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Your hospital survival guide

Here's our advice on how to prevent infections, drug mix-ups, unnecessary tests, and other common hospital errors

Last updated: November 2014

For most of us, a trip to the hospital is like being thrust into a foreign country without a guidebook. We don't speak the language, and find ourselves dependent on strangers for our basic needs. With much of our energy directed toward healing, we might simply cede control to medical professionals and hope for the best.

But planning for a hospital stay can lead to better care and a faster recovery. In fact, your involvement is critical. That's because you—or a designated friend or family member—are often the best defense against drug mix-ups, hospital-acquired infections, surgical mistakes, and other errors or adverse events. Those errors affect one in four hospitalized patients, according to recent estimates. One study found that the most serious ones contribute to the deaths of some 180,000 patients 65 and older a year.

"The best advice I can give is to be your own advocate," says Peter Pronovost, M.D., Ph.D., director of adult critical-care medicine and a patient-safety researcher at the Johns Hopkins University School of Medicine in Baltimore. "Question, question, question until things are explained in a way you understand. A health-care system that doesn't address your concerns is a risky one."

Here's our advice for a safe hospital stay, from check-in to discharge. We assume you'll be staying overnight, but much of our advice applies to outpatient visits, too.

 

Click on the map at right to find Ratings of hospitals nationwide (available to subscribers). The Ratings include those hospitals for which we have a safety score, as well as some information on performance for more than 3,000 other hospitals.

Before you are admitted

You don't always have time to plan for a hospital admission. But most often you do, even if it's just a few days. Use that time to take these steps:

1. Check our hospital Ratings. Use them to find a good hospital in your area. One particularly important piece of information: infection rates. One in 20 hospital patients develop hospital-acquired infections, according to the U.S. Centers for Disease Control and Prevention. Other research suggests that about 2 million patients a year become seriously ill from infections they pick up in hospitals and other health-care facilities, and 100,000 die as a result. Many hospitals have sharply reduced their infection rate. Use our Ratings to find out whether the hospital you're considering is one of them. Also use the Ratings to see how other patients described their experience: Did the doctors and nurses communicate well, was pain well controlled, where the rooms quiet and clean? Even if you don't have a choice in hospitals, the Ratings can help you prepare for the problems you might encounter. See our hospital Ratings.

2. Get briefed. Schedule an appointment with your doctor as far in advance of your hospital admission as possible to talk about the drugs and supplements you should start or stop, the dietary changes you should make, and the pre-admission tests you need. Also ask about the medication, tests, and procedures you can expect once you check in, and how long you might have to stay.

3. Make a drug list. Review with your doctor all of the prescription and over-the-counter drugs you take, as well as the vitamins, minerals, herbs, and other dietary supplements. Bring multiple copies of the list with you to the hospital so doctors and pharmacists there can check for any interactions or duplicates with medication you start taking while there.

4. Schedule surgery for well-staffed times, if possible. Hospital staffing can be skimpy on weekends and at night. Nonemergency procedures slated for Mondays are sometimes delayed or bumped because of spillover from emergency cases during the weekend. And if surgery is done on a Friday, you might get reduced postoperative care over the weekend. So ask if you can have your surgery on a Tuesday, Wednesday, or Thursday morning. That way staffing will be at full capacity during your immediate postoperative hours, when you'll need the most care.

5. Know your heart-attack risk. If you're going to the hospital for surgery and are 50 or older, your doctor should check your risk of having a heart attack or stroke and, if you're at high risk, consider whether you'll need medication to protect your heart or prevent blood clots. Use our calculator to estimate your risk of having a heart attack or stroke in the next 10 years

Ask a friend of family member to help monitor your care while you are in the hospital.

6. Assign a helper. Before your hospital admisssion, ask a friend or family member to help monitor your care, since you might be too ill or distracted to do it on your own. Your hospital helper can assert your needs and preferences, ask questions, record the answers, retain copies of key medical documents, and advocate for you if problems arise. Ideally, your companion should help you during check-in and discharge, and visit daily, especially in the evening and on weekends and holidays.

