Saturday, October 15, 2011

Which is the best hospital in America?

Which are the best hospitals in America? Most people who make a judgement would pick on the famous ones like: MD Anderson, Duke, Mass General, Stanford, Mount Sinai, Cleveland Clinic, Vanderbilt, the Mayo, University of Michigan, Brigham and Womens, University of Washington, Johns Hopkins etc. There are 17 that make the US News and World Report. These hospitals publish the best research and are most in the news for their innovative work.

But there is another way of looking at things. The Joint Commision for accrediting hospitals in America has released a list of the 450 best performing hospitals in America and none of the 17 makes the cut. This is because the Joint Commission focuses on everyday diagnoses such as the routine care of surgical cases, and people with pneumonia or myocardial infarction. It uses only wellattested process measures such a giving aspirin to people with chest pain and prophylactic antibiotics to patients undergoing surgery. Hospitals had to score 95% or better on all the 22 tested process measures.

The 405 hospitals included many small community hospitals and very few major urban and famous institutions. Some hospitals use their complex case mix as an excuse though it is hard to see how this would make a difference to drawing blood cultures before giving iv antibiotics or giving chemotherapy on time according to the prescribed schedule.

I do not think this is a purely American problem. In my role of inspecting pathology departments in most of teh big teaching hospitals in teh UK, I noticed remarkable carelessness in attention to detail. In looking at the glamorous aspects of a research institution they often took their eye off the ball. My son at teh CQC and my daughter as a junior doctor would concur, and most of the medicao-legal cases that I have been involved with involve large teaching hospitals.

I think at Bournemouth we had the best of both worlds. We were undoubtedly the District General Hospital with the best record for research and innovation, but we were also consistantly one of the best in teh country interms of achieving the highest standards in patient care and financial management.

1 comment:

TomD said...

The other aspect of the 'famous hospitals' is that many are teaching hospitals and a good portion of the patient care is left up to the younger, less experienced doctors-to-be. It is one thing to have a well known researcher set a course of treatment but one must remember who is responsible for the 3 am crisis
calls. Regards, TomD