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Health Sentinel: Hospital patients should expect and ask for quality care

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How to get good hospital care

Heading to the hospital? Here are a few tips:
*From the time of admittance to discharge, have a family member or close friend at your bedside.
*Take a notebook and pen. Ask your advocate to jot down questions or concerns as they arise; record the time and staff involved.
*If your concerns are not addressed by your nurse, call the patient advocate, the nurse manager or house supervisor. Notes on the discussion should be recorded in the notebook and ask for verbal follow-up.
*Surgery can temporarily affect the voice due to intubation or the procedure; anesthesia and pain medications affect memory and thought processes. Prior to surgery, discuss with staff how you will communicate your needs in recovery or at other times when your advocate cannot be by your side.
*Avoid being transferred from recovery to your room or being sent for tests during a nurse shift change.
*Be truthful about your pain level. If medications are not keeping the pain in check, say so.
*Though opting to have elective surgery on a Friday may seem like the practical decision, especially if you are employed, be aware the risk of death within 30 days of an elective inpatient procedure is 44 percent higher if done on a Friday than a Monday. Fewer senior experienced staff and reduced staffing levels may be to blame.
*Having surgery toward the end of the week increases the likelihood the weekend rounding doctor will not be your own.
*Patients admitted to the hospital on a holiday have higher mortality rates at seven days and 30 days compared to patients admitted on other days.

Sources: Journal of the American Medical Association; British Medical Journal; Agency for Healthcare Research and Quality; Jennifer L. Boen

Monday, July 8, 2013 - 12:01 am

In writing this medical column for more than a decade, I have repeatedly told readers — and friends and family, in general — to speak up if they think something about the health care provided them is not as it should be. After surgery and three days of hospitalization a few months ago, I finally took my own advice.

It was a difficult decision to write the administrators of a Fort Wayne hospital and give details of what I and my family experienced, but I've many times urged others to speak up, if not for them, then to spare others the same fate.

According to a study of nonfatal errors reported by hospitals across the county, Harvard School of Medicine researchers found nearly one in five people are in some way harmed during the course of their hospital care. Those are the reported cases.

Researchers at Johns Hopkins University estimate 98,000 people die each year as a direct result of the care provided. Errors run the gamut from wrong medications to healthcare-acquired infections to surgical errors.

My intentions in writing hospital officials were never litigious, but truly an effort to inform the people who are in a position to review protocols and procedures and make needed changes.

I received immediate replies to my emailed letters, which was encouraging and is how all hospitals should respond. After a face-to-face meeting that included two family members who were with me throughout my hospitalization, I followed up with a letter reiterating our key points of concern.

After officials had opportunity to look into the issues, comparing hospital records with what we reported and speaking with staff involved at various points of care, I was contacted by a hospital administrator who reviewed with me the findings.

On multiple levels, hospital procedures or policies had not been followed. The official discussed what the hospital learned, what actions were taken and thanked me for bringing the matters to their attention.

Through this process, I learned several valuable lessons, most importantly, don't ignore seemingly minor quality of care issues that can have detrimental outcomes, especially when they occur alongside other seemingly minor errors.

Sponges left in patients and wrong-site surgeries are the talked-about errors. Accumulation of what patients deem less serious mistakes can lead to complications that result in longer hospitalization, greater cost and other negative outcomes.

Don't chalk up care that seems inadequate but yet not life-threatening to just being the way it is these days in hospitals, with overworked nurses, lack of communication between various departments and insurance companies pushing patients out as fast as possible.

My experience confirmed what I have intuitively known: Until patients learn to speak up and do so with integrity, with confidence and without punitive intention, though in some cases the latter may be warranted, one in five of us will continue to be harmed by hospital care. Until hospitals encourage patients to give honest assessment of their care and experience, 98,000-plus people will die every year from avoidable medical errors.

The burden to improve care rests with all of us, patient and care provider. I would like to think that everyone in this hospital who received reminders or re-education on certain policies and procedures embraced the instruction. Regardless, I applaud officials at this hospital for how they handled our concerns.

As a health and medical journalist who regularly interviews hospital officials, taking my concerns forward carried risk. As that journalist, I really had no other option.

Every patient should do the same. I would hope this hospital and all others genuinely put out a welcome mat for any person, not just a journalist, who has experienced less than optimal care to come forward.

Such actions by patients and hospitals will save lives.