Know the questions to ask about your health care facility.
For a variety of reasons—elective surgeries, emergency procedures and more—you may find yourself faced with the need for you, or someone you care about, to spend time at a medical center.
Be prepared. If a hospital stay looms, it may be wise to make some serious inquires of caregivers and health centers ahead of time. Savvy consumers might also ponder the potential that their health could go south because of the care they receive. After all, not only are thousands of patients injured due to unsafe and poor-quality health care, many others die from medical errors made on-site.
In the U.S., an estimated 160,000 people die annually due to treatment mistakes, according to the John Hopkins Armstrong Institute for Patient Safety. And another 400,000 hospitalized patients experience some type of preventable harm, according to the National Center for Biotechnology Information.Like what you’re reading? Subscribe to our weekly newsletters.
Patient safety is of such paramount concern today that the World Health Organization held its first World Patient Safety Day in September, launching a global campaign to create awareness for patient safety and to urge people to commit to making health care safer.
Globally, as many as four in 10 patients are harmed in primary and outpatient medical centers, and one in every 10 patients suffers injury while receiving hospital care in “high-income” countries. Meanwhile, nearly half of the adverse events that cause these problems could be prevented, according to the WHO.
Oversight of hospital operations has increased over the years, but boosting the public’s awareness of these issues is critically important, says Dr. Michael R. Jaff, president of the greater Boston area’s Newton-Wellesley Hospital and a professor of medicine at Harvard University.
“This has been on the radar in health care circles but not in the public realm, and it couldn’t happen soon enough,” Jaff says. “Everyone in medicine is a human being and despite all the efforts, mistakes happen.”
Many changes and developments in the past decade have both helped improve safety and increase problems. For instance, technology has enhanced patient monitoring, while also increasing the number of alarms that can disturb or frighten patients. Also, people are sicker today when admitted to a hospital than in past years, with serious illnesses and infections that can put everyone around them at higher risk in a closed environment, says Jaff, who offers blunt advice for would-be patients.
“People used to be put in hospitals to take a week of rest but they don’t do that anymore,” he says. “I tell my own family and friends, ‘You don’t want to be in a hospital if you don’t have to be.’”
Good advice, indeed, but those in need of hospitalization would be wise to arm themselves with information about the health care providers they will see and the institutions where they will be treated.
Medical errors, basically, fall under two major categories:Errors of omission, such as not strapping a patient in a wheelchair or failure to stabilize a gurney before transferring a patient Errors of commission, such as giving a patient medication they are allergic to, or improperly labeling a lab sample that is then assigned to the wrong patient
Multiple sources for details and statistics are available for patients to help choose hospitals, examine infection rates and other medical issues at medical centers, query doctors and ask questions about procedures and medicines. Lists of potential questions to ask can be found on both WebMD and the website for the Agency for Healthcare Research and Quality, which also surveys the patient safety culture of hospitals.
Consumer Reports is a good first stop for finding a nearby hospital. The magazine rates hospitals on patient experience, patient outcomes and hospital practices. U.S. News & World Report ranks hospitals nationally by specialty, while the Centers for Disease Control and Prevention maintains national data on infections for acute care hospitals.
Medicare rates hospitals with a system assigning one to five stars that reflects common conditions that hospitals treat, such as pneumonia or heart attacks, and how well each institution performed, on average, compared to other U.S. hospitals.
The Leapfrog Group, a national nonprofit, assigns letter grades to hospitals on its Hospital Safety Grade website based on their record of patient safety. A recent search of the site for Columbus-based hospitals indicated that local medical centers had either A or B grades. Some in outlying areas don’t fare so well.
Rating services like these are valuable, but consumers must exercise caution if they decide to choose a hospital based on a billboard advertisement that claims the organization is highly rated, advises Dr. Gary Ansel, Ohio Health’s system medical chief for vascular services.
