Sooner or later we are all going to need to be admitted to a hospital. Most of the time the decision is made for us by our physician. Unless you are going to be admitted for a very minor procedure (very few “minor” procedures require hospital admission), I would suggest patients should investigate all available choices.

Many criteria can be used to select a hospital.

Let’s start with what those that should not be avoided. First, geographical considerations should not be taken into consideration under most cases. We take pleasure trips of many hours duration, to take a one- or two-hour trip to a more appropriate health care facility should not be considered a burden.

Sadly for many of us, health insurance is a very important factor and limits our choices. Often we cannot consider out-of-network institutions because of the significant financial penalties.

This is an area of active legislation in some states including California. However, under some extreme circumstances exceptions may be made. Always explore alternatives with your health insurance company. Most likely you will start your conversation with the consumers service center, but do not hesitate to ask for a supervisor’s opinion.

Very few medical centers excel in every specialty. The reason for the hospitalization should have a significant impact in your decision. Although the internet provides a wealth of information, it is also a fact that health providers and hospitals use it for advertising. You must use unbiased resources, and try to separate true patient surveys and data from hospital advertisements.

Some basic criteria should be considered in your choice. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) is responsible for the accreditation of hospitals as well as long term care facilities. Relatively few long term care facilities have agreed to go through the scrutiny of JCAHO. On the other hand, most hospitals have.

If a hospital does not participate in this process, it is usually for a good reason, and in most cases you do not want to be there. The Joint Commission’s Annual Report on Quality and Safety is a good place to start. Their web site is www. joint and provides a wealth of information, including the Joint Commission Annual Report which names 620 Hospitals as ‘Top Performers on Key Quality Measures’ in 2012.

Another excellent source is the Medicare program. Specifically, they provide an exhaustive list of parameters used to compare hospitals. The information is based on surveys conducted among patients. They can be found at

Another area with which to be concerned is medical errors. Under extreme conditions, these errors may lead to the death of the patient.

The Institute of Medicine ( estimated that as many as 98,000 deaths a year in U.S. hospitals were attributable to medical errors in 1999. Most data would indicate that little progress has been made in this area since then.

Among medical errors, the most serious are the “never events”. The National Quality Forum defined “never events” as “errors in medical care that are clearly identifiable, preventable, and serious in their consequences for patients”. A list of 28 “never events” has been compiled, including wrong-site surgeries, pressure ulcers (bedsores), falls or trauma, administration of incompatible blood, and hospital-acquired infections associated with surgeries or catheters.

New Medicare regulations make hospitals responsible for the costs associated with a never event. Hospitals cannot bill the patients for this additional care. Several private insurance companies are following Medicare’s lead and will not pay for the costs associated with or attributable to never events.

Some of this information may be found at the Agency for Health Care Research and Quality. Although not particularly a user-friendly database, the quality of the data is excellent (

Medical errors total more than $4.5 billion in additional health spending a year, according to Centers for Disease Control & Prevention. Other sources have calculated a much larger price tag for errors.

Another source of information for hospital rankings in some of the most common adverse outcomes is Consumer Reports at “How safe is your hospital” Consumer Reports requires a subscription for their online service; is also available in some public libraries.

The recent increased requirements for hospitals will make it, even easier in the future to find hospital data.

One area of caution is that when choosing a hospital one should take into consideration the type of services they provide and the community being served. For instance, if you are interested in comparing rates of Cesarean section, hospitals that provide specialized perinatal and neonatal care will have a higher rate than others.

One more excellent source of information is the Leapfrog Group ( The Leapfrog Group rates hospitals for overall safety and also within the context of certain surgical procedures. You will find many hospitals under the “Fail to Respond” rubric in several important parameters. It is up to the consumer to evaluate how critical is that information for the particular case.

In summary, not all hospitals have the same outcomes even for relatively common conditions. The possibility of being readmitted for serious complications varies from hospital to hospital. It is up to the consumer to determine what the best match for him or her is.

This is by no means a complete list of resources; I would encourage you to use this as your starting point.