Hospitals: Can Yours Handle Your Emergency?

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Medical Author: Benjamin C. Wedro, MD, FACEP, FAAEM
Medical Editor: Melissa Conrad Stöppler, MD

Most of us have our favorite places to eat and hang out. There is the neighborhood coffee shop where we stop for our morning cup. However, that isn't the place we would choose for a Sunday morning brunch or the special anniversary night out. Each place serves our special wants and needs. Hospitals are no different, but do you know what hospital to choose in an emergency…and does it matter?

Medicine has changed in the past generation. Not so long ago, medical practice was good at diagnosing conditions and diseases, but had little to offer the patient in the way of treatment to intervene in life-threatening events. Thirty years ago, the heart attack victim was admitted to the hospital for weeks as the damaged heart muscle was replaced with scar tissue and the patient adapted to a new life with a weakened heart. People had strokes, and there were no intervention options available. Survival rates from trauma were better in Vietnam than on American highways.

Medical research advanced, and hospitals developed systems to care for patients with life-threatening conditions. Some hospitals developed expertise in trauma or cardiac care. Others centered on pediatrics or stroke care. National organizations like the American College of Surgeons and the Joint Commission for Accreditation of Hospital Organizations review hospitals around the country and designate their special areas of expertise.

So why should it matter to you, the patient, when an emergency exists? Every hospital should be about the same…right?

The answer is a little complicated and is based upon geography. In larger cities, the hospital you choose could make a difference in the care you receive and the outcome of the event that brought you to the hospital. In smaller towns and rural areas, where there may be only one hospital if even that, the opportunity for cutting edge medical care may not be available and that's the trade off for small town life.

But when the choice is available, it's important to know what hospital to choose. Most hospitals are equipped to handle routine urgent and emergent problems. Their staff has the training and the available equipment to stabilize even the most critically ill patient. Issues arise after the initial patient stabilization -  when it's time to get specific patient care. Consider the following:

• Not all hospitals have surgeons in-house 24 hours a day to treat trauma victims, or cardiologists for heart attacks, or neurologists for strokes.
• It's not just the availability of doctors. It's the number and availability of operating rooms, cath labs, CT or MRI scanners, and ICU machines.
• It is the specialty trained nurses, respiratory therapists, and the "behind the scenes" people that the patient never sees (from lab and radiology technicians to laundry and housekeeping).

And it does make a difference. Trauma centers have higher survival rates than community hospitals. Patients in the midst of a heart attack do better with emergency heart catheterization to open up a blocked blood vessel than those patients who get treated with medications only. And patients who are in the midst of a stroke have a better outlook when treated at a stroke center.

For those without the option of different hospitals, systems have been developed to refer patients emergently. In small towns and cities, treatment protocols allow standard care to begin while transportation is arranged to specialized centers. Depending on distance, time and weather - helicopters or aircraft can be used to shorten the time to get the patient to the specialist.

Usually, the paramedics will transport the patient to the nearest hospital, and sometimes will honor the request of the patient or family to go to another emergency room than the one planned. But if specific problems are known to exist, EMTs go to the hospital designated for the issue at hand.

People need to know the capabilities of their local hospital. Talking with your family doctor is a good place to start. Friends and neighbors may have experiences to share in regard to different hospitals. Otherwise, the research is pretty easy to do on the Web. Most hospitals will tout their special designations in their advertising. Check their Web site to see what services are offered. Hospital performance can also be reviewed at http://www.hospitalcompare.hhs.gov or Joint Commission's Resources website at www.QualityCheck.org.

The key to good outcomes in medicine is planning, and that planning starts with you, the patient. Finding the right restaurant takes a little time. Finding the right hospital should be worth the same effort.