Here we go again… the phone rings, and an elderly relative has fallen and is being taken by ambulance to the hospital… this time with a gash in her forehead. And once again, I am hundreds of miles away while she is being left to fend for herself in a busy emergency room. Fortunately, the injury was bloodier than it was dangerous, but that didn’t mean that she needed any less support to ensure she got proper and prompt care during her stay.
Hospitals are intimidating places—even for healthy people. Even on the happy floor—the maternity ward—visitors and patients face a labyrinth of hallways…overworked staff burdened by the pressures of the health-care system…and antibacterial goo dispensers every three feet to minimize the risk for COVID as well as hospital-born infections.
Now imagine you’re sick or elderly and thrown into that world. You just want to feel better…but the staff is busy juggling patients and priorities, and the on-call team rotates every few days. You’re scared…you’re alone. You may or may not have the focus to answer all of the hospital’s in-take questions. You don’t have the strength to speak up when you need help.
This is a recipe for disaster. It’s no wonder that more than 250,000 people die every year in the US as a result of hospital medical errors. According to a report by Johns Hopkins researchers, hospital medical errors are the third-leading cause of death In America.
I beg you…don’t leave your loved one alone in the hospital.
Several years ago one of my loved ones was in the hospital with a severe intestinal infection. A friend dropped her off but she hadn’t notified us of her illness. After six days and many, many tests, she finally called to let us know. The assorted doctors were at a loss for what was causing the problem. She was getting weaker and developed complications that landed her in the intensive care unit. Time for a new strategy. A family member hopped on a plane to be the on-premises eyes, ears and voice, and I got on the phone with the doctors and nurses from afar.
Frankly, we were wrong to have waited as long as we did. There simply are too many questions to ask and too much information to remember for someone who is ailing. The staff at this hospital, like many others, is undersized and overworked—so the squeaky wheel gets the grease. During COVID the hospital and healthcare resources are even more limited and access for non-patients (i.e., family or friends with a patient) even more restrictive.
Bottom Line has repeatedly reported on the importance of having a family member or friend in attendance either in person or on the phone during doctor’s appointments and about the improved outcomes for patients who have family with them at the hospital. I can’t stress this enough.
With today’s event, the ER was crowded and my family member was left to wait in the hall…alone. I called the ER nurse to find out status and shared my concerns about an elderly person alone in the ER. The nurse totally understood and thought I was wise to be concerned. “Coincidentally” a nurse and doctor came to attend to her within 15 minutes of my call. I was on the phone when the doctor and nurse were in the room, helping to decide on who should stitch up her head wound (ER doc or Plastic Surgeon) and suggesting that the nurse try a pediatric cervical collar when the small adult one was excessively uncomfortable. The nurse was open to the suggestion and surprised that it worked. Had I not been on the phone, the patient would have had even more discomfort than necessary.
What do you need to ask about and look out for? Here are my top items…though not all of them will apply to every situation…
Get the full…entire…every-detail story: What is the diagnosis? What is causing the problem? What does the health-care team know, and what does it still need to figure out? Are there any other health issues impacting the situation?
Ask for daily progress reports: Be at the hospital or on the phone every day to talk to the nurses and the docs. Ask what has changed since the previous day? You want to know who is caring for the patient, and you want the staff to know who you are and that you’re there. Different hospitals schedule their doctors differently, but the vast majority of hospitals now use hospitalists (physicians who care only for hospitalized patients) or covering physicians to oversee patient care. This creates two problems—the doctor may not know the patient or his/her history…and there could be a different doctor attending every few days. Sure, doctors have “team meetings” and theoretically share vital information. But are they sharing the human elements or more subtle details? Or just focusing on the latest scores, meds and patient profile? You need to be sure no details are overlooked in the hand-off.
Validate what you’re hearing with your own medical team: The politics of in-hospital care has gotten very complicated, and most personal practitioners stay away from “interfering” with the hospital staff. My opinion? Talk to the patient’s personal physicians or medical professionals you know even if you trust what you’re hearing at the hospital. The patient’s personal physician knows the patient better and can put you at ease regarding how things are being handled. If the situation is “sticky,” as ours was, then it’s even more important to talk to your own people for perspective and a second opinion. Again, the hospital team is doing its best. Second opinions are common and expected outside of the hospital. But if a problem is serious enough for the patient to be in the hospital, it’s serious enough to get second opinions. A word of warning: This strategy won’t be very popular among the hospital staff, so you will need to be as charming as possible to encourage both groups to communicate.
Ask, “Who are you?”: Find out the names of the members of the health-care team—all of them. Check the doctors’ bios. Know who they are and what their experience is. Show appreciation to the nurses. If permitted, bring them treats…snacks…flowers. They have very hard jobs. Let them know that you appreciate them.
Ask, “Why that test?” Hospital administrations have been known to pressure the staff to pump up revenues by running as many tests as possible. Always ask, “What test are you recommending? Why? What will it tell us that we don’t already know? What is the risk of not doing that test?” Elderly patients are especially vulnerable to unnecessary testing (sure, Medicare will pay for that). Each test puts more stress on the patient, and tests can be risky if there is any kind of invasive procedure.
Check the chart: Electronic health records are supposed to make life easier and more shareable among medical professionals. The only problem? They are prone to errors. It just takes one typo in a diagnosis code or prescription dose to create a disaster. Get a copy of the patient’s medical records, and review them carefully. Recent example: A friend’s mother was in the hospital. When my friend read her mother’s records, they stated she had melanoma. But when asked, her mother said, “I don’t have melanoma now or ever.” What else may have been hiding in that chart?
Ask, “Why that medication?” Hospitals have worked hard to reduce medication errors by checking ID bracelets and having special dispensing machines. But you still have to ask about every medication that is prescribed, especially if it is something that wasn’t being given previously. What is it? What is it for? Why was it added to the regimen? What are the risks? If it’s to offset the side effects of another medication, are there other options so that the patient doesn’t have to take more medications? Once again, elderly people are especially vulnerable to being overmedicated.
Check out what’s on the food tray: You can’t heal without wholesome food…and you won’t find that on most hospital trays. Special dietary restrictions don’t always make it from the doctor’s instructions to the cafeteria tray. Be sure that what is being given is what is needed. I have smuggled many a meal into hospitals. Note: Nutrition is especially critical for elderly people. They can become malnourished very quickly.
Today’s hospital episode is sadly only the latest in what has occurred multiple times a year for the past several years…and is the latest example of the importance of being present when your loved ones are in need. The health-care system is simply too complicated and strained, it’s too overwhelming for anyone of any age to be alone when they have a serious illness or problem, and the health of your loved ones is simply too important to passively sit by and risk becoming one of those medical-error statistics. My motto is that we all have far more power in our lives than we realize. Being in a hospital is not the time or place to relinquish that power.