Going above and beyond the call of duty.
As a hospital patient, your goal is to get treatment, get better and go home. Your top priority should be recovery, not worrying about data privacy, avoidable treatments or questionable billing practices. Being expected to adopt infection- and error-prevention responsibilities might seem like piling on. Even so, experts recommend taking the following super-precautions to avoid bad outcomes and keep yourself and your loved ones safe in the hospital.
Monitor hand-washing.
No question: Doctors, nurses and other hospital staff members shouldn’t need reminders to wash their hands. But with hospital-acquired infections like methicillin-resistant Staphylococcus aureus, or MRSA, still rampant, the Centers for Disease Control and Prevention encourages patients to speak up through its Clean Hands Count campaign. Improving hand hygiene works: A September 2016 study found that as more hospital staff members followed hand-washing guidelines, fewer patients developed hospital-related infections.
Question cybersecurity.
With your personal health history, identification and financial information all included, electronic medical records reveal a lot about you. Medical centers struggle to limit hospital data breaches. Frankly, it’s difficult to control the privacy of your electronic medical records from a hospital bed. Your likely best bet is to get ahead of the problem, by asking about date encryption and other cybersecurity measures before a planned hospitalization. After discharge, practicing potential damage control by monitoring insurance statements and medical-record changes can help you spot data-breach signs.
Challenge costly test choices.
The Choosing Wisely campaign, an initiative of the American Board of Internal Medicine’s ABIM Foundation, is meant to help practitioners across medical fields order the best, evidence-based treatments. Informed patients can speak up when doctors order costly tests or procedures that might not be needed. However, a June 20 column in Health Affairs suggests that patients fear being labeled as “troublemakers” if they question orders. Column author and Medicare expert Bill Vaughan described his own reluctance to challenge orders for a routine electrocardiogram test before eye surgery — although he had no signs or history of heart disease. Ultimately, he concludes, it’s up to the health care system, not patients, to make cost-saving guidelines work.
Verify your admission status.
You have been moved from the emergency room into what seems like a regular hospital unit. But don’t assume you’re admitted just yet — instead, you might be on “observation” status. That distinction can make a big difference in your hospital bill, especially for seniors on Medicare. Because it’s considered an outpatient service, with less-comprehensive coverage, observation care often costs more out of pocket. Vaughan, who serves as a volunteer Medicare counselor for seniors in Fairfax County, Virginia, recommends asking about admission status. “That’s a financial thing patients can do without feeling like they’re questioning their doctor’s medical degree and competence,” he says. You should get a Medicare Outpatient Observation Notice, or MOON, if you’re staying on observation at least 24 hours. Ask doctors whether you can be treated as an inpatient instead.
Take part in ‘time out.’
Getting the wrong type of surgery or having surgery on the wrong body part are both hospital nightmares that unfortunately still occur. Operating room time-outs — when the surgical team re-verifies the patient’s identity, correct surgical site and procedure type — add a layer of protection but aren’t fail-safe. As a patient, ask to have the surgical site marked with a permanent marker and be involved in the marking process, suggests the American Society of Aesthetic Plastic Surgery on its list of surgery safety tips. “This means that the site cannot be easily overlooked or confused (for example, surgery on the stomach instead of the breasts),” the society’s website notes.
Coordinate your care.
“Even though patients may not always realize it, they need to follow up on care coordination inside the hospital as well as the outside,” Helen Haskell, president of Mothers Against Medical Error, writes in an email. “Are your specialists talking to each other? It may be up to the patient to arrange a meeting. Do they disagree on your treatment? This can be a matter of life or death for the patient, but the patient and family may not even know unless they ask for an overview.” Start with your providers, or, if you ask, a patient advocate, social worker or case manager may be able to help arrange meetings, Haskell adds.
Double-check orders.
Hospital errors can and do occur. Haskell, whose young son Lewis died from a medical error in 2000, says one of the most difficult jobs for patients and families is making sure everything is done correctly. “If you have been told that something was being ordered, did it actually happen?” she writes. “The patient and family need to follow up on this if they have any doubts.” With tests or scans, she adds, you should ask about results and whether the appropriate person has seen them. She also suggests keeping a journal to check off these important items.
Sanitize surfaces.
What if your ailing loved one is vulnerable to infections but his or her hospital room is dirty? Of course, you should complain. But ultimately, families may have to take matters into their own hands. “Hygiene is another issue,” Haskell says. “Patients don’t always get bathed daily as they once were and hospital rooms aren’t always properly cleaned. And people’s hands carry bacteria. I recommend bringing bleach wipes and wiping bedrails, doorplates, hand-sanitizer dispensers and other ‘high-touch’ surfaces a couple times a day.”
Direct your discharge.
Discharge planning is supposed to start the moment a patient is admitted to the hospital. Your input can ensure that discharge orders cover all contingencies at home, important for heading off missing supplies and gaps in care. First, get informed. Ask how your health has changed since you’ve been in the hospital. If you’ll need help with transportation, medication costs or access to groceries and hot meals, speak to the hospital social worker. Verify that your medication orders are up to date and coordinated with all outside health providers, to avoid drug duplication and overmedication.
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