How to Pick the Right Hospital


Picking the right hospital can be a daunting decision especially when there are two or more hospitals in a close proximity. Hospital preferences are often a visceral, palpable feeling for a patient. Family, friends, and community groups often mold patient's opinions. Despite this, I am often asked how to choose the right hospital. In my opinion, multiple factors should be considered when making this choice including which (of your doctors) are on staff or have coverage at the hospital, which services are or are not offered at each hospital, location/convenience, insurance details- the list goes on and on. This article is meant to be an overview of this difficult decision, it is meant to be comprehensive but by no means will it cover all angles related to your choice


Your Preferred Local Hospital

Most experts would recommend choosing a preferred local hospital so that you can establish a relationship with the admitting physicians, the consulting physicians, the Emergency Department physicians, and the hospital staff. It is also important to consider which hospital your primary care physician (PCP) and/or specialists admit patients to or have a relationship with. Patients and families often establish this type of relationship with a hospital in order to be more comfortable in the future when trying to make difficult medical decisions.

Molding your hospital preference to your PCP's choice is important mainly when that physician still admits his/her own patients to the hospital. These days, PCPs are admitting less and are deferring the admission/discharge work to a hospitalist. However, if your PCP admits you should have a discussion with him/her so that you can work out a plan prior to needing to be admitted.

If you have one main medical problem and see a specialist more than you see your PCP (i.e. COPD/Pulmonologist, heart disease/Cardiologist, back pain/Spine Surgeon, etc.), then you need to be aware of which hospital(s) that specialist prefers.

There are certain situations when a patient might have more than one preferred local hospital. I have patients who get their heart care and major medical issues cared for at our tertiary care center, get their cancer care at the local academic center or regional oncology center, and get their orthopedic care at the local surgical hospital. In order to do this, a patient must be extremely savvy and aware of which hospitals can care for each of their problems and any new problems that may arise.

In the end, most patients should choose a preferred local hospital in order to become familiar with its doctors and staff.


Medical Staff

The environment and makeup of a hospital physician staff has changed over time and continues to evolve. Hospitalists are admitting more patients than primary care physicians in most areas. Specialists are consulting more and admitting less. Large groups of specialists are becoming employees of hospital systems and thus can be limited to a single hospital due to this. The integration of physicians with hospitals can force some hospitals not to have coverage for certain subspecialty areas. All of the above factors can impact your choice of hospital.

Most experts recommend that a patient with multiple complex medical problems choose a hospital that can offer comprehensive medical care. The reason for this involves the common circumstance in which a patient gets sick with one illness but multiple organ systems suffer or a complication occurs. When this type of patient gets sick, they need a full staff of medical professionals and services in order to survive. Just to repeat, patients with multiple medical problems tend to develop complications and other illnesses that require a full complement of doctors and services.


Emergency Services

Going to the Emergency Department in an ambulance after a 911 call is very different from walking in to the ED for a trivial illness or issue. When choosing the right hospital, it is important to take into account why you are going to the hospital in the first place. Patients who call 911 and are taken to the ED by ambulance can have a significant medical condition that will require immediate attention whether it be a trauma, heart attack, stroke, or other condition. In these situations, you will most likely need to be taken to the closest emergency department as long as they offer the necessary services.

Not all EDs will not be capable of caring for all types of emergencies. For instance, small EDs are not usually equipped to handle traumas or major injuries. Other "major” hospitals may not have a staff of neurologists to care for stroke patients. Despite the prevalence of heart disease in our country, certain hospitals will not have cardiologists or catheterization lab services to take care of heart attack patients. DoctorRated and other websites can aid you in determining which hospitals have the appropriate and needed services.


Outpatient Services

Convenience is often cited as the reason why a patient will pick one hospital over another for outpatient services like radiology, lab testing, outpatient surgery or procedures including cardiac cath, endoscopy, chemotherapy, etc. I am not going to insist that this is the wrong motivation, but I want the reader to be aware that the quality of hospital, staff, and physicians is far more important than the convenience factor when it comes to outpatient services.


