JCIPatientSafety.orgHospital Quality Directory

Acute Care Hospitals · Voluntary non-profit - Private

Southwest General Health Center

4 / 5

At a glance

Southwest General Health Center carries a 4-star CMS overall rating — above 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 Limit0.096Same as national
Central Line Associated Bloodstream Infection (ICU + select Wards): Upper Confidence Limit1.898Same as national
Central Line Associated Bloodstream Infection: Number of Device Days4332Same as national
Central Line Associated Bloodstream Infection (ICU + select Wards): Predicted Cases3.482Same as national
Central Line Associated Bloodstream Infection (ICU + select Wards): Observed Cases2Same as national
Central Line Associated Bloodstream Infection (ICU + select Wards)0.574Same as national
Catheter Associated Urinary Tract Infections (ICU + select Wards): Lower Confidence Limit0.272Same as national
Catheter Associated Urinary Tract Infections (ICU + select Wards): Upper Confidence Limit1.645Same as national
Catheter Associated Urinary Tract Infections (ICU + select Wards): Number of Urinary Catheter Days7739Same as national
Catheter Associated Urinary Tract Infections (ICU + select Wards): Predicted Cases6.739Same as national
Catheter Associated Urinary Tract Infections (ICU + select Wards): Observed Cases5Same as national
Catheter Associated Urinary Tract Infections (ICU + select Wards)0.742Same as national
SSI - Colon Surgery: Lower Confidence Limit0.015Same as national
SSI - Colon Surgery: Upper Confidence Limit1.526Same as national
SSI - Colon Surgery: Number of Procedures125Same as national
SSI - Colon Surgery: Predicted Cases3.232Same as national
SSI - Colon Surgery: Observed Cases1Same as national
SSI - Colon Surgery0.309Same as national
SSI - Abdominal Hysterectomy: Lower Confidence LimitNot available
SSI - Abdominal Hysterectomy: Upper Confidence LimitNot available
SSI - Abdominal Hysterectomy: Number of Procedures107Not available
SSI - Abdominal Hysterectomy: Predicted Cases0.841Not available
SSI - Abdominal Hysterectomy: Observed Cases2Not available
SSI - Abdominal HysterectomyNot available
MRSA Bacteremia: Lower Confidence LimitSame as national
MRSA Bacteremia: Upper Confidence Limit1.031Same as national
MRSA Bacteremia: Patient Days47470Same as national
MRSA Bacteremia: Predicted Cases2.907Same as national
MRSA Bacteremia: Observed Cases0Same as national
MRSA Bacteremia0.000Same as national
Clostridium Difficile (C.Diff): Lower Confidence Limit0.171Better than national
Clostridium Difficile (C.Diff): Upper Confidence Limit0.698Better than national
Clostridium Difficile (C.Diff): Patient Days44870Better than national
Clostridium Difficile (C.Diff): Predicted Cases21.776Better than national
Clostridium Difficile (C.Diff): Observed Cases8Better than national
Clostridium Difficile (C.Diff)0.367Better 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 patients2.2Same as national263
Hybrid Hospital-Wide All-Cause Risk Standardized Mortality Rate3.8Same as national1828
Death rate for heart attack patients11.4Same as national172
Death rate for CABG surgery patientsNot available
Death rate for COPD patients6.9Same as national218
Death rate for heart failure patients10.6Same as national392
Death rate for pneumonia patients13.8Same as national515
Death rate for stroke patients14.4Same as national187
Pressure ulcer rate1.40Worse than national6012
Death rate among surgical inpatients with serious treatable complications156.60Same as national72
Iatrogenic pneumothorax rate0.30Same as national7102
In-hospital fall-associated fracture rate0.32Same as national7306
Postoperative hemorrhage or hematoma rate2.49Same as national1266
Postoperative acute kidney injury requiring dialysis rate1.76Same as national635
Postoperative respiratory failure rate13.44Same as national672
Perioperative pulmonary embolism or deep vein thrombosis rate3.79Same as national1216
Postoperative sepsis rate5.39Same as national436
Postoperative wound dehiscence rate1.57Same as national373
Abdominopelvic accidental puncture or laceration rate2.06Worse than national1423
CMS Medicare PSI 90: Patient safety and adverse events composite1.40Worse than 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 patients30.8Not available165
Hospital return days for heart failure patients-0.2Not available427
Hospital return days for pneumonia patients2.9Not available545
Hybrid Hospital-Wide All-Cause Readmission Measure (HWR)15.2Same as national2998
Rate of unplanned hospital visits after colonoscopy (per 1,000 colonoscopies)13Same as national2550
Rate of inpatient admissions for patients receiving outpatient chemotherapy13.3Same as national121
Rate of emergency department (ED) visits for patients receiving outpatient chemotherapy4.6Same as national121
Ratio of unplanned hospital visits after hospital outpatient surgery0.8Same as national878
Acute Myocardial Infarction (AMI) 30-Day Readmission Rate15.2Same as national165
Rate of readmission for CABGNot available
Rate of readmission for chronic obstructive pulmonary disease (COPD) patients18.1Same as national236
Heart failure (HF) 30-Day Readmission Rate21.1Same as national427
Rate of readmission after hip/knee replacement5.6Same as national255
Pneumonia (PN) 30-Day Readmission Rate17.4Same as national545

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 rating41254
Doctor communication - star rating31254
Communication about medicines - star rating21254
Discharge information - star rating31254
Cleanliness - star rating21254
Quietness - star rating31254
Overall hospital rating - star rating41254
Recommend hospital - star rating41254
Summary star rating31254

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 Events06976
Healthcare workers given influenza vaccination532942
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 better199403
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 better199378
Average (median) time psychiatric/mental health patients spent in the emergency department before leaving from the visit. A lower number of minutes is better18821
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 seen536871
Head CT results9431
Endoscopy/polyp surveillance: appropriate follow-up interval for normal colonoscopy in average risk patients9973
Improvement in Patient's Visual Function within 90 Days Following Cataract Surgery
ST-Segment Elevation Myocardial Infarction (STEMI)
Safe Use of Opioids - Concurrent Prescribing132982
Appropriate care for severe sepsis and septic shock89319
Septic Shock 3-Hour Bundle92147
Septic Shock 6-Hour Bundle99120
Severe Sepsis 3-Hour Bundle94319
Severe Sepsis 6-Hour Bundle99213
Discharged on Antithrombotic Therapy98171
Anticoagulation Therapy for Atrial Fibrillation/Flutter
Antithrombotic Therapy by End of Hospital Day 294153
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 Southwest General Health Center rated?
Southwest General Health Center has a 4 out of 5 CMS overall star rating as of the latest CMS release.
Does Southwest General Health Center have emergency services?
Yes. Southwest General Health Center operates a 24/7 emergency department.
Where is Southwest General Health Center located?
Southwest General Health Center is located at 18697 Bagley Road, Middleburg Heights, OH 44130.
What type of hospital is Southwest General Health Center?
Southwest General Health Center 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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