JCIPatientSafety.orgHospital Quality Directory

Acute Care Hospitals · Voluntary non-profit - Private

Baylor Scott & White Medical Center at Irving

5 / 5

At a glance

Baylor Scott & White Medical Center at Irving carries a 5-star CMS overall rating — above the national norm. On healthcare-associated infection measures, it performs better than the national average on 12 and worse on 0.

Healthcare-Associated Infections

lower is better · 36 measures reported

Rates of infections patients can acquire while receiving care, such as central-line and catheter-associated infections, MRSA, and C. difficile.

MeasureScoreCompared to national
Central Line Associated Bloodstream Infection (ICU + select Wards): Lower Confidence Limit0.223Same as national
Central Line Associated Bloodstream Infection (ICU + select Wards): Upper Confidence Limit2.387Same as national
Central Line Associated Bloodstream Infection: Number of Device Days3323Same as national
Central Line Associated Bloodstream Infection (ICU + select Wards): Predicted Cases3.420Same as national
Central Line Associated Bloodstream Infection (ICU + select Wards): Observed Cases3Same as national
Central Line Associated Bloodstream Infection (ICU + select Wards)0.877Same as national
Catheter Associated Urinary Tract Infections (ICU + select Wards): Lower Confidence LimitBetter than national
Catheter Associated Urinary Tract Infections (ICU + select Wards): Upper Confidence Limit0.541Better than national
Catheter Associated Urinary Tract Infections (ICU + select Wards): Number of Urinary Catheter Days4086Better than national
Catheter Associated Urinary Tract Infections (ICU + select Wards): Predicted Cases5.535Better than national
Catheter Associated Urinary Tract Infections (ICU + select Wards): Observed Cases0Better than national
Catheter Associated Urinary Tract Infections (ICU + select Wards)0.000Better than national
SSI - Colon Surgery: Lower Confidence Limit0.242Same as national
SSI - Colon Surgery: Upper Confidence Limit1.841Same as national
SSI - Colon Surgery: Number of Procedures195Same as national
SSI - Colon Surgery: Predicted Cases5.242Same as national
SSI - Colon Surgery: Observed Cases4Same as national
SSI - Colon Surgery0.763Same as national
SSI - Abdominal Hysterectomy: Lower Confidence LimitNot available
SSI - Abdominal Hysterectomy: Upper Confidence LimitNot available
SSI - Abdominal Hysterectomy: Number of Procedures61Not available
SSI - Abdominal Hysterectomy: Predicted Cases0.511Not available
SSI - Abdominal Hysterectomy: Observed Cases2Not available
SSI - Abdominal HysterectomyNot available
MRSA Bacteremia: Lower Confidence Limit0.093Same as national
MRSA Bacteremia: Upper Confidence Limit1.836Same as national
MRSA Bacteremia: Patient Days67702Same as national
MRSA Bacteremia: Predicted Cases3.599Same as national
MRSA Bacteremia: Observed Cases2Same as national
MRSA Bacteremia0.556Same as national
Clostridium Difficile (C.Diff): Lower Confidence Limit0.030Better than national
Clostridium Difficile (C.Diff): Upper Confidence Limit0.316Better than national
Clostridium Difficile (C.Diff): Patient Days60481Better than national
Clostridium Difficile (C.Diff): Predicted Cases25.800Better than national
Clostridium Difficile (C.Diff): Observed Cases3Better than national
Clostridium Difficile (C.Diff)0.116Better than national

Complications & Deaths

lower is better · 20 measures reported

Rates of serious complications (like hip/knee replacement problems or accidental cuts during surgery) and 30-day mortality rates for common conditions.

MeasureScoreCompared to nationalSample
Rate of complications for hip/knee replacement patientsNot available
Hybrid Hospital-Wide All-Cause Risk Standardized Mortality Rate3.4Same as national830
Death rate for heart attack patients11.5Same as national72
Death rate for CABG surgery patientsNot available
Death rate for COPD patients7.1Same as national90
Death rate for heart failure patients8.2Better than national247
Death rate for pneumonia patients13.2Same as national240
Death rate for stroke patients10.9Same as national100
Pressure ulcer rate0.20Same as national3332
Death rate among surgical inpatients with serious treatable complications173.05Same as national28
Iatrogenic pneumothorax rate0.17Same as national3959
In-hospital fall-associated fracture rate0.23Same as national4018
Postoperative hemorrhage or hematoma rate2.76Same as national622
Postoperative acute kidney injury requiring dialysis rate1.59Same as national127
Postoperative respiratory failure rate9.03Same as national132
Perioperative pulmonary embolism or deep vein thrombosis rate3.93Same as national618
Postoperative sepsis rate4.56Same as national121
Postoperative wound dehiscence rate1.68Same as national143
Abdominopelvic accidental puncture or laceration rate1.13Same as national633
CMS Medicare PSI 90: Patient safety and adverse events composite0.85Same as national

Unplanned Hospital Visits & Readmissions

lower is better · 14 measures reported

How often patients return to the hospital unexpectedly within 30 days of discharge — a marker of care quality and discharge planning.

