JCIPatientSafety.orgHospital Quality Directory

Acute Care Hospitals · Proprietary

Elmhurst Memorial Hospital

3 / 5

At a glance

Elmhurst Memorial Hospital carries a 3-star CMS overall rating — in line with 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 LimitBetter than national
Central Line Associated Bloodstream Infection (ICU + select Wards): Upper Confidence Limit0.361Better than national
Central Line Associated Bloodstream Infection: Number of Device Days10477Better than national
Central Line Associated Bloodstream Infection (ICU + select Wards): Predicted Cases8.300Better than national
Central Line Associated Bloodstream Infection (ICU + select Wards): Observed Cases0Better than national
Central Line Associated Bloodstream Infection (ICU + select Wards)0.000Better than national
Catheter Associated Urinary Tract Infections (ICU + select Wards): Lower Confidence Limit0.211Same as national
Catheter Associated Urinary Tract Infections (ICU + select Wards): Upper Confidence Limit1.278Same as national
Catheter Associated Urinary Tract Infections (ICU + select Wards): Number of Urinary Catheter Days10089Same as national
Catheter Associated Urinary Tract Infections (ICU + select Wards): Predicted Cases8.673Same as national
Catheter Associated Urinary Tract Infections (ICU + select Wards): Observed Cases5Same as national
Catheter Associated Urinary Tract Infections (ICU + select Wards)0.577Same as national
SSI - Colon Surgery: Lower Confidence Limit0.067Same as national
SSI - Colon Surgery: Upper Confidence Limit1.330Same as national
SSI - Colon Surgery: Number of Procedures187Same as national
SSI - Colon Surgery: Predicted Cases4.968Same as national
SSI - Colon Surgery: Observed Cases2Same as national
SSI - Colon Surgery0.403Same as national
SSI - Abdominal Hysterectomy: Lower Confidence LimitSame as national
SSI - Abdominal Hysterectomy: Upper Confidence Limit1.987Same as national
SSI - Abdominal Hysterectomy: Number of Procedures186Same as national
SSI - Abdominal Hysterectomy: Predicted Cases1.508Same as national
SSI - Abdominal Hysterectomy: Observed Cases0Same as national
SSI - Abdominal Hysterectomy0.000Same as national
MRSA Bacteremia: Lower Confidence Limit0.687Same as national
MRSA Bacteremia: Upper Confidence Limit3.525Same as national
MRSA Bacteremia: Patient Days89756Same as national
MRSA Bacteremia: Predicted Cases3.540Same as national
MRSA Bacteremia: Observed Cases6Same as national
MRSA Bacteremia1.695Same as national
Clostridium Difficile (C.Diff): Lower Confidence Limit0.018Better than national
Clostridium Difficile (C.Diff): Upper Confidence Limit0.190Better than national
Clostridium Difficile (C.Diff): Patient Days87674Better than national
Clostridium Difficile (C.Diff): Predicted Cases42.898Better than national
Clostridium Difficile (C.Diff): Observed Cases3Better than national
Clostridium Difficile (C.Diff)0.070Better 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 patients4Same as national898
Hybrid Hospital-Wide All-Cause Risk Standardized Mortality Rate4.9Same as national3006
Death rate for heart attack patients11.2Same as national184
Death rate for CABG surgery patients2.5Same as national96
Death rate for COPD patients7.1Same as national279
Death rate for heart failure patients9.7Better than national962
Death rate for pneumonia patients17.2Same as national719
Death rate for stroke patients13.6Same as national313
Pressure ulcer rate0.11Same as national9604
Death rate among surgical inpatients with serious treatable complications172.32Same as national99
Iatrogenic pneumothorax rate0.20Same as national11578
In-hospital fall-associated fracture rate0.27Same as national11653
Postoperative hemorrhage or hematoma rate1.67Same as national3562
Postoperative acute kidney injury requiring dialysis rate1.58Same as national2294
Postoperative respiratory failure rate11.34Same as national2333
Perioperative pulmonary embolism or deep vein thrombosis rate5.23Worse than national3685
Postoperative sepsis rate3.54Same as national2266
Postoperative wound dehiscence rate1.59Same as national645
Abdominopelvic accidental puncture or laceration rate1.04Same as national2267
CMS Medicare PSI 90: Patient safety and adverse events composite0.89Same 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 patients23.8Not available181
Hospital return days for heart failure patients15.3Not available1124
Hospital return days for pneumonia patients24.1Not available758
Hybrid Hospital-Wide All-Cause Readmission Measure (HWR)15.7Same as national4725
Rate of unplanned hospital visits after colonoscopy (per 1,000 colonoscopies)11.9Same as national2039
Rate of inpatient admissions for patients receiving outpatient chemotherapy11Same as national293
Rate of emergency department (ED) visits for patients receiving outpatient chemotherapy4.3Same as national293
Ratio of unplanned hospital visits after hospital outpatient surgery0.9Same as national1105
Acute Myocardial Infarction (AMI) 30-Day Readmission Rate14.4Same as national181
Rate of readmission for CABG11.2Same as national96
Rate of readmission for chronic obstructive pulmonary disease (COPD) patients18.1Same as national321
Heart failure (HF) 30-Day Readmission Rate21.5Same as national1124
Rate of readmission after hip/knee replacement5.2Same as national894
Pneumonia (PN) 30-Day Readmission Rate16.9Same as national758

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 rating41238
Doctor communication - star rating31238
Communication about medicines - star rating21238
Discharge information - star rating31238
Cleanliness - star rating31238
Quietness - star rating41238
Overall hospital rating - star rating41238
Recommend hospital - star rating41238
Summary star rating31238

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 Hypoglycemia14642
Hospital Harm - Opioid Related Adverse Events
Healthcare workers given influenza vaccination944367
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 better171407
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 better168392
Average (median) time psychiatric/mental health patients spent in the emergency department before leaving from the visit. A lower number of minutes is better24813
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 seen189449
Head CT results6411
Endoscopy/polyp surveillance: appropriate follow-up interval for normal colonoscopy in average risk patients10072
Improvement in Patient's Visual Function within 90 Days Following Cataract Surgery
ST-Segment Elevation Myocardial Infarction (STEMI)5052
Safe Use of Opioids - Concurrent Prescribing184979
Appropriate care for severe sepsis and septic shock64190
Septic Shock 3-Hour Bundle7573
Septic Shock 6-Hour Bundle8045
Severe Sepsis 3-Hour Bundle82190
Severe Sepsis 6-Hour Bundle98120
Discharged on Antithrombotic Therapy99298
Anticoagulation Therapy for Atrial Fibrillation/Flutter7670
Antithrombotic Therapy by End of Hospital Day 2
Venous Thromboembolism Prophylaxis
Intensive Care Unit Venous Thromboembolism Prophylaxis

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 Elmhurst Memorial Hospital rated?
Elmhurst Memorial Hospital has a 3 out of 5 CMS overall star rating as of the latest CMS release.
Does Elmhurst Memorial Hospital have emergency services?
Yes. Elmhurst Memorial Hospital operates a 24/7 emergency department.
Where is Elmhurst Memorial Hospital located?
Elmhurst Memorial Hospital is located at 155 East Brush Hill Road, Elmhurst, IL 60126.
What type of hospital is Elmhurst Memorial Hospital?
Elmhurst Memorial Hospital is classified by CMS as a Acute Care Hospitals facility (Proprietary).

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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