7. Prepare a living will and choose a health-care proxy. This should be done long before you even think about going to a hospital, but if you haven't executed a living will or designated a health-care proxy yet, now's a good time. A living will states your preferences for medical intervention if you become incapacitated, enter a coma, or develop a life-threatening condition. It can specify that you don't want overly aggressive or prolonged care, for example. Make sure the admitting doctor and the hospital have a copy of the will. Also appoint a health-care proxy, someone you designate to make medical decisions for you if you become incapacitated or a decision is needed while you're unconscious. That person should have copy of your living will and understand your health-care priorities.

8. Bank your blood. Blood transfusions generally pose a very slight risk of transmitting an infectious disease. Still, some people prefer banking their own blood before their hospital admission if they're undergoing a procedure that could require a transfusion.

9. Quit smoking, even temporarily. You won't be allowed to smoke in the hospital anyway, and stopping as long as possible before admission can speed your recovery and reduce the risk of infection and other problems.

10. Pack a bag. Don't include valuables, but do bring a few comforting items: a music player and headphones; a favorite pillow, blanket, or robe; or a photo or two. Such items offer reassurance and can make you seem like more of a real person to staff.

11. Consider being screened for MRSA. Finding out whether you have low levels of methicillin-resistant Staphylococcus aureus, a potentially deadly bacterium that's resistant to many antibiotics, before surgery might allow hospital staff members to take steps to prevent it from worsening or spreading to other patients.

When you check in

In addition to taking care of financial and insurance questions, make sure you take these steps at your hospital check-in:

1. Hand over your drug list. Don't assume your doctor already provided this information to the hospital staff. Give a copy to an in-charge person on your floor, too.

2. Introduce your hospital helper. Make sure someone in authority has his or her name, home, and cell-phone numbers, and e-mail address.

3. Ask about a patient rep. Many hospitals have someone on staff whose sole job it is to help patients who have problems or questions. Find out the person's name and contact information.

4. Find out who's in charge. The admitting doctor usually coordinates care but might not always be around or reachable. Some hospitals now use hospitalists, doctors who oversee a patient's care while he or she is in the hospital. If your hospital doesn't, ask who you should contact and how.

5. Check your wristband. Look for misspelled names and missing information, such as drug allergies. Hospital staff should check the band each time they give you a drug, take a blood sample, or perform a test. If they don't, mention your name and your allergies.

During your stay

Hospital staff members aren't out to hurt you but mistakes happen, especially when things are busy or chaotic. So be polite—but alert. These steps can help improve hospital-patient safety:

1. Monitor your meds. The average hospital patient gets 10 different drugs, some of which might look similar or have names that sound alike, prescribed by various specialists with cryptic handwriting who don't always communicate with each other. Busy staffers may mistake micrograms (mcg) for milligrams (mg) or one patient for another. The Institute of Medicine estimates that, on average, there's at least one medication error for every admitted patient. So before taking any drug ask what it is, why it's necessary, and what the dose is. You, or your helper, should also note any side effects.

2. Guard against infection. Infections most often come from dirty instruments or hands during surgery, from improperly sterilized or handled catheters or needles, or from the contaminated hands of doctors or other health-care workers. The emergence of antibiotic-resistant bacteria has further increased the risk of such infections. Take these steps to prevent infections:

  • Insist on clean hands. Anyone who touches you, including your visitors, should first wash his or her hands with soap and water or use an alcohol-based hand sanitizer. Don't hesitate to say: "I'm sorry, but I didn't see you wash your hands. Would you mind doing it again?"
  • Ask every day if catheters, ventilators, or other tubes can be removed. The risk of infection from a urinary catheter, for example, increases significantly if it's left in place for more than two or three days.
  • Ask if an antibiotic is necessary in the hour before surgery. A single dose can be appropriate for certain operations, but research suggests that the drug or its timing is wrong in up to half of cases.
  • Ask if shaving your surgical site is necessary. Nicks can provide an opening for bacteria.
  • Question the need for heartburn drugs. Hospital patients are often prescribed a proton pump inhibitor, such as lansoprazole (Prevacid and generic) or omeprazole (Prilosec and generic). But since those drugs can increase the chance of intestinal infections and pneumonia, make sure you really need one.