MeasureScoreCompared to nationalSample
Hospital return days for heart attack patients-19.2Not available55
Hospital return days for heart failure patients4.6Not available287
Hospital return days for pneumonia patients-7.3Not available245
Hybrid Hospital-Wide All-Cause Readmission Measure (HWR)14.8Same as national1424
Rate of unplanned hospital visits after colonoscopy (per 1,000 colonoscopies)13Same as national500
Rate of inpatient admissions for patients receiving outpatient chemotherapyNot available
Rate of emergency department (ED) visits for patients receiving outpatient chemotherapyNot available
Ratio of unplanned hospital visits after hospital outpatient surgery1.1Same as national117
Acute Myocardial Infarction (AMI) 30-Day Readmission Rate13.5Same as national55
Rate of readmission for CABGNot available
Rate of readmission for chronic obstructive pulmonary disease (COPD) patients18.9Same as national103
Heart failure (HF) 30-Day Readmission Rate21.3Same as national287
Rate of readmission after hip/knee replacementNot available
Pneumonia (PN) 30-Day Readmission Rate17.6Same as national245

Patient Experience (HCAHPS)

higher is better · 9 measures reported

What patients say about their hospital stay — communication with nurses and doctors, responsiveness, cleanliness, pain management, and whether they would recommend the hospital.

MeasureScoreSample
Nurse communication - star rating3753
Doctor communication - star rating3753
Communication about medicines - star rating3753
Discharge information - star rating4753
Cleanliness - star rating4753
Quietness - star rating4753
Overall hospital rating - star rating4753
Recommend hospital - star rating4753
Summary star rating4753

Timely & Effective Care

higher is better (unless a wait time) · 30 measures reported

How consistently hospitals follow recommended care processes — for example, giving heart-attack patients aspirin on arrival, or the average time spent in the emergency department.

MeasureScoreSample
Emergency department volumevery high
Global Malnutrition Composite Score
Global Malnutrition Composite Score: Malnutrition Diagnosis Documented
Global Malnutrition Composite Score: Malnutrition Risk Screening
Global Malnutrition Composite Score: Nutrition Assessment
Global Malnutrition Composite Score: Nutritional Care Plan
Hospital Harm - Severe Hyperglycemia
Hospital Harm - Severe Hypoglycemia
Hospital Harm - Opioid Related Adverse Events
Healthcare workers given influenza vaccination932578
Average (median) time all patients spent in the emergency department before leaving from the visit, including psychiatric/mental health patients and patients who were transferred to another facility. A lower number of minutes is better151399
Average (median) time patients spent in the emergency department before leaving from the visit, excluding patients transferred to another facility or psychiatric care/mental health patients. A lower number of minutes is better150391
Average (median) time psychiatric/mental health patients spent in the emergency department before leaving from the visit. A lower number of minutes is better
Average (median) time patients spent in the emergency department before being transferred to another facility. A lower number of minutes is better
Left before being seen085029
Head CT results10012
Endoscopy/polyp surveillance: appropriate follow-up interval for normal colonoscopy in average risk patients8636
Improvement in Patient's Visual Function within 90 Days Following Cataract Surgery
ST-Segment Elevation Myocardial Infarction (STEMI)
Safe Use of Opioids - Concurrent Prescribing83666
Appropriate care for severe sepsis and septic shock93165
Septic Shock 3-Hour Bundle8947
Septic Shock 6-Hour Bundle10035
Severe Sepsis 3-Hour Bundle96166
Severe Sepsis 6-Hour Bundle10088
Discharged on Antithrombotic Therapy99173
Anticoagulation Therapy for Atrial Fibrillation/Flutter
Antithrombotic Therapy by End of Hospital Day 2
Venous Thromboembolism Prophylaxis897302
Intensive Care Unit Venous Thromboembolism Prophylaxis95955

Maternal Health

lower is better · 4 measures reported

Measures of maternal outcomes and safe delivery practices, including severe complications during childbirth.

MeasureScoreSample
Cesarean Birth
Risk Adjusted Severe Obstetric Complications (All)
Risk Adjusted Severe Obstetric Complications (excluding blood-transfusion-only cases)
Maternal Morbidity Structural MeasureYes

Frequently asked questions

How is Baylor Scott & White Medical Center at Irving rated?
Baylor Scott & White Medical Center at Irving has a 5 out of 5 CMS overall star rating as of the latest CMS release.
Does Baylor Scott & White Medical Center at Irving have emergency services?
Yes. Baylor Scott & White Medical Center at Irving operates a 24/7 emergency department.
Where is Baylor Scott & White Medical Center at Irving located?
Baylor Scott & White Medical Center at Irving is located at 1901 N Macarthur Blvd, Irving, TX 75061.
What type of hospital is Baylor Scott & White Medical Center at Irving?
Baylor Scott & White Medical Center at Irving is classified by CMS as a Acute Care Hospitals facility (Voluntary non-profit - Private).

Data as of 2026-06-14. Source: CMS Provider Data Catalog. This is public data provided for informational purposes only and is not medical advice. See our methodology and editorial policy.

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