So many organizations rate hospitals it can be both confusing and misleading, and making a decision based on a billboard claim “is the last thing you should do,” he says.
Consumers should seek doctors who are open about second opinions, and they should seek physicians and hospitals that have the most experience with the type of health care or procedure they need, Ansel says.
“A doctor should want you to be comfortable with your care, but if a doctor says ‘I’m insulted,’ that is a bad sign,” he adds.
Other potential questions might center around billing practices and insurance; the use of electronic medical records, which many hospitals do not yet employ; pastoral care; and the confidence level doctors have with students at a teaching hospital. It can also be helpful and revealing if a patient knows someone who works inside the hospital, Ansel says.
“People might also want to consider finding a hospital they might want to use before something complex happens because it’s not the time to do that when you are really sick,” he says. “You should have a comfortable feeling with the physicians and the hospital. I tell people to follow your gut.”
Consumers should be proactive, and one of the most important things to do is to either bring a current list of medications or the actual prescriptions when admitted to a hospital, says Dr. Iahn Gonsenhauser, the chief quality and patient safety officer for the Ohio State University Wexner Medical Center.
“That is priority No. 1, and they also need to be open and honest with the care team on how they take these medicines, especially if it differs from the label,” Gonsenhauser says. “About 30 percent of hospitalized patients encounter some degree of medication-related harm and 7 percent of those are severe.”
More than 7 million preventable, but harmful, medication incidents happen every year in the U.S., costing an estimated $21 billion. “It can impact your length of stay and morbidity and mortality, as well as increase costs, and we believe a significant number of those are preventable,” Gonsenhauser says.
About 10 years ago, the Ohio Hospital Association, the Ohio State Medical Association and the Ohio Osteopathic Association created the Ohio Patient Safety Institute focused on working with hospitals and health care providers to improve health care outcomes in Ohio. OPSI collects medical error data from hospitals around the state and shares information with patients needing health care services, including preparation for hospitalization.
“We’ve spent a lot of time working with these hospitals and a goal for us is to make sure patients are actively involved in their health care process,” says John Palmer, the director of public affairs for the hospital association. “A lot of times they may not know what questions to ask or what arrangements need to be made.”
Palmer says patients need to ask standard questions to health care providers, such as:Why is the surgery appropriate? What are the risks and side effects? What is the impact of allergies, chronic conditions or other ailments? What alternatives are available? Is the procedure covered by insurance? What happens if I don’t do anything?
Most importantly, every patient should have a supporter by his or her side, even though many, if not most, hospitals have in-house advocates. Whether this person is a relative, a friend or a neighbor, this step is critical, says Allen Vaida, executive vice president for the Institute for Safe Medication Practices.
“A patient has a lot on their mind, and it can be intimidating or they may feel terrible or maybe they are sedated or not in the presence of mind to listen closely,” Vaida says. “Unless they get written instructions, it can go over their heads. Hospitals are really pushing for this also.”
Not surprisingly, patient safety is near the top of the responsibility list for hospitals and is also a major focus of The Joint Commission, a nonprofit organization that accredits and certifies more than 22,000 health care organizations in the United States. That accreditation reflects a medical center’s commitment to maintaining certain health care standards. The commission assists an organization in seeking the root cause of any on-site problems and helps them identify tools to improve, says Dr. Ed Pollak, the commission’s medical director and patient safety officer in the division of health care improvement.
“It’s really about improvement, and the ultimate goal is to achieve zero harm,” Pollak says. “Accreditation, itself, has a number of requirements, many of which are imposed on organizations, and we try to tie as much of that as we can to patient safety and improvement work.”
A vast amount of data related to medical error exists, but the reliability of some of it is open to interpretation, Pollak says. Nonetheless, the U.S. is not highly rated in many comparisons, including in a 2019 WHO ranking of the world’s health systems, which puts the U.S. as No. 37 out of 190 countries.
Reprinted from Columbus Monthly Health 2020.