Most people expect to leave the hospital in better shape than they came in – and while they're hospitalized, they take their safety for granted.
But a hospital stay involves risks and could cause you harm. At times a patient’s very survival is at stake. It’s been estimated that more than 400,000 deaths occur in U.S. hospitals each year arising from medical errors.
While some risks are beyond your control, four experts weigh in on what you can do to defend against some common hospital safety hazards.
Surgical errors include performing the wrong surgery, operating on the wrong part of the body and operating on the wrong person. Wrong-site surgeries happen 40 to 60 times a week in the United States, according to Erin DuPree, vice president and chief medical officer of the Center for Transforming Healthcare, an affiliate of the Joint Commission – the group responsible for accrediting hospitals.
Before each surgery, surgeons and operating room staff must follow certain safeguards, such as going through several layers of verification – right patient, right procedure and right site – and clearly marking the operative site. But, DuPree says, don’t pull out a marker and try this yourself at home as some patients have – correct site marking is a critical part of safety process.
The surgical team also takes a brief "time out" before any procedure to make sure everyone is on the same page. Ideally, patients are awake, alert and able to participate during one of the verification points.
[Read: When to Fire Your Doctor.]
Risk doesn't end once surgery's over. The postoperative period is even more critical, says Helen Haskell, of South Carolina, who learned this the hardest way possible in 2000 when her 15-year-old son, Lewis Blackman, died after surgery to correct a sunken breastbone.
Postoperative care given by inexperienced medical residents, she says, combined with the staff's failure to follow up on her son's worsening condition, led to his death. “The worst thing was that we had no means of directly contacting our son's doctors or other experienced clinicians who might have seen how rapidly he was deteriorating,” says Haskell, who founded the nonprofit Mothers Against Medication Errors in 2002.
In 2005, Haskell's group saw the passage of the Lewis Blackman Hospital Safety Act in South Carolina, which requires clear identification of all clinical personnel and that patients or families receive an emergency number to call to reach staff – like an attending physician – to assess a patient when concerns arise.
Haskell says patients or family members advocating for them should keep journals to record the events of a hospitalization: “Who’s been in the room, what’s been done, what tests need to be followed up on, have you gotten the results from that test? Or the test that was supposed to be ordered – is it really on schedule?”
She also advises keeping track of simple indications, like the patient's vital signs, to be able to recognize downward trends and point them out to the doctor or nurse. Other signs to watch and report, she says, include “pallor and level of consciousness and whether they’re in terrible pain.”
Before You Leave Home
Preparing for a surgical procedure means more than just packing a bag.
Start early by doing research online – look up doctors on care rating sites as well as those of medical boards, which may be more updated about disciplinary actions. Research also involves learning more about the upcoming procedure, what studies show about its effectiveness and the risk it carries.
If you can choose the hospital, select one where many patients have had the same surgery you're having, the Agency for Healthcare Research and Quality recommends. Also, look for hospitals designated as Centers of Excellence, says David Mayer, an anesthesiologist and vice president for quality and safety at MedStar Health, based in Columbia, Maryland.
The Joint Commission’s website offers "Helping You Choose" guides, and health consumers can also search the site for accredited hospitals.
Staving Off Medication Errors
When you get to the hospital, let staff know all the medications you already take, including over-the-counter drugs. Communicate any drug allergies or reactions you've had. And throughout your stay, be part of the medication safety process.
It sounds basic, but whoever’s giving you a medication should verify that you’re the right patient. Staff members should always double-check medications, and if you don’t know what you’re taking or why, or you have questions about side effects, timing or dosage, don’t hesitate to ask.
[Read: How to Keep Your Loved One Safe in the Hospital.]
Patients have a role in defending against health care-acquired infections, different types of blood clots, sepsis (blood infection) and “general failures of communication,” each of which kills about 100,000 U.S. patients each year, according to Peter Pronovost, senior vice president for patient safety and quality at Johns Hopkins Medicine.
He urges patients to ask to be screened for blood-clot risk, so that if indicated, they can be started on blood-thinning medications or be placed on a mechanical device to prevent blood from pooling in the legs.
Patients who have a tube placed, such as central intravenous lines or a catheter to collect urine, face a higher infection risk the longer it stays in, Pronovost says, and every day, you should ask staff whether you still need it.
Ask About Hand-Washing
When it comes to stopping the spread of antibiotic-resistant, hospital-based infections, it’s a must for staff members to wash their hands before and after each patient contact. But the reality is that many don’t do so without prompting, and it can fall to patients and families to politely remind them.
Preventing Hospital Falls
“For patients in the hospital, all the medications they get and the new setting can be very discombobulating,” DuPree says, and it’s not always older, higher-risk patients who fall while they’re in the hospital. An estimated 700,000 to 1 million U.S. hospital patients fall each year, according to the AHRQ.
The best way to avoid falls, she says, “is always getting assistance getting out of bed. Making sure somebody’s always in the room with you when you’re going to the toilet or whenever you’re walking.” For his part, Mayer says that while it's hard for patients to give up their autonomy, family members can help by reminding them that they're in the hospital, not as strong as usual; that the floors could be wet and they don't know their way around in the dark. He adds that bed alarms can alert nurses that patients at risk for falls are trying to get out of bed on their own.
Communication All Around
Shared best practices in areas like central line placement as well as data-driven approaches – like those introduced by the Center for Transforming Healthcare – are making some inroads on reducing hospital hazards. But more must be done, experts say.
When you’re in the hospital and you’re worried, it’s critical to get all the health team members together to talk, Pronovost says. That includes patients and family members, who have the wisdom of experience – they know what’s normal and what isn’t.
“So if a parent says ‘my child doesn’t look right,’” he says, “as a doctor, I’d better listen because they will see things with that kid that I will never see.”