Best Hospitals 2007
When You Need the Best
Patients in ICUs are the sickest of the sick--many are breathing with the help of mechanical ventilators, and all are closely monitored 24 hours a day. At most hospitals, they are under the care of the doctor who admitted them--most often a surgeon in the case of a stubborn post-op infection, say, or an internist or other primary-care physician. Few of these physicians are trained to treat critically ill patients.
Intensivists are. They're expert, for example, at staving off lethal infections, stabilizing an erratic heartbeat, and catching potential drug interactions. An eye-opening analysis in 2002 by Johns Hopkins's Pronovost and others found that patients are almost 40 percent less likely to die in ICUs supervised full time by these specialists. Yet only about 20 percent of hospitals--most of them referral centers--have intensivist-directed ICUs.
An intensivist-run ICU is so valuable, Pronovost believes, that it more than cancels out the disadvantage of going to a hospital that doesn't see a large number of patients with a particular condition. Not having intensivists "is part of the invisibility of poor quality," he says. "No hospital is going to tell you your father died because he didn't have an intensivist--they'll say it was pneumonia or a blood infection or something else."
A TECHNOLOGY IS NEW
An implanted titanium apparatus relieves breathing and heart problems for a child with a severely deformed chest and spine. MRIs during surgery indicate whether cancerous tissue has been completely removed. Without treatment, a carotid aneurysm--a weakened, bulging spot in one of the arteries to the brain--kills more than 70 percent of its victims. Surgery to reinforce the artery or to tie off the bulge can damage nearby nerves, risking death or major stroke. But a new, less drastic alternative pushes a mesh cylinder through a catheter to the aneurysm. The "stent graft" isolates the aneurysm and reinforces the artery walls. Only at referral centers are such technologies tested and refined, and until they are, only at such centers will patients be able to exploit them.
Bobbie Nuhfer's good fortune was to find such experience near her home in Orlando. From the time she was a young girl in West Virginia, Nuhfer, 62, had been passing out briefly, sometimes twice a week. Her own children "knew if I reached out and grabbed hold of them, they were to set me down easy," she says. In 2003, a cardiologist found the explanation: an atrial septal defect--a hole between two chambers of Nuhfer's heart that was short-circuiting oxygenated blood.
Nuhfer could have had open-heart surgery. But she'd been told about the recently approved Amplatzer septal occluder, which was pushed through a catheter to seal the hole. The year before, a study of the repair had put the rate of major complications at 1.6 percent, compared with 5.4 percent for open-heart surgery. Evan Zahn, chief of cardiology at Miami Children's Hospital's congenital heart institute and one of the few doctors familiar with the plug, took her on and installed the device. "I have not fainted once," she says, since seeking out the treatment she considered best. "Minor surgery is what they do on you," says Nuhfer. "Major is what they do on me. And I wanted minor."
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