Photos: Silvia Otte
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The Top Hospital in America
By Joe Bargmann
Spend a hectic day at North Shore University Hospital, and see how a mix of exemplary teamwork, cutting-edge technology, and generous community support pushed it to the top of the 50 Top Hospitals list.
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When Debbie Bothe first saw Andy DiMarino heaped on the floor of his hospital room, incoherent and muttering to himself, she thought he might be coming out of a bender.
Bothe and another nurse returned Andy to bed. According to his chart, the 42-year-old landscape contractor had been admitted the previous day, dizzy and vomiting. Initial diagnosis: vertigo. Alcohol abuse was a possibility. But Bothe had a gnawing feeling something else was wrong.
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A Winning Combination
Andy DiMarino and wife Robin (standing center, in red) flank nurse Debbie Bothe. Surrounding are North Shore staffers who helped save Andy from a near-fatal stroke. |
DiMarino's wife, Robin, was in a panic. She'd just spoken with her husband, and he didn't know where he was. "What's wrong with him?" she asked the nurse.
"I don't know," said Bothe. "Is it possible that he was drinking a lot?"
"No!" Robin insisted.
Bothe silently considered other possibilities: hypoglycemia, hypotension, encephalitis, brain tumor, stroke.
"Is he going to die?" Robin wept.
"It's serious, but he's in good hands," Bothe said, hugging her.
Then Robin mentioned that Andy's father had suffered a stroke at age 40. An alarm went off in Bothe's head. If this were a stroke, there was not a second to lose. Bothe sought out the closest doctor, a young resident.
"We'll get a CAT scan," he said after examining DiMarino. But as he wrote up the order, Bothe noticed, he didn't add the notation "stat" for "immediate."
"Maybe you want to make it stat," she suggested. "This guy is really sick."
The doctor glanced up at her, then went on writing.
Bothe kept at him. She said that when DiMarino came in, he was alert and able to walk, "but something happened in the night. So, how about a 'stat' on this?"
"Okay," the doctor agreed. "Let's get him down there right away."
In many other hospitals, a nurse pressing a doctor like that would have been ignored or, worse, reprimanded. But luckily for Bothe—and for Andy DiMarino—this scene unfolded at North Shore University Hospital in Manhasset, New York. Its policy of treating all staffers like valued members of a team is part of what makes North Shore one of the finest hospitals in the country.
Located in affluent suburbs 20 miles east of Manhattan, this jewel of the 18-hospital North Shore-Long Island Jewish (LIJ) Health System collects awards for excellence in service—including nursing—like the Yankees collect World Series rings.
And now, we're adding one more. North Shore is the top hospital among those in the nation's largest metropolitan areas, according to a new study by the Washington, D.C.-based Consumers' Checkbook, an independent, nonprofit organization. The hospital study, reported here for the first time, took into account several statistical measures of safety, plus a survey filled out by 20,000 physicians nationwide. Examining the records for patients with acute illnesses that affect older adults—such as heart attack and joint fracture—the researchers determined which hospitals had the best outcomes for the most patients. (See 50 Top Hospitals.)
The statistics are remarkable. The mortality rate (risk of dying within 30 days) for surgery patients at North Shore is about half the national average. And in a survey in which the average hospital was ranked "very good" or "excellent" by 33 percent of responding doctors, North Shore garnered a 79 percent approval rating.
All the hospitals in the top 50 scored well on such measures and were rated highly by the boards that accredit them. All are involved in medical research and in training the next generation of doctors. And their scores were very close, several scoring higher than North Shore in one measure or another. Vying for the top spot were such centers as Cedars-Sinai Medical Center in Los Angeles and Northwestern Memorial Hospital in Chicago.
But numbers don't tell the whole story. At North Shore, what lies behind the numbers is a deep sense of community. Employees—from food-service workers to nurses to top surgeons—confess a zealous dedication to their jobs. Case in point: At a time when hospitals nationwide have nursing vacancies of 10 to 12 percent, only 5.7 percent of the nursing jobs at North Shore are unfilled. The hospital has instituted a novel in-house recruiting program—offering any employee a free nursing education—that promises to eliminate the shortage entirely in coming years.
North Shore Executive Director Dennis Dowling seems almost embarrassed by the accolades the hospital has received. "The recognition, I'm proud of it—it's wonderful, really, it is," he says during an interview in his office. "But this …" His words hang in the air as he drops a manila folder on the table and taps it. "… This is what matters." The folder is stuffed with letters from patients. The hospital receives thousands of them a year, and each one is answered, many by Dowling himself. "Careful," he softly warns, "they'll bring tears to your eyes."
One mother whose baby died before birth writes, "The staff knew we wouldn't be leaving with our son, and they did their utmost to help us in that horror …. We can't thank them enough for their tenderheartedness." Another family lauds a nurse who got their father, who was non-responsive and breathing on a ventilator, to respond to her. One woman wrote, "I couldn't have asked for a more wonderful experience"—and this after undergoing breast surgery. Then there was the retired English teacher who wrote that her experience as a heart surgery patient had made her feel like part of the "larger family of man."
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