Ivo Fattorini, director of the Paediatrics Ward of the Faculty of Medicine, University of Zagreb With the assistance and suggestions of 14 prominent physicians, Nacional has selected the best medical wards in Croatia. This process has been ongoing for several months and during this period, we spoke with numerous experts and patients, analysed the work of twenty hospitals which in fact proved that these are centres of excellent in our national medicine. The basic conclusion is that though the Croatian health care system faces numerous difficulties and affairs, there are clinics and, more importantly, staff that achieve top results, similar to those in the most developed countries. Some seventy wards were considered and the best sixteen amongst them selected. At first glance, it is evident that the majority of these clinics are in Zagreb, with only three outside the capital: the Split Clinical Hospital Centre, where Eduard Vrdoljak has established a top-rate oncology department, Magdalena in Krapinske Toplice where the most complicated heart operations are carried out and Varazdinske Toplice with its excellent rehabilitation program.

In addition to the opinions of the informal panel of doctors, Nacional applied the criteria that have for years been used in the US News & World Report, an American magazine which for the past two decades has been selecting the nation’s best health care facilities. Among the criteria were the number of university professors and leading physicians working in the ward, the number of patients, the complexity of the operations and results achieved, the length of hospital stay and the patients’ opinions about the physicians and nurses.

Our research, though, showed that there is something else that links these top clinics, the top quality within. Another good thing is that fact that there were minimal differences among many clinics, proving that there are a larger number of excellent health care centres. As such, the oncology ward in Split was assessed better by a hair that its counterpart in Zagreb’s Rebro Hospital. In cardiology, the differences between Zagreb Clinical Hospital, Dubrava Clinical Hospital and Magdalena were minimal. The orthopaedics ward in Lovran was only slightly behind that in Zagreb while first-rate rehabilitation is provided in both Varazdin and Krapinske Toplice, as well as in Thalassoterapija and Terme Selce. All the leading wards are run by internationally recognized physicians. For the past 16 years, the top American clinics are rated by the magazine US News & World Report. This is a massive research project assessing 6007 medical centres including 176 elite hospitals. However, even among the top medical systems like those in the US, a number of medical institutions stood out as the best of the best. 16 fields of medicines were ranked, from oncology and cardiology to psychiatry and veterans’ medicine. John Hopkins in Baltimore was rated the best hospital in the US with its wards among the top in all 16 fields.

The Mayo Clinic in Rochester was ranked second and Boston’s Massachusetts Hospital third. The rest of the top ten was rounded out with: Cleveland Clinic, UCLA Medical Center, Barnes - Jewish Hospital (St. Louis), New York - Presbyterian University Hospital, Duke University Medical Center (Durham), University of Washington Medical Center (Seattle) and the University of San Francisco Medical Center.

The critera for ranking medical clinics: Fourteen of the top experts in the field of medicine and sciences assessed the clinics based on 1. number of annual examinations and operations, ranked by weight of disease and success of therapy. 2. number of doctors and professors operating or examining more than 200 patients per year, as they are the only ones capable of properly operating or treating. 3. number of doctors also with universities, as this provides the opportunity for further learning at congresses. 4. number of specialists learning from these doctors, involvement of the hospital/warn in the educational process at universities and colleges. 5. number of papers cited in current contents in the past five to seven years and their citation index in the international literature. 6. number of projects led by hospital and ward staff. 7. number of staff having undergone training in internationally recognized expert and health care institutions in the EU and US. 8. Published textbooks. 9. Equipment of the ward for adequate diagnostics and treatment. 10. Ward operations without financial losses. 11. Procurement of medical equipment at the usual prices and without affairs. 12. patients assessments through patient questionnaires (doctor attitude, hospital food, quality of nurses, hygiene). 13. number of nurses per patient. 14. number of patients per room, number of patients per washroom. 15. quality of infrastructure: informatization and quality of electronic data archiving.