3. Watch for unnecessary tests. They're not only a waste of time and money but can also expose you to radiation or other side effects. Moreover, they can produce false positive results that lead to unnecessary follow-up tests and treatment. So make sure you understand the purpose of each test and that you're not getting a test meant for someone else.

Many patients say their pain was not well controlled while they were in the hospital, which increases the risk of a long hospital stay and complications.

4. Get "just enough" pain relief. Many hospital patients report that their pain was not adequately managed. And uncontrolled pain increases the risk of long hospital stays and complications. But too much of a pain reliever can slow recovery and increase the risk of falls. To get the right amount:

  • Ask your admitting doctor to leave standing orders for pain medication (as well as for constipation and sleep), so if the need arises you won't face a long wait while the nurse calls your doctor.
  • Discuss anesthesia with the surgeon or anesthesiologist well before the procedure. Too much increases the risk of complications during surgery. But up to 40,000 surgical patients a year actually wake up in the middle of their operation because of insufficient anesthesia . Also mention your pain tolerance. Saying you have a low tolerance makes it more likely that you'll get pain meds on time and in adequate doses. Saying you have a high tolerance might mean starting on lower doses, which could reduce the risk of grogginess and other side effects.
  • Speak up if pain is bothering you. And don't be afraid of the strongest painkillers after surgery. Short-term use poses little if any risk of addiction.
  • Nerve blockade (pain drugs directly injected into your spine) might be preferable to narcotics for certain operations, such as joint replacement. They control pain equally well but won't make you groggy.
  • Most hospitals now offer patient-controlled intravenous analgesia (PCA). This lets you administer your own medication (while also preventing overdoses) by pushing a button on a computerized pump.
  • Some self-help steps might provide further pain control, research suggests. They include listening to soothing music, guided imagery, or self-hypnosis tapes through headphones; deep breathing; and muscle relaxation.

5. Get moving. That can help prevent bedsores and blood clots that can form in leg veins. So when you're up to it, ask your nurse—or a friend or relative—to help you out of bed and, if possible, take a stroll. If you have to spend a lot of time in bed, ask for special pads that help prevent bedsores, and "pneumatic" stockings that can help prevent blood clots.

6. Stay warm. Body temperature drops by several degrees during surgery, which can impair immune function and blood flow and make infections more likely. So ask your doctor if it makes sense in your case to use a special surgical blanket or other technique to keep you warm.

7. Get autographed. While operations on the wrong patient or the wrong part of the body are becoming increasingly rare, they do happen. So make sure the surgeon knows who you are and, if applicable, initials the surgery site.

8. Stay alert. If you sense that something isn't right, trust your instincts and speak up. "When we go back and look at places where errors occurred we often find that the consumers' perception was spot on but their concerns weren't voiced or they were ignored," says Pronovost of Johns Hopkins.

When you leave

More than a third of hospital patients fail to get needed follow-up care once they get home, according to research from the Agency for Healthcare Research and Quality. To prevent that from happening to you, take these steps as you prepare for your hospital discharge:

1. See a discharge planner. You or your hospital helper should try to do this at least a day before you leave so your family, your doctor, or the hospital can arrange for monitoring or services you'll need at home.

