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Hospitals can make you well, but they can also make you sicker – or, in extreme cases, take your life.About 100,000 deaths are linked to hospital infection every year, according to Consumer Reports on Health.Add freshmen med students to the rounds and the safety risk rises even more, reports a study by the University of California, San Francisco School of Medicine.
“As procedures become more complicated and more invasive, they can be very dangerous,” agrees Suzanne Henry, a policy analyst at Consumers Union Safe Patient Project in Austin, Texas. (Consumers Union is the not-for-profit publisher of Consumer Reports magazine.)
That’s why patients must take an active role in preventing mistakes and managing their own care.
The more you know about what could go wrong, the greater your chances of leaving the hospital healthy.
“Be vigilant – do your homework,” advises Terry A. Clyburn, M.D., professor of orthopedic surgery at the University of Texas Medical School in Houston.
Barring an emergency, use these 11 ways to stay safe during a scheduled hospital stay. 1. Choose your surgeon – and surgery – carefully.
Look up your surgeon on websites, such as Lifescript.com’s doctor directory and Healthgrades.com, which list doctors’ education, board certification and licensing, along with patient ratings and insurance plans they accept.
Next, interview the physician, Dr. Clyburn advises. “Ask the doctor how many times he’s done the surgery over how many years, and how often he does it,” he says.
Then, talk to family and friends who have had similar surgeries and ask if they had good results.
Finally, avoid surgery if it doesn’t compromise your health, Henry says.
“Don’t go into major surgery if you’re functioning fine without it [because] you can get a hospital infection, or things can be put in the wrong way, and you have to deal with that the rest of your life,” she warns.
2. Investigate the hospital.
“Most people do less hospital research than they do when they buy a car,” Dr. Clyburn says.
Before your surgery, ask the doctor where they practice, which hospital they prefer and why, he advises.
Then look up the hospital’s rating on reputable websites, like Consumers Union (www.safepatientproject.org), which rates hospital care.
“If a hospital is under investigation by its licensing board, that’s a big red flag,” Dr. Clyburn says. 3. Never go to the hospital alone.
“The most important thing is to have an advocate with you,” Henry says.
Because you may not be functioning in top condition, ask a friend or family member to be another set of eyes and ears. They can make sure everything goes smoothly, from the way you’re treated to the medications you’re given.
“If you’re unconscious, the advocate can remind staff to follow infection protocols and keep an account of details the patient might want to know,” Henry says.
Ask your advocate to stay during your surgery to answer questions or provide details about you or your care.
4. Avoid surgery in July.
According to the 2011 University of California study mentioned earlier, July is the worst month to schedule a stay in a teaching hospital.
That’s because death rates increase in teaching hospitals between 8% and 34% that month, coinciding with the arrival of freshmen residents.
That doesn’t mean “patients should delay care they need, but they should be aware of the July staff turnover,” says John Q. Young, M.D., M.P.P., associate program director of the Residency Training Program, Department of Psychiatry at the University of California, San Francisco, and lead author of the July death rate study.
“That’s another important reason to have someone come to the hospital who can advocate for you.”
Every team has experienced doctors overseeing care provided by residents, and patients may ask to see the attending physician if they’re worried about hospital care, Dr. Young says. 5. Schedule procedures early in the week.
Any time of year, schedule surgery – particularly major surgery that requires a several-day stay – early in the week because the staff will be fresher, Dr. Clyburn advises.
“The aggressiveness of weekend physical therapy may not be as good as it is during the week,” he warns.
Nursing care also will be better, Henry says.
“Newer nurses get the last pick of the schedule – nights and weekends,” she says. “The best time to go in is Monday morning, when the nursing shift has just changed and you have the best continuity of care.”
6. Mind your medications.
Medication errors are the most common hospital mistakes, harming at least 1.5 million people per year, according to a 2006 report by the National Academy of Sciences.
That’s why it’s important to carry a list of every medication you take, including prescriptions and supplements, Henry says.
For drugs prescribed in the hospital, ask what each drug is and why it’s being prescribed, Dr. Clyburn advises.
Ask your advocate to keep a record of any medication you’re prescribed and take, says Henry.
“And review the medical chart to make sure it’s consistent with your notes,” she advises. 7. Prevent infection.
Hospitals are notorious breeding grounds for infection, but prevention begins before you enter the hospital.
That’s because a hospital infection usually occurs because patients themselves carry bacteria into the hospital, Dr. Clyburn says.
