David (pseudonym) entered an esteemed teaching hospital to have his prostate surgically removed following a cancer diagnosis. As the surgical team prepared him for surgery, he noticed that they put marks on one of his legs. He mentioned it to his wife and right before he was wheeled into the operating room, she checked his chart, where she saw the horrifying instructions—David’s leg was going to be amputated! As it turned out, the charts for David and another patient with the same surname had been switched accidentally. The patient scheduled for the leg amputation was probably being prepped for prostate surgery. Fortunately, David’s wife caught the error in time, and both men received the correct surgery. To make matters even worse, when David was recovering from his prostate surgery, his wife came into his hospital room and nearly sat on a full hypodermic needle that had been left in the chair.
When we think of medical errors in hospitals, our thoughts turn immediately to surgical errors, which make headlines because they are either very serious, very bizarre, or both. However, surgical errors are less common than other hospital adverse events including drug-resistant infections caused by improper infection control; pressure sores; patient mix-ups; dietary mix-ups; falls; misdiagnosis; laboratory, X-ray, and pathology errors; and the number one adverse event, medication errors.
I conducted an online physician survey to gather data for for my book Taking Charge of Your Own Health, and found that 50 percent of respondents named Medication Errors as the top hospital mistake; 32.6 percent selected Delays in the Emergency Department Waiting for Treatment; 4.3 percent chose Wrong-site Surgery; 4.3 percent picked Lab or X-ray Errors; and 8.7 percent cited Other Errors.
Why do these errors occur? Fatigue, distractions, multitasking, patient handoff during shift changes and surgery, resident changes, miscommunication, and overworked physicians and staff all contribute to adverse events in hospitals. Dangerous errors are rarely attributable to just one person or process but instead are often the result of a combination of breakdowns in several individual processes that may have occurred over time, each without harm. But sometimes, the conditions are just right for a harmful event to occur.
The news isn't all bad, with the level of oversight available to and required of hospitals in the U.S. Hospitals cannot receive reimbursement from CMS (Centers for Medicare and Medicaid Services) unless they have satisfactorily completed a rigorous process called a survey by an accrediting body, usually The Joint Commission www.jointcommission.org. The Joint Commission is there not just to investigate, but also to guide physicians and hospitals, offering numerous tools for creating a safe and efficient environment.
Another organization heavily invested in patient safety and quality care is the Institute for Healthcare Improvement www.ihi.org. IHI encouraged health care professionals worldwide to participate in their 5 Million Lives Campaign, which challenged health care professionals to save five million patients from harm from December 2006 to December 2008 and resulted in 122,000 fewer fatalities during that period. IHI provides training for medical professionals worldwide through seminars, conferences, fellowships and online mini-courses. Other organizations committed to hospital safety and quality care include the World Health Organization, the U.S. Department of Health and Human Services, the National Patient Safety Foundation, Campaign Zero, The Josie King Foundation, the Agency for Healthcare Research and Quality, Texas Medical Institute of Technology and the Partnership for Healthcare Excellence.
So what can you do as a patient to ensure your safety in the hospital? You will find ten proactive patient strategies for optimal hospital care and safety listed below:
1) If your physician has privileges at more than one hospital, ask which hospital she recommends and why. She will have insight into the safety culture of each hospital.
2) If you have options, select a larger hospital that offers a variety of treatments and surgeries, or a teaching hospital. If you are scheduled for surgery, make sure the hospital performs this procedure on a regular basis. Your surgeon or the hospital quality assurance manager can provide information about its experience with your type of surgery.
3) Check hospital credentials, licensing, ratings, and infection rates. Hospitals make accreditation information available on their Web sites, in their patient literature, posted in their hallways, or any combination of the above. To find a Joint Commission accredited organization, visit www.QualityCheck.org. You can check with your state department of health services to ensure that the hospital is licensed, and you can visit www.leapfroggroup.org/for_consumers, www.healthgrades.com, or www.hospitalcompare.hhs.gov for hospital ratings. The hospital’s quality assurance manager should have statistics on infection rates.
4) If possible, select a hospital with sophisticated equipment, including electronic medical records. Again, your surgeon or PCP will have this information, as will the hospital’s quality assurance manager.
5) Avoid a hospital stay during the weekend, if possible. Weekend admissions are associated with higher mortality rates than weekday admissions because of lower staffing levels.
6) Have an advocate (friend or family member) who can speak up on your behalf when you are unable to speak for yourself, due to illness or sedation.
7) Be sure your attending physician and your advocate have your medical history, including current medications and drug allergies.
8) Do not take any medication administered by anyone who fails to check your ID bracelet first.
9) Do not allow any hospital staff member to touch you without first donning gloves or washing her hands. Hospital-acquired infections, particularly MRSA, are on the rise.
10) If you are concerned about any aspect of your care, don’t hesitate to call the patient advocate or hospital administrator.
You can learn more about hospital safety by visiting www.jointcommission.org/PatientSafety/SpeakUp for brochures on prevention of infection, medical testing mistakes, avoidance of surgery mistakes, and follow-up care after discharge. The American College of Surgeons offers an abundance of general patient and surgical safety information at www.facs.org/patienteducation/index.html. For downloadable tools to help you record your medical history, you can visit www.theproactivepatient.com/page7.php.
Good luck and good health!