First with the Doppler. Neurology Ward, Sestre Milosrdinice Clinical Hospital, assessed best of Croatia’s five neurology clinics. The ward cares for almost 40,000 patients a year for a wide spectrum of illnesses, the most common of which are cerebrovascular disease, stroke and epilepsy. First gamma knife. The best neurosurgery ward was assessed to be the Neurosurgery Ward of Rebro Hospital (Faculty of Medicine, University of Zagreb). Today this is the national referential centre for the Ministry of Health for Telemedicine and vascular illnesses of the brain and is the best such equipped clinic in Croatia. This is the only clinic in this part of Europe to have the gamma knife, which has led to the development of radiosurgery. Over 1800 operations are conducted in the clinic each year, including 250 with the gamma knife.

Tradition since the 19th century. Ear, Nose and Throat Surgery Ward, Sestre Milosrdinice Clinical Hospital. This is the oldest and largest ENT ward, founded in 1894 and opened by the Emperor Franz Joseph, when it was one of the rare hospitals in the world to have an ENT ward. “We were recently the first in Croatia to surgically build in hearing aids. We’ve also installed the largest number of cochlear implants in the entire region,” commented chief surgeon Pegan. Croatian pioneers in distance treatment. Of the four Croatian clinics, the Ophthalmology Clinic of the Sestre Milosrdinice Clinical Hospital was proclaimed the best. This is the oldest specialized eye clinic in Croatia and the region. It was among the first to conduct corneal transplants, laser cataract surgery and interocular lens implants. This was also the first ophthalmology clinic in Croatia to apply telemedicine, thanks to young doctors like Drazen Grgic, who applied his knowledge of modern technology.

Of the some 20 orthopaedic centres in Croatia, the best rated was the Orthopaedic Clinic of the Zagreb Clinical Hospital at Salata. Last year alone, 3300 patients were operated on, setting this clinic above the rest. The ward facilities are currently undergoing reconstruction to increase capacities and efficiency. The most common operations conducted in the clinic are joint replacements, predominantly knees and hips, with about 700 such operations each year. World class. The Clinic for Facial, Jaw and Mouth Surgery is among the best in Europe in terms of the complexity of operations conducted and their results. Each year, the team of 16 doctors conduct approximately 1500 operations, 23,000 outpatient examinations and some 3000 outpatient operations.

It is a little known fact that each year, several hundred people in Croatia are diagnosed with jaw cancer, an exceptionally high figure. Also, during the 1990s, a large number of complex war-related operations were carried out and therefore, it is no surprise that even doctors from the US, Germany, Switzerland and elsewhere come for training here. The clinic is run by Miso Virag, the first Croatian physician to be accepted into the Royal College of Surgeons. 18 years of heart transplants. The cardiology ward of Zagreb Clinical Hospital was rated the best cardiology clinic. The clinic conducted the first heart catheter surgery in 1950, only four years after the first such operation in the world. In 1978, the echocardiograph laboratory was established and the clinic soon became a referential centre for the European Cardiology Association and the World Health Organization, with over 700 domestic and foreign cardiologists trained here. “Our clinic has a team of 26 doctors treating over 4000 patients each year.

Of these, interventions on coronary arteries are conducted in more than 1000 and invasive diagnostics on some 3500 patients. We also have a ward for paediatric invasive cardiology, which is also the first of its kind in the country,” commented director Smalcelj. 98% success rate. Magdalena Hospital, thought be many to be the best cardiology clinic in Southeast Europe, opened 10 years ago and was the first private hospital in Croatia. Its objective was to bring together the best cardiologists. The hospital is known for its specialists and the quality of their work is best seen in the death rate of patients. “In terms of diagnostics, complications in our hospital are at a minimum, while the number of deaths is expressed in per mille. In therapeutic cardiology operations, our success rate is 98%. Last year, our mortality in coronary artery surgery was zero, less than 4% with heart valves and overall about 1.5%,” commented professor Sesto. Magdalena is also specific for its telemedicine. Masters of endoscopics. The Gastroenterology and Hepatology Clinic of Zagreb Clinical Hospital plays a dual role: it treats emergency patients for the areas of Novi Zagreb, Velika Gorica and Maksimir and serves as a tertiary centre for complex gastroenterological patients from throughout the country. The most common ailments are Crohn’s diseased and ulcerized colitis, chronic liver disease, malignant diseases of the digestive tract and complications in digestive tract disease. Last year, 2347 patients were admitted, 3500 outpatient examinations conducted, 15,000 endoscopic examinations an 2400 ultrasound and colour Doppler exams.