For example, “patients with chronic gallbladder, colon or urinary tract infections are at increased risk for [other] infections,” Dr. Clyburn says.
“They should see a doctor before going into the hospital to make sure they don’t have an infection.”
Other steps to take:
- Schedule a checkup with a dentist to ensure your teeth aren’t harboring an infection.
- Clean your skin with Hibiclens, an over-the-counter antibacterial skin soap, 2-3 times a day for several days before surgery, Dr. Clyburn advises.
- Avoid shaving several days before surgery because “bacteria live in hair follicles, and shaving stimulates them to the skin surface,” Dr. Clyburn warns.
- “Ask your doctor about whether you should take a preventive antibiotic before surgery,” Henry says.
At the hospital, ask all visitors to wash their hands with soap or use alcohol-based hand sanitizer. And insist that doctors do too.
Physicians tend to be lax about hand-washing, Henry warns.
“They’re busy, rushing from one room to the next, so if they haven’t washed their hands, you have to point it out,” she says. “Insist they also take precautions like wearing gowns, masks and sterilized gloves, and discarding them before they leave a room.”
To broach such a delicate subject, Henry suggests saying, “Doc, I’m concerned about getting a hospital infection. Is it policy that doctors wash their hands between patients?”
Patients with infections should be isolated in the hospital, she adds.
“The spread of superbugs like methicillin-resistant Staphylococcus aureus (MRSA) starts because people walk out of the hospital after being exposed,” Henry says.
8. Assess your tests.
You and your advocate should know what tests your doctor has ordered and why.
Make sure you’re getting the right tests and ask about whatever you don’t understand or doesn’t make sense to you.
“The best question is, ‘Is this test medically necessary?’” Henry says. “People should feel empowered to speak up, even to the doctor.” 9. Ask before you dine.
“Hospitals use wristbands on patients to identify specific conditions, like diabetes, and drug and food allergies, and risk of falling,” Henry says. “Rooms usually have whiteboards listing allergies and food needs, informing all staff.”
Still, mix-ups are common, and patients or their advocates must be watchful. If you have a special diet because of conditions such as diabetes, high blood pressure or kidney disease, look for a sheet indicating your diet on the food tray.
Ask the attendant or nurse who brings the meal, “Is this the platter for diabetics [or other condition]?”
And watch out for well-meaning family members and friends bearing goodies. They’re some of the biggest offenders, says Dr. Clyburn.
His advice: Thank them and then pass the treats to those who can safely eat them.
10. Prevent falls.
About 3%-20% of patients fall during a hospital stay, a 2011 review by the University of Texas Medical School found.
“The longer they’re there, the higher the risk,” says Dr. Clyburn, the study’s lead author.
Delirium, often caused by anesthesia and pain medications, is often the cause. “One patient said ‘her dog’ wanted out,” he recalls.To avoid potential falls:
- Ask a family member or friend to spend the night in the room.
- Ask for a bed rail and a room close to the nurses’ station if you feel you’re at risk.
- Beware of wet floors and items that may cause slips, such as long bathrobes and floppy bed shoes. Instead, wear socks with rubber treads or gym shoes.
- Give yourself a preparatory talk, reminding yourself that you’re going to be in the hospital, that you may wake up and not know where you are. “That can help some people stay oriented,” Dr. Clyburn says.
Ready to be discharged? Congratulations. But remember to take safety precautions at home.“Have a family member write down whatever advice and instructions are given to the patient,” Dr. Clyburn advises. “Most hospitals have a written discharge form, where the doctor checks off what medications the patient will be taking and how much.”The form should also indicate when to return for a follow-up visit and what danger signs to watch for, such as an elevated temperature or redness around the wound or incision.It’s also a good idea to meet with a discharge planner at the end of your stay who can go over discharge instructions and schedule your follow-up visit.
When you get home, “tape the instructions to your refrigerator,” so you’ll see them and be reminded often, Dr. Clyburn says. “If you don’t understand the directions, call the doctor and find out what you’re supposed to do,” he says.
Hospitals are taking steps to reduce mistakes and are tracking outcomes to tell if they’re getting safer, Henry says.
They’re measuring complication rates and hospital infections, and taking steps to improve the quality of care, Dr. Young says.
Though that’s starting to translate into improved reliability and quality of care, much more needs to be done. “What we’ve learned in the last 20 years is that we have a lot to learn from other industries,” Dr. Young says.