How safe is your hospital: 21,000 Consumer Reports readers rate the care they or a relative received. What we learned can make a critical difference for you.(Special Report)

The quality of care you receive during a hospital stay can determine how quickly and how well you recover--or if you recover at all. You might expect consistently good care to be delivered at almost every hospital in a nation with the world's top doctors, most advanced technology, and highest per-capita spending on health care. But when we surveyed and invited e-mails from CONSUMER REPORTS readers about their recent hospital experiences, we found enormous variations. They ranged from an Alabama man's smooth-sailing, lifesaving, $1.5 million liver transplant to an 83-year-old Tennessee man's death after a careless emergency-room staff sent him home without treating the broken bones and internal injuries he had suffered from falling down the basement stairs.

Just how dramatically the quality of hospital care can affect your outcome was driven home to one reader, Kate Parks, 25, from Denver, when she needed surgery twice in one month for a detached retina. Both surgeries were performed by the same doctor, but for scheduling reasons the two procedures took place in different hospitals, comparable in size and facilities. At the first hospital, it took so long for anyone to answer Parks' call for assistance when she awoke after surgery that she nearly fainted while getting out of bed to use the bathroom. In contrast, after her surgery at the second hospital, a nurse not only answered her call, but also discovered the reason for Parks' lightheadedness--low blood pressure--which she treated with extra intravenous fluids. "The first time, it took me at least two or three days after I went home before I felt OK again," Parks says. "With better care the second time, I felt much better, much sooner."

Robert Brook, M.D., director of the RAND Health Institute in Santa Monica, Calif., put the matter bluntly: "Most people will just go to wherever their doctor hospitalizes them. But the hospital you're in absolutely makes a huge difference."

If, like 55 percent of our survey respondents, you have a choice of which hospital to use, this article explains the information you need to select wisely and where to find it. If you don't have a choice of hospitals because you're admitted for an emergency or the hospital is dictated by your health plan or doctor, we explain how to work around problem areas to make sure you get the best possible care.

AT RISK FOR BAD CARE

A total of 21,144 readers told us about their own recent hospitalization or that of a close family member. Those who were less than highly satisfied with their hospital--22 percent--complained more often of unanswered calls for assistance, inadequate pain relief, pressure to leave the hospital too soon, or recovery prolonged by complications caused by the hospitalization.

The remaining 78 percent of respondents were highly satisfied with their stay. Overall, readers rated their hospital experiences higher than our survey respondents have rated service in banks, restaurants, or hotel chains. But unlike most other services, the care you get at a hospital can have serious long-term consequences, so any risk of receiving substandard care must be taken seriously. Hospital studies show, for example, that your odds of dying of a heart attack or in the intensive-care unit in the worst American hospitals are two times greater than in the best hospitals.