Inpatient Services and Specialty Care

I often have been told after the fact by a patient that they chose to go to the local heart hospital with upper abdominal pain or shoulder pain that they thought was heart related. They tell me this woefully after they were found to have a ruptured gallbladder or other emergency that could not be taken care of at that ED. In these situations, I think it is important for the patient to be aware of the possible need for specialty and subspecialty care which might not be available at all hospitals. Too often, a patient will make a poor choice of hospital and then regret it because they will either not be treated aggressively or will have to be transferred to another one for care.

The other inpatient situations that often require a full complement of physicians include severe infections/sepsis, severe respiratory disorders that require ventilators, traumas, neurological and neurosurgical illnesses, and multi-organ (kidney, liver, lung, heart) system failures. Research all of your area's hospitals by asking your doctors/friends/family and review ratings on DoctorRated and other websites. Know which ones offer the most comprehensive care and which ones offer care that is not offered at other area hospitals.


Specialty Hospitals

Specialty hospitals are springing up around the country and generally offer service to heart, orthopedic, and surgical patients. Be aware of this type of hospital and research the benefits and risks of your local specialty hospital. The quality of subspecialty care is often very good in this subtype of hospital, however there are some issues to be familiar with:
     1. The owners of the hospital, in general, are the doctors offering the services. This is occasionally a conflict of interest for the patient and doctor.
     2. Specialty hospitals often do not have a full complement of services for patients who develop complications not related to their original problem. Most commonly this involves respiratory failure requiring lung doctors, strokes requiring neurologists, and heart disease including heart attack and heart failure requiring heart doctors.
     3. When a patient gets sick and requires more comprehensive care, there is often difficulty getting the patient transferred to a full service hospital. This delay can be life-threatening.


Location, Convenience, and Regionality

As discussed above, using location and convenience as decision factors for choosing a hospital can be perilous. For instance, if your primary care physician does not admit patients at the hospital closest to you but at one a few miles farther away, you might choose the one that is less convenient but more preferred for your doctor. Alternatively, you might change your choice of doctor if you have a strong preference for a local hospital especially if you feel that the quality of hospital supersedes the quality of or connection with your physician.

One other major mistake that I have seen patients make in the past especially in rural areas is to choose a hospital based on proximity to home only to be dissatisfied with its care. This often happens when patients go into their rural hospital and must be transferred to a larger hospital for specialty care. They often choose the hospital that is closer even when the better hospital is less than an hour's drive more.


Insurance Details

As with most of the above narrative, little details can often make a big difference in your decision about choosing a hospital. One detail that is often overlooked in an emergency is whether the hospital actually accepts your insurance. In most cases, emergency care is considered covered by all insurance plans. However, remember that most visits end up with admission to the hospital and introduction and establishment of patient-doctor relationships. This becomes important when you choose one hospital in an emergency and then have to change to all new doctors and a new hospital after the hospitalization due to insurance issues.


Summary

The above article was written as an overview of a patient's choices and decisions concerning "How to Choose the Right Hospital.” As I stated, this commentary could not cover all of the necessary points or possible scenarios. Below is a list of the top five points to remember when choosing a hospital:

1. Most patients should choose a preferred local hospital in order to become familiar with its doctors and staff.

2. Patients with multiple medical problems tend to develop complications and other illnesses that require a full complement of doctors and services not offered at all hospitals.

3. DoctorRated and other websites can aid you in determining which hospitals have the appropriate and needed services.

4. The quality of hospital, staff, and physicians is far more important than the convenience factor when it comes to outpatient services like radiology, laboratory, and outpatient procedures and surgery.

5. Research all of your area's hospitals by asking your doctors/friends/family and review ratings on DoctorRated and other websites. Know which ones offer the most comprehensive care and which ones offer care that is not offered at other area hospitals.