JCIPatientSafety.orgHospital Quality Directory

Acute Care Hospitals · Government - Local

Phelps County Regional Medical Center

2 / 5

At a glance

Phelps County Regional Medical Center 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 Limit0.436Same as national
Central Line Associated Bloodstream Infection (ICU + select Wards): Upper Confidence Limit3.313Same as national
Central Line Associated Bloodstream Infection: Number of Device Days4317Same as national
Central Line Associated Bloodstream Infection (ICU + select Wards): Predicted Cases2.912Same as national
Central Line Associated Bloodstream Infection (ICU + select Wards): Observed Cases4Same as national
Central Line Associated Bloodstream Infection (ICU + select Wards)1.374Same as national
Catheter Associated Urinary Tract Infections (ICU + select Wards): Lower Confidence Limit0.218Same as national
Catheter Associated Urinary Tract Infections (ICU + select Wards): Upper Confidence Limit2.336Same as national
Catheter Associated Urinary Tract Infections (ICU + select Wards): Number of Urinary Catheter Days4914Same as national
Catheter Associated Urinary Tract Infections (ICU + select Wards): Predicted Cases3.495Same as national
Catheter Associated Urinary Tract Infections (ICU + select Wards): Observed Cases3Same as national
Catheter Associated Urinary Tract Infections (ICU + select Wards)0.858Same as national
SSI - Colon Surgery: Lower Confidence Limit0.166Same as national
SSI - Colon Surgery: Upper Confidence Limit3.279Same as national
SSI - Colon Surgery: Number of Procedures76Same as national
SSI - Colon Surgery: Predicted Cases2.015Same as national
SSI - Colon Surgery: Observed Cases2Same as national
SSI - Colon Surgery0.993Same as national
SSI - Abdominal Hysterectomy: Lower Confidence LimitNot available
SSI - Abdominal Hysterectomy: Upper Confidence LimitNot available
SSI - Abdominal Hysterectomy: Number of Procedures6Not available
SSI - Abdominal Hysterectomy: Predicted Cases0.077Not available
SSI - Abdominal Hysterectomy: Observed Cases0Not available
SSI - Abdominal HysterectomyNot available
MRSA Bacteremia: Lower Confidence Limit0.023Same as national
MRSA Bacteremia: Upper Confidence Limit2.274Same as national
MRSA Bacteremia: Patient Days39561Same as national
MRSA Bacteremia: Predicted Cases2.169Same as national
MRSA Bacteremia: Observed Cases1Same as national
MRSA Bacteremia0.461Same as national
Clostridium Difficile (C.Diff): Lower Confidence Limit0.125Better than national
Clostridium Difficile (C.Diff): Upper Confidence Limit0.644Better than national
Clostridium Difficile (C.Diff): Patient Days37956Better than national
Clostridium Difficile (C.Diff): Predicted Cases19.378Better than national
Clostridium Difficile (C.Diff): Observed Cases6Better than national
Clostridium Difficile (C.Diff)0.310Better 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 patients4.8Same as national75
Hybrid Hospital-Wide All-Cause Risk Standardized Mortality Rate4.6Same as national752
Death rate for heart attack patients11.9Same as national101
Death rate for CABG surgery patientsNot available
Death rate for COPD patients11.3Same as national131
Death rate for heart failure patients15.2Worse than national276
Death rate for pneumonia patients18.7Same as national295
Death rate for stroke patients13.4Same as national59
Pressure ulcer rate0.28Same as national2295
Death rate among surgical inpatients with serious treatable complications190.73Same as national30
Iatrogenic pneumothorax rate0.18Same as national3410
In-hospital fall-associated fracture rate0.28Same as national3315
Postoperative hemorrhage or hematoma rate2.15Same as national548
Postoperative acute kidney injury requiring dialysis rate1.63Same as national128
Postoperative respiratory failure rate10.13Same as national134
Perioperative pulmonary embolism or deep vein thrombosis rate2.78Same as national572
Postoperative sepsis rate5.80Same as national118
Postoperative wound dehiscence rate1.70Same as national76
Abdominopelvic accidental puncture or laceration rate0.97Same as national267
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 patients-0.7Not available90
Hospital return days for heart failure patients26.1Not available337
Hospital return days for pneumonia patients36Not available311
Hybrid Hospital-Wide All-Cause Readmission Measure (HWR)16.2Same as national1137
Rate of unplanned hospital visits after colonoscopy (per 1,000 colonoscopies)12.9Same as national886
Rate of inpatient admissions for patients receiving outpatient chemotherapy11.7Same as national130
Rate of emergency department (ED) visits for patients receiving outpatient chemotherapy5.8Same as national130
Ratio of unplanned hospital visits after hospital outpatient surgery0.9Same as national362
Acute Myocardial Infarction (AMI) 30-Day Readmission Rate13.7Same as national90
Rate of readmission for CABGNot available
Rate of readmission for chronic obstructive pulmonary disease (COPD) patients18.8Same as national130
Heart failure (HF) 30-Day Readmission Rate21.9Same as national337
Rate of readmission after hip/knee replacement5.1Same as national71
Pneumonia (PN) 30-Day Readmission Rate17.9Same as national311

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 rating3510
Doctor communication - star rating3510
Communication about medicines - star rating2510
Discharge information - star rating4510
Cleanliness - star rating3510
Quietness - star rating3510
Overall hospital rating - star rating3510
Recommend hospital - star rating4510
Summary star rating3510

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 volumemedium
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 vaccination792161
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 better215376
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 better212344
Average (median) time psychiatric/mental health patients spent in the emergency department before leaving from the visit. A lower number of minutes is better25721
Average (median) time patients spent in the emergency department before being transferred to another facility. A lower number of minutes is better47112
Left before being seen233171
Head CT results6526
Endoscopy/polyp surveillance: appropriate follow-up interval for normal colonoscopy in average risk patients8567
Improvement in Patient's Visual Function within 90 Days Following Cataract Surgery
ST-Segment Elevation Myocardial Infarction (STEMI)
Safe Use of Opioids - Concurrent Prescribing241358
Appropriate care for severe sepsis and septic shock54511
Septic Shock 3-Hour Bundle69111
Septic Shock 6-Hour Bundle9432
Severe Sepsis 3-Hour Bundle61511
Severe Sepsis 6-Hour Bundle99209
Discharged on Antithrombotic Therapy9654
Anticoagulation Therapy for Atrial Fibrillation/Flutter
Antithrombotic Therapy by End of Hospital Day 29653
Venous Thromboembolism Prophylaxis
Intensive Care Unit Venous Thromboembolism Prophylaxis90682

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 Phelps County Regional Medical Center rated?
Phelps County Regional Medical Center has a 2 out of 5 CMS overall star rating as of the latest CMS release.
Does Phelps County Regional Medical Center have emergency services?
Yes. Phelps County Regional Medical Center operates a 24/7 emergency department.
Where is Phelps County Regional Medical Center located?
Phelps County Regional Medical Center is located at 1000 W 10th St, Rolla, MO 65401.
What type of hospital is Phelps County Regional Medical Center?
Phelps County Regional Medical Center is classified by CMS as a Acute Care Hospitals facility (Government - Local).

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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