programs, and family support programs, Wade suggests. Also ask about the referral network, he notes. If the hospital is part of a larger referral system, ask what type of access you will have to other physicians or other types of care, such as mental health care.

"If you need a particular type of surgery, find out which of the hospitals that you have to choose from has handled the most of these cases and has had the technology the longest," Wade offers. "It's important to find out how many patients with your particular problem that your doctor handles and how many procedures he does per year," suggests Theimann. And look on the office wall to find out if the physician is board certified in his field, he advises.

When it comes to how many of a particular procedure a hospital performs, "four is bad and 1,000 is good, but 500 is a reasonable minimum," Theimann notes, pointing out that in rural areas hospitals may not be able to perform 1,000 of any such procedures. "More is always better," he adds. A particular surgeon or doctor should perform 75 of a given procedure each year, and more is better, he adds. "This probably spans the entire range of serious medical procedures," Theimann notes.

But remember that "heart attack patients don't have much choice. It is not a matter of using an ambulance as a cab to go to the hospital of your choice," Theimann warns. "If you are having a heart attack, take an aspirin and call 911." In other words, sometimes closest is best.

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Overall, choosing a hospital is a very individualized process and decision, he notes. "Patients need to ask about what's important to them and the people who they care about," Wade says.

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