The opinions expressed by 1,150 area physicians in our hospital survey are just that--opinions. They are reasonably well informed, but they are based on the observations of each doctor and the reputations of the hospitals, not on hard science.
We included a hospital questionnaire in our survey of area physicians for our July issue on Top Doctors. Other than heart attack, stroke, and births, we did not ask about the best hospitals for procedures such as hip replacement. We sought more-general opinions related to patient care.
Keep in mind that a hospital that did not receive a lot of votes may be almost as good as one that did. We asked physicians to name one hospital in each category. This may be why smaller or lesser-known hospitals such as Inova Alexandria, Holy Cross, and Washington Adventist were not often cited.
Also keep in mind that opinions often reflect a doctor's familiarity with a hospital. The doctors in our survey are concentrated around the DC area, so they may have less knowledge of the hospitals outside the immediate Washington orbit. This may be why hospitals such as Southern Maryland, Inova Mount Vernon, Howard County, and even Johns Hopkins and the University of Maryland Medical Center were cited so infrequently.
Anne Arundel Medical Center also was not cited often even though Solucient named it this year as one of the nation's top 100 community hospitals, the only large Maryland hospital so designated.
INOVA FAIRFAX drew the most consistently good ratings, ranking highest or second-highest in every category related to patient care. Sibley Memorial Hospital in DC also got high ratings from doctors, gaining the highest vote total for the quality of its staff and its patient care. Doctors ranked Sibley as the hospital they'd most like to go to for a serious nonemergency illness. This contradicts the relatively weak ratings Sibley received in the intensive-care-unit category, which some doctors attribute to the fact that Sibley does not have board-certified intensivists on duty around the clock. Although well regarded for its radiology, Sibley does not have a catheterization lab for angioplasty, which may be why it did not rate highly for emergency heart-attack care.
What also stands out is the surprisingly low opinion doctors expressed about George Washington University and Georgetown University hospitals in some categories. One explanation may be that most of the survey responses came from private-practice doctors, many of whom harbor lingering resentments. Many of these physicians have expressed annoyance at these two academic hospitals, feeling they were not treated as well as staff doctors.
Many physicians did not include Hopkins in their ratings because they are less familiar with hospitals outside metropolitan Washington. Like all academic hospitals, Hopkins has felt the effects of diminished reimbursement, but it still has maintained a medical staff with internationally recognized specialists and a research program that has been awarded more NIH research grant money each year than any academic hospital in the country. Many Washington physicians regard it as the best regional hospital for patients suffering from unusual or complex medical conditions.
Hopkins's lofty reputation was damaged by two well-publicized deaths in 2001--an 18-month-old burn victim who died of dehydration and a healthy 24-year-old female volunteer who died from lung and kidney failure after inhaling hexamethonium during an asthma experiment. The federal Office of Human Research Protections (OHRP) cited Hopkins for violations of federal regulations, including the failure to review medical literature showing an association between hexamethonium and lung toxicity. OHRP temporarily suspended the hospital's federal license to conduct research involving human subjects.
Howard University Hospital also did not rate highly in part because many area physicians are less familiar with it. Although Howard remains fully accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and has done consistently well in its assessments, the Accreditation Council for Graduate Medical Education revoked accreditation for Howard's graduate training programs in pediatrics and emergency medicine. Howard appealed without success.
In the physician survey, we asked which hospital has the weakest staff and the weakest intensive care unit. Shady Grove Adventist Hospital received the most votes in both categories, but most of the doctors didn't vote in those categories, so Shady Grove's negative vote totals were relatively low--47 for weakest ICU and 45 for weakest staff. Although it rated well as a place to have a baby, it was the hospital most doctors said they would want to avoid if hospitalized for a serious illness. This harsh perception is probably due in part to the negative publicity Shady Grove received six years ago when JCAHO sanctioned the hospital with preliminary nonaccreditation. The hospital's problems came to light when doctors and nurses there publicly complained of low nurse staff levels that led to patient-care problems.
Shady Grove's problems were serious, but were they more serious than those of other area hospitals or just more publicized? One hospital administrator says "but for the grace of God," many of the patient-care problems that came to light at Shady Grove might have surfaced at any of a number of hospitals.
Here are the survey questions and top vote-getters.
Where do you admit most patients?
Shady Grove Adventist--104
Washington Hospital Center--72
Virginia Hospital Center--46
Reston Hospital Center--44
Inova Fair Oaks--39
Children's National Medical Center--36
Which hospital would you want to go to if you were having a heart attack?
Washington Hospital Center--478
Virginia Hospital Center--33
The high vote totals for Washington Hospital Center and Inova Fairfax are likely a result of the significant investments in technology and personnel both hospitals have made in cardiac care, the reputations they have earned, and their experience in treating heart and heart-related problems.
Which hospital would you want to go to if you were having a stroke?
Washington Hospital Center--191
Doctors were emphatic in choosing Inova Fairfax, WHC, and Suburban for stroke treatment. Suburban's inclusion is likely a reflection of its collaborative stroke-care program with the NIH. The WHC has a similar collaboration.
If you could choose one hospital at which to be treated for a serious illness that is not an emergency, which would you choose?
Virginia Hospital Center--58
Washington Hospital Center--43
Which hospital would you want to go to if you or a family member were having a baby?
Virginia Hospital Center--49
In 2004, Inova Fairfax delivered 11,152 babies--more than any other area hospital. Sibley, which delivers about 3,200 babies a year, enjoys a good reputation for its staff and amenities. Holy Cross Hospital has made its women's-and-infant services one of its priorities and last year delivered 7,874 babies, the most of any suburban Maryland or District hospital.
Which hospital do you think has the best emergency department?
Washington Hospital Center--207
Virginia Hospital Center--44
Reston Hospital Center--23
The vote totals for Inova Fairfax and Washington Hospital Center likely reflect the high regard that physicians have for their heart-attack and stroke-treatment programs; these serious conditions bring patients to emergency rooms. Besides its collaborative stroke and cardiac-care programs with the NIH, Suburban also has a cardiac-catheterization lab for angioplasty, which doctors regard as important for emergency heart-attack care.
GW, which came in fourth, has operated a well-regarded emergency department and cardiac-catheterization lab for many years.
Although our survey focused on adult care, Children's National Medical Center received recognition for its emergency care. Children's has a highly regarded pediatric burn and trauma center and probably has more nationally regarded specialists on its staff than any area hospital.
Which hospital do you think has the best staff?
Washington Hospital Center--82
Virginia Hospital Center--51
Inova Fair Oaks--31
If you could have privileges at only one hospital, which one would you choose?
Washington Hospital Center--70
Virginia Hospital Center--41
Which hospital do you think is best managed from a patient-care standpoint?
Virginia Hospital Center--54
Inova Fair Oaks--52
Washington Hospital Center--52
Which hospital do you think has the best medical equipment?
Washington Hospital Center--199
Virginia Hospital Center--44
Which hospital has the best ICU and ICU staff?
Washington Hospital Center--262