|Ten Tips for a Safe Hospital Stay
We’re going through a sticky patch in hospital care.
Patients and their loved ones often feel that there are too many
doctors (and you rarely see the same one twice) and too few nurses (and
it’s hard to get their attention). Worse: it’s hard to figure out just
who is in
charge -- or whether anyone is. Here’s why:
Too many doctors:
Many hospitals are Teaching Hospitals. That means that medical
students, young MD’s not yet licensed to practice, (Residents), and
practicing doctors who are earning a Subspecialty degree (Fellows) all
contribute to patient care. And all of them work under the
supervision of a fully qualified Specialist or Subspecialist. Many
patients have complicated conditions and a resulting profusion of
doctors in various stages of training.
All these doctors may appear at your bedside,
individually or en masse. They rotate in shifts that are shorter than
they used to be; your daytime doctor is unlikely to be your nighttime
doctor. And they change crews as often as week to week.
Nobody in charge:
If you have only two doctors, they need to communicate only with you
and with each other. If you have three doctors, there are six
crosspaths for communication. If you have six doctors, there are
potentially 720 types of doctor-doctor communication. Nobody checks
that every such communication takes place and is accurate.
Medical specialists often vie with each other for
decision-making power. Who decides if the lung abscess needs
antibiotics, or surgical drainage? The lung doctors, the surgeons, or
the infectious disease specialist?
Just to top it off, many hospitals now employ their
own Hospitalists -- physicians who are charged with being the final
decision maker at the patient’s overpopulated bedside, able to overrule
a Specialist’s and or a Primary Care Doctor’s recommendations.
Too few nurses:
We are coping as a nation with a severe nursing shortage. Even if lots
more people were eager to become nurses, there are fewer and fewer
expert Registered Nurses around willing and able to teach them.
So nurses may not only be few and far between, but
exhausted by longer shifts, higher patient loads, the paperwork
demanded by Managed Care and the Joint Commission, (a private,
non-profit watchdog for hospital standards,) and the rapid development
of new skills for them to master.
What can be done?
The fall out from these developments can be serious:
errors and delay in diagnosis, dangerous glitches with medication and
care techniques, and oversights in ordinary patient safety.
Here are my suggestions for staying safe in the
1. Ensure that a competent adult stays at the
patient’s bedside, and goes along on trips requiring wheelchair or
gurney, as close to 24/7 as possible.
2. That adult should serve as a Sentinel, alert to
obvious deviations in care (food being given to a patient who is
supposed to have nothing by mouth, for instance); ominous changes in
the patient’s condition unnoticed by the staff (increased trouble
breathing, poor color, incoherence); and situations that are dangerous,
such as an unconscious patient who is vomiting and in danger of
aspirating the vomitus.
3. The Sentinel should be prepared to perform tasks
that free up the nurse for more sophisticated patient care. Offer to
empty basins and bedpans, sponge-bathe the patient, tidy the bed, know
where vomit basins, bedpans, towels etc. are located, and how to help
the patient put on a hospital gown. The Sentinel also may have to call
for, or even administer, emergency treatment, such as suctioning the
4. Ask every caregiver not only their name, but their
exact title. If you don’t know what the title means (“I’m a first year
fellow in Invasive Radiology,” for instance) then ask (“What is a
Fellow? What is Invasive Radiology?”).
5. Ask for the training credentials of the
Hospitalist. “Hospitalism” is not a specialty in itself; there are no
required credentials, no Board Certification in Hospitalism. Your
Hospitalist should be a Board Certified Specialist in the kind of
condition the patient has. If not, or if you’re not sure, call your own
Primary Care Physician.
6. Every student, resident, and fellow works under
the supervision of a senior, board-certified physician. Ask each one
who their supervisor is and the nature of his or her credentials. If a
surgeon-in-training appears at the bedside to perform a procedure, make
sure that the senior surgeon knows about it and agrees to it beforehand
(unless it is a truly urgent situation.)
7. The potentially most dangerous area of the
hospital is the MRI suite. It contains an extremely powerful magnet
that acts on every magnetizable object in the room. Metal devices or
fragments inside the body can shift and damage tissue. Loose objects in
the room, such as an oxygen tank, will “home in” on the magnet at great
speed, regardless of what is in the way -- such as your head. Make sure
your technician has checked on all possible dangers. There are no
“national” guidelines for MRI safety.
8. Every study or lab test performed is ordered to
answer a specific medical question. For instance, Is the bone broken?
Is the pneumonia improving? Has the heart suffered damage? If you don’t
know why a test has been ordered, clarify it and write it down. Once
the test is performed, make sure that the physician who “read” the
results actually answers the question.
9. Wear a shrill whistle on a chain around your neck,
hidden under your top, to use ONLY in the case of a true desperate
10. As soon as possible after discharge, obtain and
review the records of the stay with an eye towards accuracy, logic, and
the credentials of the physicians. Make sure the reports of studies
answer the medical question that was asked, and that the reports of
students and doctors in training have been annotated and co-signed by
If this all sounds daunting, well, it is. But after
thirty years as a physician, and sixty-seven days and nights with my
husband in four different hospitals, I can’t honestly offer less
It is likely to be decades before we get medical care
under better control, and in the meantime it is up to us, the Sentinels
of our loved ones, to become the crucial missing member of the Health
Care Team: that is, the person ultimately in charge.
© 2007 Laura Nathanson