Americans die unnecessarily in hospitals, according to a recent study from doctors at the Yale School of Medicine.
Prior studies suggest the death toll could be even higher. In 1999, the Institute of Medicine estimated that 44,000 to 98,000 people die from medical errors each year. A paper in the Journal of Patient Safety suggested that the true figure could be as high as 440,000 people per year. In 2016, Johns Hopkins University researchers released their estimate of 250,000 people. These earlier studies, however, have been subject to controversy over their methods, while the Yale study took a more conservative approach.
When you enter a hospital, you face a variety of risks:
- You could be misdiagnosed, especially in the emergency room.
- You could receive the wrong treatment or your condition could be poorly monitored and managed.
- You could be the victim of a surgical error. A 2015 study from Massachusetts General Hospital found that some sort of mistake or adverse event occurred in half of all operations.
- You could receive the wrong drug, the wrong dose of a drug, or the drug you need might not even be ordered.
- The Centers for Disease Control and Prevention estimates that there are 1.7 million hospital-acquired infections a year. You could get an infection from difficult-to-treat bacteria, such as Clostridium difficile or methicillin-resistant Staphylococcus aureus (MRSA).
- You could develop a pressure ulcer (bedsore) that becomes infected.
- You could fall, usually while going from the bed to the bathroom.
- You could develop deep-vein thrombosis, a blood clot that typically forms in the leg, but can travel to the lungs or heart, threatening your life.
All of these possibilities increased during the pandemic, when family members, friends, and professional health advocates were rarely permitted to enter hospitals and hospital staff were often spread dangerously thin. Now, more than ever, you need to look out for yourself or have someone else looking out for you. Here are several straightforward and commonsense strategies to do that:
Choose the best hospital
If possible, choose a university-affiliated teaching hospital over a public hospital or for-profit hospital. At teaching hospitals, you’ll be asked the same question about your care many times—by medical students, interns, residents, fellows, and your medical team. This type of redundancy, where everybody is checking everybody else’s work, is the best way to keep a patient safe. If you don’t live near a city, use tools like https://www.hospitalsafetygrade.org to research the best hospitals near you. (Editor’s note: See the “Your Advocate” column on page 5 of the May 2021 issue of Bottom Line Health for more information on choosing a hospital.)
Choose an experienced surgeon
The best way to prevent errors during elective surgery is to choose an experienced surgeon. Ask, “How many such procedures have you performed in the past 12 months?” If it’s a relatively low number, find another surgeon. And always get a second opinion before any surgery. ProPublica, a nonprofit that conducts investigative journalism, publishes Medicare-based data on surgeons’ procedures and complication rates at https://projects. propublica.org/surgeons/.
Have a designated advocate
Arrange to have an advocate who is tasked with knowing the daily details of your condition and your treatment plan, and to maintain regular communication with nurses and physicians who are supervising and delivering your care. Your advocate can be a family member, a friend, or a paid professional.
To find a professional, visit the website www.advoconnection.com, which provides a free directory of independent patient advocates. Interview one or more people to find out if you have a rapport with the advocate, if they’ve worked with patients with a similar problem to yours, and what the process of advocacy will entail. Ask about their credentials, references, and the cost.
Ask for a consultation
If you have or develop a symptom that you want evaluated by a specialist rather than the hospitalist (the physician who is managing your care in the hospital), ask for a consultation. If the physician says no, insist.
This is always important to help prevent hospital-acquired infections, but it has taken on added importance during the pandemic. If a clinician or caregiver wants to come into your room but you haven’t seen them wash their hands or hit the hand sanitizer dispenser, insist they do so. If they say they have done it, insist they do it again, if only to “humor” you. Likewise, ask the nurse or doctor if they have sanitized the stethoscope before putting it on you.
If you’re unsteady on your feet or have any question about your balance, or if you’re taking a medication that has drowsiness as a side effect, always get a nurse’s assistant or nurse to help you to the bathroom. About 40 percent of falls in hospitals occur when a patient tries to get to the bathroom unassisted. If you go to the bathroom by yourself, or otherwise move about the room, always bring your hospital call button so if you do fall, you can get help as soon as possible.
Bedsores can develop when you don’t move enough and there is pressure on your skin for long periods of time. People who are frail, bedridden, or diabetic have the highest risk. To prevent a bedsore, you should turn and reposition yourself at least every two hours to relieve the pressure on any one part of your body. Your heels and tailbone are particularly risky spots.
If you can’t move yourself, call for a nurse to help you. Ask if the hospital can provide a pressure-relieving mattress or other protective devices. If you do develop a bedsore, you will need regular wound cleaning, dressing changes, and good nutrition to speed the healing.
Know the details of any drug you take in the hospital
If the nurse wants to give you a pill or injection that you’re not familiar with, ask about it. Who ordered it? What is it for? What are the side effects? If the answers aren’t satisfactory, demand to speak with your physician before you take the drug.
Ask about your medications at discharge
Medications are often added or changed while you’re in the hospital. To ensure drug safety when you are being discharged, ask the nurse, hospitalist, or hospital pharmacist the following questions: Have any medications been added, stopped, or changed while I was in the hospital, and why? What medications do I need to keep taking, and why? How do I take my medications, and for how long? How will I know if my medication is working, and what side effects do I watch for?
Discharge and beyond
Also ask the following questions at discharge: What is my diagnosis? What medical equipment will I need? Can the hospital order it for me? What follow-up care will I need? When and how will I receive test results? Are my records available to me through a patient portal? Whom should I call if I have a question or problem? How soon should I make a follow-up appointment?