2. Decide if you're ready to go home. Hospitals and insurance companies have strong financial incentives to discharge you as soon as possible. And for most patients, the sooner you get home the better. But if you don't feel ready, say so. You shouldn't go home if you feel disoriented, faint, or unsteady; have pain that's not controlled by oral medication; can't go to the bathroom unassisted; can't urinate or move your bowels; or can't keep food or drink down. If your doctor isn't able to extend your stay, appeal to the discharge planner, the hospital's patient advocate or, if available, a state appeals board.

3. Get a discharge summary. Ask for a clear written statement of what you should do when you get home—for example, how to care for surgical wounds or a broken bone covered by a cast, how active you should be, and when you can shower, drive a car, return to work, and resume your normal diet.

4. Get a discharge list of medication. Ask about drugs you started in the hospital that you should continue when you get home, including their purpose and side effects, and if you should resume or eliminate drugs you were on before your admission. If you had anesthesia, ask what lingering side effects you might expect.

5. Get late test results. Make sure your doctor has test results that were done while you were in the hospital, especially those in the 24 hours before you left. Consider asking for copies of the results so you can give them to your doctor. Also find out what follow-up blood or imaging tests you'll need after you leave.

6. Schedule an appointment with your doctor. It should be about a week or two after your hospital stay, though in some cases, such as to check the healing of surgical wounds, it might be sooner. If you don't have a primary-care doctor, ask the physician who oversaw your care in the hospital whom you should see.

Have you been harmed in the hospital?

Medical mistakes are all too common in hospitals, but you might not hear much about them from patients themselves. For one thing, many victims and their families, understandably, don't want to talk publicly about painful memories. And even if they do, they're often prevented from speaking out by gag orders or sealed legal settlements.


That's unfortunate, says Lisa McGiffert, director of Consumers Union's Safe Patient Project. "The best cure for medical harm is full disclosure," she says.


Before you tell your story, follow these steps to protect yourself:


Get prompt medical attention. A trusted primary care doctor, for example, can help you decide how to proceed. Or see an independent doctor for another look. If you suspect a friend or family member is in danger, call a meeting with all of her or his doctors.


Get a copy of your medical records. They belong to you and can help you and your other doctors understand what happened, and what needs to happen. Your physician, or the hospital's records department, can help you obtain a complete copy, including medical summaries, doctor and nursing notes, test results, and diagnostic images. Note that you might have to pay for copies. If you believe that someone died from hospital harm, ask for an autopsy, to determine the most likely cause of death. Hospitals don't always do them automatically, but the person's next of kin or the legally responsible party can request one. Because autopsies help doctors learn more about illness and ways to improve medical care, autopsies are usually performed without charge. Although you have the right to pay for an independent one on your own.


Report the problem. Only about 14 percent of medical harm events are reported by hospital staff, according to federal estimates. Make sure you tell your version of events to the hospital. Then contact:

• Your local or state health department.

• The Joint Commission, an organization that accredits and certifies more than 19,000 health care organizations.

• Your state's Medicare Quality Improvement Organization, if you are a Medicare patient.


Don't pay. "You shouldn't have to pay for a mistake or its consequences," says John Santa, M.D. director of the Consumer Reports Health Ratings Center. For example, patients shouldn't be billed for treatment related to hospital error, such as treating a broken hip after a preventable fall in the hospital.


Consider hiring a lawyer. Medical malpractice has a high standard of proof, and attorneys might reject your case. But a lawyer can also help you negotiate with hospitals over medical bills or compensation agreements, even if you aren't considering legal action.


Tell others about your experience. If you have been harmed in the hospital, we encourage you to consider sharing your story with our Safe Patient Project. Consumers Union's advocates use those patient experiences to help push for legislative and regulatory changes. ProPublica, an independent newsroom that has also written extensively about patient safety, also maintains a database of patient stories. In addition, it recently started a Patient Harm Community on Facebook.


Consumer Union's Safe Patient Project recently gathered together a group of patients who had been harmed in the hospital to hear their ideas on how to stay safe in the hospital. Watch the video, at right, to hear their advice.

 

   

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