by James C. Sherlock
A recent note from a reader brought up the issue of emergency room quality.
The Kaiser Family Foundation reported that Virginians made 423 ER visits per 1,000 population in 2017 (the most recent data available). That number doesn’t have to be current to be attention-grabbing.
VDH’s vhi.org does not report on quality of emergency departments. It does offer ARHQ quality indicators, for hospitals, but the data used currently are from 2019.
The best regular citizens can do to determine what hospital they should use if they have a choice is Medicare.gov’s data. It is updated four times a year.
The quality of the hospital will matter more than most people know. I got a good look at a bunch of them professionally in systems engineering projects.
I learned that the quality variances can be enormous.
EMS. Before you check on the quality of E.R.’s, you should as a citizen support quality Emergency Medical Services (EMS) systems. Those are the first responders if you need help, and they will treat and transport you to the hospital if you need it.
If your local service is volunteer, make sure you help fund them If a city or county service, inquire about how they are doing. You can go to a local station and ask the professionals themselves.
ER Quality. As for hospitals, Go here. Click on whatever hospital you wish.
Page down to quality. Click on “timely and effective care.” Page down to emergency department care.
You will see data for
- patient departures before being seen;
- how quickly stroke victims received a brain scan;
- emergency department volume; and
- the average time spent in the ER before leaving.
That is not all of the information you would like, but it is better than nothing.
The other thing you can do is look for a Level I or Level II trauma center. Not because you are a trauma victim, but because the ER physicians will have specialists available to consult at 3 a.m.
A Level I center is the best staffed.
Also remember that if you go to an ER and they want to admit you, you can request transportation to another, higher-rated facility as soon as you are well enough to be transported.
Hospital quality by condition. To find the best hospital for you or your loved one’s condition, you can go to the rest of the quality measures on any hospital’s page on the Medicare.gov care-compare website linked above.
Look at:
- Complications and Deaths — complications, infections and death rates are measured and compared against national norms;
- Unplanned Hospital Visits — readmissions for a medical condition and after a procedure by type;
- Maternal Health;
- Psychiatric Unit Services — preventive care and screening, substance use treatment, patient safety, follow-up care, unplanned readmission; and
- Payment and Value of Care — look at value of care for heart attack, heart failure, hip-knee replacement and pneumonia.
A personal recommendation.
I did hospital quality improvement work professionally for several years among my other systems engineering projects. We sought to help make hospitals more efficient and effective to support their medical skills.
I learned a lot in the dozen or so hospitals in which I spent considerable time. I learned that hospital quality varies a very great deal, even among departments in one hospital.
As a first step, I recommend you ask your primary care physician (if you have one) for a recommendation of both specialist and hospital. If you are a Medicaid patient, your managed care organization should help you with the information you need and with your choices. Same with Medicare Advantage.
Regardless, to ask the right questions, you can check the Medicare compare ratings of local hospitals. The ratings are the result of a vast amount of data professionally assessed with nationally approved algorithms. As I wrote earlier, the data are updated four times a year. The algorithms are tweaked nearly every year.
Remember that your surgeon or other specialist, regardless of quality, will not be taking care of you in the hospital. He or she will be assisted by hospital staff in any procedure, and you will be cared for by staff. Including nights, weekends and holidays when there is not as much supervision.
If your specialist does not have privileges at a hospital that is 4- or 5- star rated in the treatment of your condition and there is a higher quality hospital in your area, consider a specialist with privileges where you want to go.
In my experience, it is that important.
Updated Nov 1 at 20:24
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