JCIPatientSafety.orgHospital Quality Directory

Acute Care Hospitals · Proprietary

Hospital Pavia Santurce

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At a glance

Hospital Pavia Santurce carries a 1-star CMS overall rating — below the national norm. On healthcare-associated infection measures, it performs better than the national average on 0 and worse on 12.

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 Limit1.003Worse than national
Central Line Associated Bloodstream Infection (ICU + select Wards): Upper Confidence Limit4.102Worse than national
Central Line Associated Bloodstream Infection: Number of Device Days5320Worse than national
Central Line Associated Bloodstream Infection (ICU + select Wards): Predicted Cases3.703Worse than national
Central Line Associated Bloodstream Infection (ICU + select Wards): Observed Cases8Worse than national
Central Line Associated Bloodstream Infection (ICU + select Wards)2.160Worse than national
Catheter Associated Urinary Tract Infections (ICU + select Wards): Lower Confidence Limit1.289Worse than national
Catheter Associated Urinary Tract Infections (ICU + select Wards): Upper Confidence Limit3.710Worse than national
Catheter Associated Urinary Tract Infections (ICU + select Wards): Number of Urinary Catheter Days8395Worse than national
Catheter Associated Urinary Tract Infections (ICU + select Wards): Predicted Cases6.181Worse than national
Catheter Associated Urinary Tract Infections (ICU + select Wards): Observed Cases14Worse than national
Catheter Associated Urinary Tract Infections (ICU + select Wards)2.265Worse than national
SSI - Colon Surgery: Lower Confidence LimitNot available
SSI - Colon Surgery: Upper Confidence LimitNot available
SSI - Colon Surgery: Number of Procedures5Not available
SSI - Colon Surgery: Predicted Cases0.117Not available
SSI - Colon Surgery: Observed Cases0Not available
SSI - Colon SurgeryNot available
SSI - Abdominal Hysterectomy: Lower Confidence LimitNot available
SSI - Abdominal Hysterectomy: Upper Confidence LimitNot available
SSI - Abdominal Hysterectomy: Number of Procedures83Not available
SSI - Abdominal Hysterectomy: Predicted Cases0.563Not available
SSI - Abdominal Hysterectomy: Observed Cases2Not available
SSI - Abdominal HysterectomyNot available
MRSA Bacteremia: Lower Confidence LimitNot available
MRSA Bacteremia: Upper Confidence LimitNot available
MRSA Bacteremia: Patient Days10518Not available
MRSA Bacteremia: Predicted Cases0.390Not available
MRSA Bacteremia: Observed Cases0Not available
MRSA BacteremiaNot available
Clostridium Difficile (C.Diff): Lower Confidence LimitNot available
Clostridium Difficile (C.Diff): Upper Confidence LimitNot available
Clostridium Difficile (C.Diff): Patient DaysNot available
Clostridium Difficile (C.Diff): Predicted CasesNot available
Clostridium Difficile (C.Diff): Observed CasesNot available
Clostridium Difficile (C.Diff)Not available

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 Rate4.9Same as national213
Death rate for heart attack patients13.5Same as national47
Death rate for CABG surgery patientsNot available
Death rate for COPD patientsNot available
Death rate for heart failure patients10.4Same as national33
Death rate for pneumonia patients22.8Same as national33
Death rate for stroke patientsNot available
Pressure ulcer rateNot available
Death rate among surgical inpatients with serious treatable complicationsNot available
Iatrogenic pneumothorax rateNot available
In-hospital fall-associated fracture rateNot available
Postoperative hemorrhage or hematoma rateNot available
Postoperative acute kidney injury requiring dialysis rateNot available
Postoperative respiratory failure rateNot available
Perioperative pulmonary embolism or deep vein thrombosis rateNot available
Postoperative sepsis rateNot available
Postoperative wound dehiscence rateNot available
Abdominopelvic accidental puncture or laceration rateNot available
CMS Medicare PSI 90: Patient safety and adverse events compositeNot available

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 patients59.5Not available50
Hospital return days for heart failure patients33.5Not available39
Hospital return days for pneumonia patients-30.9Not available31
Hybrid Hospital-Wide All-Cause Readmission Measure (HWR)15.7Same as national320
Rate of unplanned hospital visits after colonoscopy (per 1,000 colonoscopies)12.8Same as national33
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 surgery0.9Same as national34
Acute Myocardial Infarction (AMI) 30-Day Readmission Rate13.7Same as national50
Rate of readmission for CABGNot available
Rate of readmission for chronic obstructive pulmonary disease (COPD) patientsNot available
Heart failure (HF) 30-Day Readmission Rate20.5Same as national39
Rate of readmission after hip/knee replacementNot available
Pneumonia (PN) 30-Day Readmission Rate15.7Same as national31

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

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 volume
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 vaccination67598
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 better
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 better
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 seen
Head CT results
Endoscopy/polyp surveillance: appropriate follow-up interval for normal colonoscopy in average risk patients
Improvement in Patient's Visual Function within 90 Days Following Cataract Surgery
ST-Segment Elevation Myocardial Infarction (STEMI)
Safe Use of Opioids - Concurrent Prescribing
Appropriate care for severe sepsis and septic shock1087
Septic Shock 3-Hour Bundle
Septic Shock 6-Hour Bundle
Severe Sepsis 3-Hour Bundle2487
Severe Sepsis 6-Hour Bundle011
Discharged on Antithrombotic Therapy
Anticoagulation Therapy for Atrial Fibrillation/Flutter
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 Measure

Frequently asked questions

How is Hospital Pavia Santurce rated?
Hospital Pavia Santurce has a 1 out of 5 CMS overall star rating as of the latest CMS release.
Does Hospital Pavia Santurce have emergency services?
Yes. Hospital Pavia Santurce operates a 24/7 emergency department.
Where is Hospital Pavia Santurce located?
Hospital Pavia Santurce is located at Street Profesor Augusto Rodriguez #1462, San Juan, PR 00910.
What type of hospital is Hospital Pavia Santurce?
Hospital Pavia Santurce 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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