Patients go to the hospital to get their health problems treated, but it’s distressingly common for hospital stays to cause health problems instead. A 2022 report by the Department of Health and Human Services Office of Inspector General estimated that 25% of hospital patients experience “care-associated harm” during their stays. While that research relied on data from 2018, there’s little reason to believe things have improved since then. If anything, the widespread resignations and retirements of experienced health-care workers during the pandemic probably made things worse.
Bottom Line Personal asked leading patient-safety expert Peter Pronovost, MD, PhD, what patients and their families can do to prevent the health risks caused by hospital stays…
Medication errors. A large-scale study by researchers at Texas Tech University and UCLA found that more than 5% of hospital patients experience medication errors. Some of these errors are as straightforward as a nurse handing a patient the wrong pill, but medication mistakes also involve the interactions between drugs prescribed to a patient in the hospital and drugs the patient already is taking. Hospitals attempt to avoid this by compiling a list of all the drugs a patient is taking, a process called medication reconciliation, but oversights are common. What to do…
Create and continually update a list of all the medications you’re taking, both prescription and over-the-counter, and bring this list with you when you go to a hospital.
If you have not recently updated such a list when a trip to the hospital becomes necessary, bring all of your medication bottles or instruct a loved one to do so. Use your list or bottles to confirm that the hospital has a complete record of all the drugs you’re taking.
When you’re given a drug in the hospital, say something along the lines of, “I know you’re working hard to provide me the best care, but could you help me understand what this drug does and how it interacts with the drugs I’m already taking?” Voicing confidence in the doctor or nurse’s good intent before asking a question can deflate defensiveness.
Surgical errors. Every week, surgeons in the US accidentally leave sponges or other foreign objects inside patients nearly 40 times…they perform the wrong procedure around 20 times…and they operate on the wrong side of the body 20 times, according to Johns Hopkins researchers. These figures include only errors that result in malpractice claims, so the actual number of surgical errors is likely significantly higher. A separate study by University of Michigan researchers found that the overall postoperative complication rate—a useful though imperfect proxy for surgical errors—was 14.5%. What to do…
Before settling on a doctor for a surgery, ask him/her, “How often do you do this procedure?” Numerous studies have found a very strong link between quantity and quality when it comes to surgery—doctors who do a particular procedure often are much less likely to make mistakes with that procedure.
If the doctor’s answer is only a handful of times per year or less, strongly consider choosing a different doctor unless it’s an extremely rare procedure that few doctors perform often. Also ask, “Does the hospital where you will perform this procedure on me handle this procedure often? Is this where you usually do this procedure?” The experience of the team that will be working with the surgeon during the operation and caring for you after the operation matters, too.
None of this should come as a surprise—practice might not make perfect, but we all know it makes better. Yet many patients never ask doctors about their experience with the procedure and end up trusting their lives to novices. A recent study by a Stanford University professor found that hundreds of patients in California receive cancer surgery at hospitals that perform only one or two of their type of procedure all year—even though a hospital that performs the operation much more frequently is located within 50 miles in more than two-thirds of these cases.
Infections, blood clots and other medical complications. A 2014 study by the Centers for Disease Control and Prevention (CDC) suggested that around 4% of hospitalized patients experience a hospital-acquired infection. This risk is substantially higher for intensive-care patients—a large-scale German study estimated that nearly 20% of ICU patients acquire one or more infections while in the hospital.
Thrombosis, also known as blood clots, are another common hospital complication—they’re among the leading causes of hospital deaths. The National Blood Clot Alliance estimates that up to 40% of surgery patients—including up to 60% of patients who have major orthopedic surgery—will experience blood clots if proper preventive steps are not taken. What to do…
If a hospital staff member is about to put a catheter into any part of your body, ask, “Do I really need that?” If the answer is yes, ask, “Do you follow a checklist procedure to reduce catheter infections?” Catheters are a very common source of hospital infections, but research has shown that this risk is dramatically reduced when hospital staff use a simple best-practices checklist.
Ask every day if you still need the catheter. They are sometimes left in longer than necessary simply because no one bothers to take them out—and the longer a catheter is in, the greater the odds of infection.
Brush and floss multiple times each day while you are in the hospital. Oral hygiene sometimes is overlooked by hospital patients who are coping with major medical issues, but neglecting this increases the odds that bacteria from the mouth will get into your lungs and lead to pneumonia.
Sit up in your hospital bed as much as possible—the more hours spent lying flat, the greater the odds that fluid from the mouth will find its way into the lungs.
Following surgery, ask, “Have I had deep vein thrombosis (DVT) screening?” and “What DVT treatment am I receiving?” The answer might include anticoagulants, intermittent pneumatic compression devices (IPCs) or other strategies. What is most important is that the staff is monitoring your DVT risk.
Ask, “What should I do to reduce my risk for DVT?” Getting out of bed and walking in the days following the surgery can reduce the odds of clots. If an IPC is used to reduce the odds of clots in your legs, periodically confirm that it’s still connected to the machine that inflates it—sometimes these become disconnected and/or are not reconnected after a patient gets out of bed.
Falls. Walking around a bit is generally healthier for patients than lying in bed all day, but patients who are very ill or recovering from surgery can be unsteady on their feet, leading to dangerous falls. These falls often occur when patients ring for a nurse to help them to the bathroom, then attempt to make this trip on their own when a nurse doesn’t arrive quickly. What to do…
Don’t wait until you’re desperate to use the bathroom to call for a nurse—plan ahead so you can wait for assistance if the nurses are busy.
Confirm that a bedpan and/or urinal is within reach of your bed for emergencies.
Hospital staffing and policies. It pays to select a hospital that performs the specific procedure you require regularly. It also pays to seek out hospitals that use staff and practices that are associated with lower error rates. What to do…
Choose a hospital with “intensivists” on staff if you or your loved one is going to be in the intensive care unit (ICU). These doctors specialize in treating critically ill patients. Having these specialists on staff is associated with an astonishing 30% reduction in hospital mortality, according to researchers at Johns Hopkins University. To find out which hospitals in your area have intensivists on staff: Search local hospitals on Ratings.LeapfrogGroup.org, then click the “Critical Care” tab.
Look for a hospital that has implemented “Enhanced Recovery After Surgery” protocols (ErasUSA.org). These protocols are associated with substantially reduced odds of post-operative complications, shorter hospital stays and less pain despite lower use of painkillers. They ensure the patient is as healthy as possible through exercise and weight loss…they seek to avoid narcotics…and they get patients to ambulate soon after surgery. Unfortunately, only a small number of US hospitals have adopted them so far.
