Consumer Reports Insights

Consumer Reports Insights: How Healthy Is Your Hospital?

Tuesday, August 25, 2009

You may already worry that hospitals aren't as safe or sanitary as they should be, but nurses say you don't know the half of it. That's the startling conclusion of Consumer Reports' first side-by-side surveys about hospital conditions from the perspectives of two different groups: nurses and patients.

CR heard from the groups in spring 2009 and 2008. In 2009, CR surveyed a national sample of 731 nurses who care for patients in emergency rooms, critical-care units, operating rooms and other areas of the hospital. For the patient's viewpoint, in 2008 more than 13,540 readers told CR about their own or a family member's hospital stay during the previous year. (CR's readers aren't a representative sample of the U.S. population, and they are especially well-insured.)

Depending on your vantage point, hospitals may look very different. About 4 percent of patients said they saw problems with cleanliness, compared with 28 percent of nurses. Thirteen percent of patients said care wasn't coordinated properly, while 38 percent of nurses said that was a problem. Five percent of patients -- but 26 percent of nurses -- said hospital staff members sometimes did not wash their hands before approaching a patient.

From the survey and after interviewing patients, social workers and hospital personnel, CR offers this guidance on how you can have a safe, minimally confusing hospital stay.

1 Do your homework. According to the survey, in which respondents were asked to indicate their top three reasons for choosing a hospital, 65 percent of patients went to a hospital recommended by or affiliated with their physician, 40 percent chose a hospital based on its location and 28 percent opted for a hospital because it was in their health plan's network. Only 11 percent chose the hospital for its record in treating their condition and only 2 percent on the basis of the hospital's ratings as reported in books, magazines or online. It's unfortunate that records and ratings aren't considered more often, because they can provide insight into the challenges that other patients have experienced at various hospitals.

For chronic medical conditions that can lead to frequent hospitalization, such as heart disease or respiratory problems, researching local hospitals is highly beneficial. Doing so will help patients be better informed about their hospital stay, including the quality of care the hospital delivers for a specific condition or illness. Research can also pay off for patients requiring highly specialized or technologically difficult treatment, including those who need surgery for a brain aneurysm, a pediatric heart condition or esophageal cancer. These patients should see if a surgeon has extensive and regular experience with that specific surgery.

Further, if you have health insurance, be sure to get an up-to-date list of providers in your network and understand your plan's rules, especially pre-authorization requirements.

2 Plan for a smooth admission. The leading cause of preventable injury for hospital patients in the United States is medication errors. Research suggests medication mix-ups are especially likely during "care transitions," when patients are admitted, transferred from one ward to another or discharged from the hospital.

The confusion may stem from the lack of a comprehensive electronic records system that makes patient information readily available to any appropriate party in the hospital. It is estimated that less than 2 percent of U.S. hospitals have such a system.

That means you'll have to be your own record-keeper. Keep a list of your current medications and their dosages, including over-the-counter drugs and dietary supplements, in your handbag or wallet at all times. (Include your emergency and primary care provider's contact information, too.) If you have a chronic condition or significant medical history, jot down a summary of your experiences. Make sure to note dates of significant events such as treatments and tests so you can fill out forms accurately.

3 Avoid chaotic care. When care is not properly coordinated, hospital staffers might order unnecessary or duplicate tests and treatments.

If your admitting doctor or hospitalist isn't doing a good job of coordinating, you have the option of working with a patient advocate, social worker or case manager. Patients usually have to take the initiative and ask for such help. It's as simple as making a call on a bedside phone, but perhaps not many patients know it's that easy: In the survey, only 9 percent of patients and 17 percent of relatives did so.

4 Stay vigilant about problems. Just because a hospital looks clean doesn't mean it is. In the patient survey, 7 percent said an infection developed during or up to a month after their hospital stay. Further, 26 percent of surveyed nurses reported observing hand-washing lapses. You should ask doctors and nurses to clean their hands where you can see them before they treat you, and don't hesitate to ask visitors to do the same.

Mistakes don't stop there. Eleven percent of nurses said that in their most recent work week, they observed "incorrectly administered medication or dosage." Hence, you should check medications and their doses before you take them.

5 Plan ahead for discharge. Make sure you understand plans for your discharge. If you don't, ask your hospital's patient advocate, social worker or case manager for help. See your primary care physician within a week of your discharge, and make sure he or she gets copies of your hospital records.

Copyright 2009. Consumers Union of United States Inc.

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