JCIPatientSafety.orgHospital Quality Directory

Acute Care Hospitals · Voluntary non-profit - Private

Nazareth Hospital

2 / 5

At a glance

Nazareth Hospital carries a 2-star CMS overall rating — below the national norm. On healthcare-associated infection measures, it performs better than the national average on 6 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 Limit0.247Same as national
Central Line Associated Bloodstream Infection (ICU + select Wards): Upper Confidence Limit4.859Same as national
Central Line Associated Bloodstream Infection: Number of Device Days1387Same as national
Central Line Associated Bloodstream Infection (ICU + select Wards): Predicted Cases1.360Same as national
Central Line Associated Bloodstream Infection (ICU + select Wards): Observed Cases2Same as national
Central Line Associated Bloodstream Infection (ICU + select Wards)1.471Same as national
Catheter Associated Urinary Tract Infections (ICU + select Wards): Lower Confidence Limit0.027Same as national
Catheter Associated Urinary Tract Infections (ICU + select Wards): Upper Confidence Limit2.673Same as national
Catheter Associated Urinary Tract Infections (ICU + select Wards): Number of Urinary Catheter Days1735Same as national
Catheter Associated Urinary Tract Infections (ICU + select Wards): Predicted Cases1.845Same as national
Catheter Associated Urinary Tract Infections (ICU + select Wards): Observed Cases1Same as national
Catheter Associated Urinary Tract Infections (ICU + select Wards)0.542Same as national
SSI - Colon Surgery: Lower Confidence LimitNot available
SSI - Colon Surgery: Upper Confidence LimitNot available
SSI - Colon Surgery: Number of Procedures26Not available
SSI - Colon Surgery: Predicted Cases0.773Not 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 ProceduresNot available
SSI - Abdominal Hysterectomy: Predicted CasesNot available
SSI - Abdominal Hysterectomy: Observed CasesNot available
SSI - Abdominal HysterectomyNot available
MRSA Bacteremia: Lower Confidence Limit0.202Same as national
MRSA Bacteremia: Upper Confidence Limit3.978Same as national
MRSA Bacteremia: Patient Days33099Same as national
MRSA Bacteremia: Predicted Cases1.661Same as national
MRSA Bacteremia: Observed Cases2Same as national
MRSA Bacteremia1.204Same as national
Clostridium Difficile (C.Diff): Lower Confidence Limit0.172Better than national
Clostridium Difficile (C.Diff): Upper Confidence Limit0.885Better than national
Clostridium Difficile (C.Diff): Patient Days33099Better than national
Clostridium Difficile (C.Diff): Predicted Cases14.104Better than national
Clostridium Difficile (C.Diff): Observed Cases6Better than national
Clostridium Difficile (C.Diff)0.425Better 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 Rate4.4Same as national593
Death rate for heart attack patients13.5Same as national76
Death rate for CABG surgery patientsNot available
Death rate for COPD patients8.8Same as national86
Death rate for heart failure patients12.8Same as national229
Death rate for pneumonia patients16.4Same as national244
Death rate for stroke patients12.3Same as national87
Pressure ulcer rate0.21Same as national2671
Death rate among surgical inpatients with serious treatable complicationsNot available
Iatrogenic pneumothorax rate0.18Same as national3136
In-hospital fall-associated fracture rate0.28Same as national3249
Postoperative hemorrhage or hematoma rate2.10Same as national324
Postoperative acute kidney injury requiring dialysis rate1.66Same as national39
Postoperative respiratory failure rate8.67Same as national39
Perioperative pulmonary embolism or deep vein thrombosis rate4.36Same as national335
Postoperative sepsis rate5.13Same as national26
Postoperative wound dehiscence rate1.73Same as national52
Abdominopelvic accidental puncture or laceration rate0.96Same as national598
CMS Medicare PSI 90: Patient safety and adverse events composite0.88Same 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 patients30.6Not available54
Hospital return days for heart failure patients-8.7Not available251
Hospital return days for pneumonia patients-6.9Not available248
Hybrid Hospital-Wide All-Cause Readmission Measure (HWR)14.5Same as national964
Rate of unplanned hospital visits after colonoscopy (per 1,000 colonoscopies)12.2Same as national163
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 surgeryNot available
Acute Myocardial Infarction (AMI) 30-Day Readmission Rate13.8Same as national54
Rate of readmission for CABGNot available
Rate of readmission for chronic obstructive pulmonary disease (COPD) patients18.7Same as national98
Heart failure (HF) 30-Day Readmission Rate18.1Same as national251
Rate of readmission after hip/knee replacementNot available
Pneumonia (PN) 30-Day Readmission Rate15.6Same as national248

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 rating2404
Doctor communication - star rating2404
Communication about medicines - star rating2404
Discharge information - star rating3404
Cleanliness - star rating1404
Quietness - star rating2404
Overall hospital rating - star rating2404
Recommend hospital - star rating1404
Summary star rating2404

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 volumehigh
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 vaccination472060
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 better219415
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 better216395
Average (median) time psychiatric/mental health patients spent in the emergency department before leaving from the visit. A lower number of minutes is better39617
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 seen447449
Head CT results7713
Endoscopy/polyp surveillance: appropriate follow-up interval for normal colonoscopy in average risk patients9021
Improvement in Patient's Visual Function within 90 Days Following Cataract Surgery
ST-Segment Elevation Myocardial Infarction (STEMI)
Safe Use of Opioids - Concurrent Prescribing17884
Appropriate care for severe sepsis and septic shock82173
Septic Shock 3-Hour Bundle9564
Septic Shock 6-Hour Bundle10049
Severe Sepsis 3-Hour Bundle86173
Severe Sepsis 6-Hour Bundle95110
Discharged on Antithrombotic Therapy99146
Anticoagulation Therapy for Atrial Fibrillation/Flutter5836
Antithrombotic Therapy by End of Hospital Day 299128
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 MeasureNo

Frequently asked questions

How is Nazareth Hospital rated?
Nazareth Hospital has a 2 out of 5 CMS overall star rating as of the latest CMS release.
Does Nazareth Hospital have emergency services?
Yes. Nazareth Hospital operates a 24/7 emergency department.
Where is Nazareth Hospital located?
Nazareth Hospital is located at 2601 Holme Ave, Philadelphia, PA 19152.
What type of hospital is Nazareth Hospital?
Nazareth Hospital 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.

Report an issue with this page