According to the latest issue of Puget Sound Consumers' CHECKBOOK magazine, the area's top-rated emergency departments for both complex and simple urgent cases are at Children's Hospital & Regional Medical Center, Harborview Medical Center, and Swedish Medical Center-First Hill Campus.

CHECKBOOK collected more than 2,000 reports on emergency departments by surveying people who had used them, collected opinions from more than 300 area physicians, and collected detailed information on emergency department staffing to gauge the quality of care provided by local facilities.

CHECKBOOK advises that the first step for patients is to decide how urgent the case is.

• In the event of a life-threatening case such as heart attack, massive bleeding, or stopped or impaired breathing-cases where a patient or those helping a patient think there might be a risk of death or permanent disability if care isn't received within 30 minutes-CHECKBOOK's advice is simple: call 9-1-1 and let the ambulance crew decide where to take the patient.

• CHECKBOOK also offers simple advice for non-urgent cases-which include most sore backs, mild sore throats, painful bruises, and chronic complaints-that can await a visit to a clinic or a family doctor during regular hours: get better care and save money by waiting to see a personal physician during office hours.

• CHECKBOOK's ratings apply to patients with urgent cases that don't immediately endanger life or function but that can't wait for regular doctors' hours. For these cases, which might include unexplained abdominal pain, a laceration that appears to need stitches, or a high fever, CHECKBOOK advises patients to choose a facility based on how simple or complex the case is.

For simple cases: When you know what is wrong and the treatment is simple (for example, a small laceration that needs stitches), key issues are speed of service and pleasantness of emergency department staff. Ratings by consumers are most relevant for these issues, and CHECKBOOK found big differences.

• Some hospitals were rated just "fair" or "poor" for "speed of service" by more than 50 percent of their surveyed customers, while other hospitals got such low ratings from 20 percent or fewer of the consumers who rated them.

Doctors' ratings of facilities for "minor injuries" are also a good guide for patients, and there were big hospital-to-hospital differences.

• Several facilities were called "least desirable" for care of a loved one with a minor injury by more than 70 percent of the doctors who mentioned them, while other facilities got such unfavorable comments from fewer than 10 percent of the doctors who mentioned them.