a special program of the National Emergency Medicine Association (NEMA)
Week: 525.3 Guest: Dr. Carolyn Clancy, Director, Center for Primary Care Research, ACHPR Topic: Choosing a Hospital - One Part Host: Steve Girard Producer: Ed Graham
NEMA: With us today is Dr. Carolyn Clancy...Director of the Center for Primary Care Research with the U.S. Agency for Health Care Policy. Dr., is there a way to get some general information about hospitals?
CLANCY: In some areas, New York state and Pennsylvania are two examples, you actually can get some information, but only for certain, selected types of procedures. And the information is, in short, not widely available. One of the biggest questions I would have as a patient, and knowing what I do about research, is...How many of those kinds of procedures are done at that hospital? And all things being equal, you'd be much better off at a hospital where they do a high volume of the particular type of procedure you're going to have done.
NEMA: Some people choose the hospital where they'll have the procedure done based on proximity to their home....is that a good idea.?
CLANCY: I think that's a series of trade-offs, and one that I would get into a serious conversation with the surgeon about. If its a fairly unusual condition or a new technique, it probably would be better to go to a regional center or what are sometimes referred to as centers for excellence. If its a fairly common procedure, that's done widely, I think that's probably less important, and then the patient would need to weigh with the surgeon the benefits of having family and other support systems close by....versus maybe a small advantage in technical performance.
NEMA: What are teaching hospitals, and are there advantages to going to one for your operation?
CLANCY: Teaching hospitals are hospitals where residents, that is to say, young physicians in training, are trained....as well as often medical students. What this means at the level of the patient is that...it means they're going to have to tell their own story many more times...than if they are in a non- teaching hospital. There are some advantages....that means there's a physician usually in the hospital all night, all the time, whereas in community hospitals, where there are not residents on site, there may or may not be a physician on site. That doesn't mean they're not getting good care throughout the night, but that is one advantage. Teaching hospitals are often busier.. It is pretty standard...and its a way we both teach, as well as check each other for mistakes.
NEMA: What about tests..how can a patient know more about the battery of tests that may be administered during a hospital stay?
CLANCY: In days gone by we used to get lots and lots of tests, pre-operatively, more as a reflex than anything else...we wanted things to go as well as possible. Since then, we've found that for many routine types of procedures, the tests don't add very much value, and there's been more of a trend away from doing as many tests preoperatively,and , of course, insurers are interested in your having as few tests done prior to the procedure as possible. In general, if you're pretty healthy, there's gonna be a minimum of testing involved. You should always ask questions if you're not sure about what's going on or why they're doing tests, and so forth.
NEMA: What about banking your blood before you go in for a procedure?
CLANCY: If you're going to have an elective procedure....which is generally when you're going to have the opportunity to ask most of these questions, and there's a reasonable probability that you're going to need blood, I think it is a good thing to check into. It is probably the lowest risk way of getting a blood transfusion. On the other hand, with all the tests that exist now to check transfused blood, to make sure of the low likelihood of your having a problem with the transfusion, the advantage it adds is very small.
NEMA: Dr. Clancy says one of the best ways to get information on doctors and hospitals is to ask family or friends who have had surgery for their opinions on who to see and where to go. I'm Steve Girard.