Hospital errors -- how to avoid them

Hospitals don’t appear to be as safe as we, the potential patients, would like, a new study has found.

The question is: What can we do to protect ourselves?

Research published this week in Health Affairs found that as many as one in three admissions have some kind of injury because of medical error, not an underlying condition. Using a new way of scanning patient paperwork for notations on problems such as an abnormal lab test, researchers found 10 times more errors among three U.S. hospitals than other methods would indicate.

Some states have oversight boards to track medical errors and fine hospitals, but the effectiveness of each varies. The health care reform law will require hospitals to electronically track measures such as heart attacks and healthcare related infections and will give financial incentives for better patient outcomes by 2012. If the law exists then.

In the meantime, consumers have to take some responsibility for themselves and their loved ones. The Agency for Healthcare Research and Quality has a few tips for what to ask at the doctor’s office:

-- Ask questions if you’re confused or concerned. Bring a friend or relative along to help you ask questions.

-- Bring a list of all the medications you’re on, even over-the-counter or herbal medications. Or brown-bag the medications themselves. At the pharmacy, make sure the medicine is what the doctor ordered (and the correct dose).

-- Get your test results. Ask when you’ll get results from a test or procedure, and whether it will be in person, on the phone, or by mail. No news isn’t always good news.

-- Ask your doctor which hospital to choose for your condition, if you have the luxury of shopping around.

-- If you need surgery, ask who will be in charge of your care at the hospital. Ask what exactly will happen during the surgery and how long it will take. Tell the surgeon, anesthesiologist and nurses about any allergies, medications or previous bad reactions to anesthesia.

Such precautions are the least you can do. Between 44,000 and 98,000 people die in U.S. hospitals each year because of medical errors, according to a 1999 report from the Institute of Medicine, a toll higher than that due to breast cancer or traffic accidents.

But the above advice is just the tip of the protect-yourself-medically iceberg. Here are some more ways to watch out for errors, also from AHRQ.

-- When the doctor writes a prescription, make sure you can read the handwriting. The pharmacist might not be able to either.

-- Ask anyone who touches you if they’ve washed their hands (or used hand sanitizer). Studies show that, when patients ask, healthcare workers wash their hands more often and with more soap.

-- Ask a pharmacist for the best way to measure liquid medicine. Household measuring devices such as teaspoons aren’t always accurate.

So you know, the agency advises hospitals to make a few changes too: Among the top recommendations:

-- Prevent sepsis, a bacterial blood infection, every time a catheter is inserted. Hospital workers are advised to wash their hands, wear sterile gloves, disinfect the patient’s skin, avoid lines to the femoral artery (near the groin) and remove any unnecessary lines.

-- Create a discharge plan to schedule follow-up appointments and provide phone numbers of whom to call if a problem arises. That reduces preventable readmissions.

-- Eliminate the most common cause of hospital death, venous thromboembolism (VTE). Blood clots can block arteries in the lungs, especially if patients lie down for long periods of time.

-- Educate patients about blood thinners. Patients who just had surgery are often prescribed blood thinners to prevent clots, but overuse can cause uncontrollable bleeding.

-- Make sure the hospital staff gets some shut-eye. Residents should adhere to 80-hour workweeks.

Other advice includes: Work with patient safety organizations, design safe rooms so patients don’t fall, insert chest tubes safely, survey hospital staff to see if there is (or isn’t) a culture of patient safety and train staff to work together as a team.

That’s a lot the hospital staff has to think about, especially if they don’t get enough sleep. Pepper them with questions to keep them focused on your care.