How To Make the Best Informed Decision About Which Hospital To Choose For Your Surgery

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Johns Hopkins Health After 50 newsletter helps guide readers on how to search for an excellent hospital when they are facing surgery.

Health After 50 interviews Martin Makary, M.P.H., M.D., Mark Ravitch Chair of Gastrointestinal Surgery and Director of the Johns Hopkins Center for Surgical Outcomes Research:

During medical emergencies, the choice of where to have surgery is out of your hands. And if you already have a recommended surgeon whom you trust, then you'll go when and where that doctor is available.

However, for elective procedures, like joint replacements and cosmetic surgery, or complicated operations, like heart bypass and prostate surgery, you can--and should--consider your options carefully in order to make the most informed decision possible.

What matters most when deciding where to have surgery?
Reputation is what we health professionals rely on most when seeking medical care for our families. So ask around. Your physician is your first source for referrals. Also talk to your friends and family--particularly those who work in healthcare or who've had surgery at the hospitals you're considering.

In fact, trusting word of mouth from hospital staff may soon be backed by new, cutting-edge research. At Johns Hopkins, we're measuring the quality of over 500 hospitals around the world by asking employees to rate how likely they would be to have surgery where they work. Our preliminary findings suggest that the answer to this question is linked to surgical success rates.

Patients should also consider hospital size and the experience of both individual surgeons and institutions. Hospitals often post this information on their websites, or you can call surgical divisions at the facilities you're considering. Staff should be able to share operating statistics and put you in touch with doctors.

What do you mean by "experience?"
By that, I mean a couple of things. First, look for surgeons and hospitals that frequently perform the operation you need. There is no magic number that equals "experience" (it varies according to procedure), but you can start by talking to your doctor and comparing operation rates in the hospitals you're considering. Ask hospitals how long they've been providing your operation.

Generally, you want a facility that's not the first to adopt a new technology--or the last.
Hospitals develop institutional wisdom over time, which means that, in more experienced facilities, complications can be identified quickly not just by doctors, but also by seasoned nurses and radiologists, for example.

Are large hospitals better?
For simple procedures, the size of the institution may not matter. But for complex cases that require many specialists, we suggest you opt for larger facilities with reputed experts in several disciplines.
At a large hospital, patients may have access to a multidisciplinary clinic. This represents a new model of care that's emerging around the country. At these clinics, patients consult with several specialists from different departments, who can treat the same medical problem with a variety of methods.

For instance, at the Sol Goldman Pancreatic Cancer Research Center at Johns Hopkins, patients meet with oncologists, radiologists, nurses, surgeons, nutritionists, and geneticists. These collaborations increase quality of care.

Is accreditation by organizations like The Joint Commission important?
The vast majority of hospitals are accredited, and accreditation procedures vary, so this is not a particularly telling basis for comparison.

How significant are mortality rates?
Mortality (and infection) rates may be misleading. For instance, larger numbers could reflect an institution's acceptance of high-risk cases; for that reason, some of the best hospitals in the country have high mortality rates.

Nurse-to-patient ratio is a much more telling number. Comparing ratios can offer some insight into how well staffed the surgical floors are, and whether nurses can dedicate enough time to patients. Hopkins employs one nurse to every four or five patients.

Taken together, certain statistics can reliably measure quality. For instance, U.S. News & World Report rates facilities based on nurse-to-patient ratio, patient volume, medical school affiliation, provision of advanced services, and mortality rates adjusted for high- and low-risk cases.
The publication also assigns reputation scores to hospitals based on surveys from board-certified specialists when coming up with their annual ratings of America's Best Hospitals.

How reliable are websites that allow users to compare local hospitals?
The ranking systems used by comparison websites are highly inconsistent. But the Internet can be a good starting point for operation- and disease-specific research.

An Internet search for your procedure is likely to uncover hospitals that offer the services you need. Also, many nonprofit disease advocacy organizations (e.g., the Arthritis Foundation or the American Urological Association) have websites that can help you find reputable hospitals.

This interview with Dr. Makary was originally published in The Johns Hopkins Medical Letter: Health After 50, May 2008, Volume 20, issue 3

For more information on Health After 50, or to subscribe, please visit:
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An interview with:
Martin Makary, M.P.H., M.D., Mark Ravitch Chair of Gastrointestinal Surgery and Director of the Johns Hopkins Center for Surgical Outcomes Research, Johns Hopkins University School of Medicine and Health Policy and Management, Johns Hopkins Bloomberg School of Public Health

Biography:
Dr. Makary is an active surgeon, researcher, and speaker on healthcare quality. He is the author of several books on surgery and public health, including a leading textbook of surgery, and has authored over 60 scientific articles.

He serves in leadership roles for The United Nations World Health Organization (WHO), The International Union of Risk Management, and The American College of Surgeons, and is a regular medical commentator for CNN.

Dr. Makary's research focuses on risk assessment and clinical, economic, and public health impact of innovation in medicine. He has written for a range of medical publications, including the New England Journal of Medicine and the Advisory Board Company.

He has several ongoing studies on the international burden of disease and the public health implications of new technology. He has also received numerous teaching and service awards and is the recipient of a federal grant from the Agency for Healthcare Research and Quality to study obesity and diabetes.

He completed his education at Bucknell University, Thomas Jefferson University, and Harvard University and his general surgical training at Georgetown University. He then went on to complete further sub-specialty training at Johns Hopkins. Dr. Makary served as a consultant and writer prior to joining the faculty at Johns Hopkins.

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