AARP's Position on Social Security
ELDER POETRY INTERLUDE: Lines on Retirement, after Reading Lear

How to Survive a Hospital Stay

category_bug_journal2.gif Way back in 1977, on the day I was to begin an exciting new job, I instead wound up in a hospital with, among other symptoms, a high fever and unbearable abdominal pain.

Soon after my arrival, I lay on a gurney in a hall with a drip line in each arm as medical personnel scurried about ignoring me now that I was in no danger. Then I noticed that one arm was blowing up like a balloon. I tried to get the attention of one of the white coats but for some reason I couldn't speak above a whisper.

Okay, I thought, I better rip this thing out myself before my arm explodes. But my other arm wouldn't move much - I was weak as a newborn kitten - so that wasn't a solution. As hard as I tried, I couldn't yell but eventually, an orderly noticed that my arm was alarmingly enlarged and ripped out the line. (I'm betting he got it trouble for that, but I'm grateful.)

I don't recall much of the next 10 days – it's a blurry image of people around my bed, needles being stuck in my bottom, a lot of vomiting and horrific abdominal cramping that never let up.

Then I woke one morning with fever gone, a clear head and free of pain – unless you count muscle soreness from 10 days of constant cramps. When I asked, the doctor admitted that he had no idea what had been wrong (where's House when you need him?), but I happened to get well.

After a week-and-a-half in la-la land, the only thing on my mind was food and the doctor prescribed small amounts of strained fruits and vegetables to start off. As hungry as I was, I couldn't disagree given the residual muscle pain that made even sitting up a difficult maneuver.

Hospitals being what they are, it took several hours for a tray to arrive but instead of mashed bananas or peaches or whatever, the plate held slices of overdone roast beef, boiled potatoes and string beans. God, I wanted to dig in, but the absence of pain felt tentative and I wasn't willing to risk setting it off again.

When I tried to explain that I was on a different diet, the delivery person pointed to my name on the tray, Bennett, and refused to believe a mistake had been made as she dashed off to finish her rounds.

My stomach was growling, but I only stared at that gray roast beef - maybe drooling over it. Ten minutes later, the delivery woman came running into my room. “You didn't eat that, did you?” she asked, explaining that she had confused my tray with another Bennett down the hall.

I had mostly forgotten that hospital adventure when, in 1999, I read of the Institute of Medicine's now famous report titled, To Err is Human [pdf] about preventable hospital deaths. The statistics are shocking:

”At least 44,000 people, and perhaps as many as 98,000 people, die in hospitals each year as a result of medical errors that could have prevented...” states the report. “Even using the lower estimate, preventable medical errors in hospitals exceed attributable deaths to such feared threats as motorcycle wrecks, breast cancer, and AIDS.”

With numbers like that, it was easy to see that the report was well named, and I had only to recall my own minor hospital errors to know how easily they can happen. People make mistakes; there is no reason to believe doctors and nurses don't make them and in their case, unlike you and me most of the time, it can be a matter of life and death.

I made a mental note to stay as far away from hospitals as possible.

Several years later, surgeon and writer, Atul Gawande, caught my attention in a December 2007 issue of New Yorker with an article titled, “The Checklist,” in which he related the story of a Johns Hopkins critical care specialist and the experimental medical checklist he put into practice at one hospital over a year's time in 2001 for just one kind of hospital procedure:

”The results were so dramatic that they weren’t sure whether to believe them: the ten-day line-infection rate went from eleven per cent to zero.

“So they followed patients for fifteen more months. Only two line infections occurred during the entire period. They calculated that, in this one hospital, the checklist had prevented forty-three infections and eight deaths, and saved two million dollars in costs.”

A few years later, the results of a similar experiment with hospital checklists were even more amazing:

”Within the first three months of the project, the infection rate in Michigan’s I.C.U.s decreased by sixty-six per cent. The typical I.C.U.—including the ones at Sinai-Grace Hospital—cut its quarterly infection rate to zero.

“Michigan’s infection rates fell so low that its average I.C.U. outperformed ninety per cent of I.C.U.s nationwide...The successes have been sustained for almost four years—all because of a stupid little checklist.”

It's an astonishing story that Dr. Gawande expanded into a book, The Checklist Manifesto, but the New Yorker story will give you the essence of it.

As Dr. Gawande explains, it is an uphill battle to get physicians and hospitals to adopt something as “unscientific” as a checklist and, in a recent story at their website, AARP reports that for the 37 million Americans who are hospitalized each year, the problem of medical mistakes has only grown since the 1999 To Err is Human report:

”A report released in January on Medicare patients found that hospital staff did not report a whopping 86 percent of harms done to patients. If most errors that harm patients aren't even reported, they can never be tracked or corrected, the Health and Human Services Department report pointed out.