A large number of operations were also conducted: more than 500 polypectomies, 200 drainages, 400 liver biopsies, 250 percutaneous ethanol injections as tumour treatment, 100 dilatations of benign and malignant tumours and more. World-class care. The Nephrology and Arterial Hypertension Ward of the Zagreb Clinical Hospital includes a team of five specialists and one internal specialist. The ward is the referential clinic for glomular-tubular kidney disease and treats patients from all around the country. Despite the large volume of work and the insufficient number of doctors, in terms of therapeutics and diagnostics, this clinic is not at all lagging behind those in developed European countries. Oldest and largest gynaecological clinic. Zagreb’s Clinics for Women’s Health of the Zagreb Clinical Hospital and the Faculty of Medicine, University of Zagreb (Petrova Hospital).

This is the oldest and largest gynaecological clinic in this part of Europe and was the first clinic in the Balkans to use radium in the treatment of cervical cancer and the sixth in the world to deliver a test-tube baby 24 years ago. The work of the clinic is organized through four departments led by the best Croatian experts: the Department for Human Reproduction, the Department for Surgical Gynaecology and Urology, the Department for Gynaecological Oncology and the Department for Perinatal Medicine. Last year, there were 4130 deliveries in the ward, including 834 Caesarean sections, and 3322 operations, including 834 endoscopic. Experts for serious spinal injuries. The Varazdinske Toplice Special Hospital for Medicinal Rehabilitation was opened in 1957, however, treatments and medicinal treatments in this health facility date back to 1822. Today, this is Croatia’s best facility for the treatment of spinal injuries and disease, rheumatic, neurological and orthopaedic illnesses.

About 20,000 patients pass through the clinic each year. The hospital is equipped with the most up-to-date devices and is right in step with the best clinics in Europe. Integrated Paediatrics. The Children’s Hospital of the Faculty of Medicine, University of Zagreb, popularly called Klaiceva Hospital is Croatia’s most comprehensive hospital for the care of children under 18. Ivan Fattorini, Chief of Staff, states that the hospital is “the only health care institution in Croatia established on the principle of integrated paediatric medicine”. In addition to treating patients, the staff is also included in scientific research and education More than 11,500 children are hospitalized here annually, with 6500 operations and over 1,250,000 medical proceedings on over 250,000 patients. Against diabetes and infertility.

The University Clinic for Diabetes, Endocrinology and Metabolic Disorders “Vuk Vrhovac” started out as a Diabetic Counselling Centre in 1927, only five years after insulin was discovered in Canada. It was named after Dr. Vuk Vrhovac who underwent specialization in Canada and brought back and applied new knowledge about diabetes. The hospital stands out in the region as one of the best, and health care staff from around the world undergo education and training here. The well-known Croatian model has been applied in several countries: continued education and transfer of knowledge to all Croatian centres included in treating diabetics, in order to reduce the number of patients sent to the referential centre unnecessarily. Diabetes is on the rise in Croatia, with about 9.2% of the Croatian population suffering from this disease. Infertility is also an increasing problem and is treated at the clinic. href="mailto:robert.bajrusi@nacional.hr">email to:Rorbert Bajrusi>email to:Marina Bilus>email to:Stanko Boric>email to:Zeljko Rogosic>email to:Tanja Simic