There's often no time to research the hospital before you need it. But for everything from a scheduled surgical procedure to childbirth, you may have some breathing room, and it's worth investing a little time in research. Hospitals are not all the same, and some may be able to provide better care for your specific needs than others. Because some specialists only have privileges at selected hospitals, your choice of doctor and hospital may go together.

According to a recently released survey of 21,000 consumers by Consumer Reports magazine, the most important factors for good quality care include sufficient staff (especially registered nurses), good systems in place for organizing the care, and experience with your particular medical condition.

The Good Life compiled the following helpful tips based on things we learned researching this story and published advice from a number of different consumer and healthcare groups.

If you have insurance, does your health plan or employer provide a tool to compare the hospitals in your network with one another?

Like Aetna, a number of large national insurers now provide on-line tools for enrollees trying to select a hospital. The Texas Business Group on Health (TBGH) provides such a tool for the employees of its members. Dell Inc. and HEB are members, as well as a number of other area businesses. Ask if your employer is a member, or check for yourself at www.tbgh.org/members.htm. You can use these tools, or others listed below, to answer some of the following questions.

Does the hospital regularly treat your condition?

High-volume hospitals tend to have better outcomes, according to most research. You can ask the hospital how many procedures like yours they do every year, and compare that to other local hospitals. For many procedures, especially those that relate to heart care or childbirth, you can look up the procedure volume on-line, along with selected mortality rates. For the most recent available Texas state data, go directly to the hospital-by-hospital comparison tables for your procedure at www.thcic.state.tx.us/IQIReport2001/IQIReport2001.htm.

For an easier to use set of comparisons, there are some on-line "hospital report cards" that will provide a wide range of information. For free information about Austin area hospitals, try www.healthgrades.com.

Other free on-line report cards tested by The Good Life did not yet include Texas hospital data, which only became available last year.

How many patients are there for each registered nurse (RN) in the unit that you will need?

Recent studies indicate that each additional patient more than four in a nurse's workload increases the risk that patients will die (see main article, "How Safe is Your Hospital?"). The National Nurses Alliance says there should be no more than four patients for every RN on general medical-surgical units. Proposed mandatory staffing laws in Congress and in several states provide guidelines for staff ratios advocated by nurses. Ask how the hospital's staffing compares to these guidelines. Texas hospitals are not accustomed to giving out this information, so you may have to insist!

Are there doctors available in all the specialties you will need?

Ask your primary doctor what specialty doctors you are likely to require for your treatment, and what kind of specialists would you likely need if something goes wrong. Check to see if the hospital has a full range of these specialists available.

Will your care be coordinated by a single physician?

Depending on the complexity of your treatment, you may be visited by a number of different doctors, nurses and specialists. To reduce the chance of overlapping or conflicting orders, ask if your care can be coordinated by a single physician that you will see each day.

Is the hospital fully accredited?

All the hospitals in Austin covered in this report have received full accreditation by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and are in good standing. As you narrow down your choice of hospitals, check the accreditation status at www.jcaho.org/qualitycheck/directry/directry.asp. Ask the hospital about any outstanding issues for improvement.

How do infection and error rates compare with national benchmarks?

Most hospitals will not tell you the infection rates or error rates associated with your procedure, although most track some or all of this information. But hospitals should be able to tell you how their infection rates compare with averages published by the Centers for Disease Control and Prevention (CDC). If you are scheduling a surgery, ask whether the hospital's post-surgical infection rates are better, worse, or comparable to CDC benchmarks. You can also ask if the hospital has had to report any "sentinel events" to an accreditation body related to the treatment you need. A "sentinel event" is a complication that results in death or serious injury to a patient.

What programs does the hospital have in place to reduce errors and improve patient safety?

The Leapfrog Group, a coalition of more than 140 public and private organizations that provide healthcare benefits, recommends that hospitals computerize physician orders to reduce medication errors. Other recommendations include incorporating a pharmacist into daily rounds. Adequate infection control staff is also important. Ask whether the hospital has one or more full-time infection control specialists coordinating infection-reduction programs, and ask about the hospital's initiatives to reduce medical errors.

Is there a patient representative or ombudsman on staff?

If so, ask what services this person can provide during your hospital stay. If not, ask how complaints are handled.

What do other patients have to say about their treatment at the hospital?

Ask around. You may be surprised how many people you know who have recently visited a local hospital and have something to say about the experience. Ask them what they liked, and what they noticed about their hospital care. The federal Agency for Healthcare Research and Quality suggests you ask the hospital for a copy of its most recent patient satisfaction survey. Hospitals are not required to release patient satisfaction surveys, but it doesn't hurt to ask.

Special questions parents should ask about their birthing hospital

New parents should ask the same questions about staffing, medical errors, infection and coordination of care that other patients ask, but there are a number of special questions you can ask to identify the best hospital to have your baby, as follows;

(1) Are nurses trained in neonatal resuscitation available at all times, and does the hospital have its own neonatal intensive care unit?

Hopefully very few parents will experience the tragedy that drove the Ogle family into court over the birth of their daughter (see main article, "How Safe is Your Hospital?"). Ask the hospital to specifically describe how they would handle a sudden emergency requiring skilled resuscitation of your newborn child.

(2) How does the hospital's Caesarian-section rate compare to the state average?

This information is available at www.thcic.state.tx.us. You can also ask the hospital. A lower C-section rate may indicate better care.

(3) Will a nurse or midwife be available throughout labor at your request?

Adequate nursing attention during the whole course of labor reduces C-section rates and increases family satisfaction, according to Lourdes Hospital in New York.

(4) Does the hospital have an anesthesiologist on staff at all times?

Peg Moline, editor of Fit Pregnancy magazine, recommends that even if you don't intend to use drugs during labor that you should ensure there is flexibility to change your mind.

(5) Does the hospital provide a place for the father to sleep, and how does it handle visitors?

Your comfort, and your ability to be together as a new family, is important too.

-Kathy Mitchell