“This latest study built on an earlier HHS study of Medicare patients that found one in seven suffered serious or long-term injuries, or died, as a result of hospital care. Researchers said about 44 percent of the problems were preventable.

“In another key study published last spring in the journal Health Affairs, researchers examined patient charts at three of America's leading hospitals and found that an astounding one in three admissions included some type of harm to the patient.”

Types of "harm" are not defined and certainly some number are as minor as mine were but it is still shocking and a warning for anyone requiring hospital attention. You can read the AARP story here.

A companion piece has been posted at the AARP website with – wait for it – a checklist of things you can do to help ensure safer medical care when you, a friend or relative is hospitalized.

Print it out for yourself. It is an highly useful list. From it, two items stick out that are of paramount importance:

  1. Never, ever allow any hospital personnel (or visitor) – that means your physician too – to touch you without first washing their hands. If they approach you without having done so in your presence, politely ask them to please wash before touching you. Also, wash your own hands frequently.

  2. Have an advocate with you as much as possible. Most of the time, whatever reason you're in the hospital means you are probably not thinking clearly. You need someone to be your eyes, ears and brain when yours are not functioning at full capacity.

When someone cannot be with you, rely on that “stupid little checklist," as Dr. Gawande calls it. It saves lives.


At The Elder Storytelling Place today, Johna Ferguson: Elder Problems in China and the U.S.

Comments

This article always makes me chuckle! That's because when I entered nursing (1955)I spent a 3 month rotation assisting in the OR & WE HAD CHECK LISTS that every nurse checked including the nun supervisor. If someone arrived for surgery with an incomplete or unsigned list (by an RN)the patient was delayed & someone was called to task. Later after graduation & working in a small NJ community hospital we had CHECK LISTS!!! Every nurse & some drs. used checklists for a variety of procedures & in the OR. The news stories sound as tho' someone discovered sliced bread. I still can't get rid of the smile on my face as I read this & I'm sure other nurses who read your blog will be shaking their heads, too.
Part of the problem in hospitals, IMO, is that many of the old tried & true simple things that were done 100 years ago :) are no longer done for many reasons.....(another blog subject)& checklists may be one of those casualties. Dee

Scary, scary! My hospitalization last year for inpatient therapy after my stroke lasted 27 days not counting five days in ICU (7 days including the two day wait for a spot in the therapy unit. The therapy program was so slammed about 2 weeks after I arrived that they were pulling nurses off other floors. Most meds by mouth were given during our communal meals. One of those nurses new to the therapy unit handed me my little paper cup of meds and told me she would be by my room later to give me the injection in my stomach.

"I haven't been having any injections," I said. "What is it for."It was something, a blood thinner, I think, as a preemptive measure to prevent another stroke. Alarm bells clanged. My stroke was henorrhagic. Blood thinner was the last thing I needed. I said so. She said it is right here on your doctor's orders.

"I don't want that unless the doctor comes in and personally talks to me about it." Never happened. But if that had occurrred in my first few days there, I doubt I would have even asked what it was or processed the info quickly enough to head off that shot that was for someone else.

Thank you again.

I'm from a big family and, because I have the time, I am generally the person who sits with whatever family member is hospitalized. We get very good service in the hospital our family uses, but I have caught mistakes, oversights, delays, etc., that highlight the importance of having a patient companion present.

It is important for a patient companion to be friendly and helpful to the staff, but you must also be alert and, when necessary, assertive. In the end, a good companion helps the staff.

Agree with Dee regarding checklists. (And the value of double and triple-checking.) Nothing new about those in nursing. This is a physician, who, blessedly, has realized that even MD's can't always know and remember everything! Errors will occur when humans are working in complex situations. Fortunately most are harmless. The challenge is always creating systemic checks and balances with the goal to reduce or eliminate the potential for errors wherever you can. Patients should realize how vulnerable they are and question everything like Linda did above. Linda, I'm sorry the caregiver with the wrong medication didn't come back to discuss your meds with you. Believe me, if a patient so much as said "I don't remember that blue one" , I went back to check again. You have to realize you are human and can make an error, as can anyone else who played a role in getting that pill to the bedside. The system is frought with alligators!
Thank you Ronnie. More articles on this topic of empowering patients in their own care would be very useful.
My experiences since I retired more than a decade ago have been with family members in the hospital and I felt at a loss for information. I honestly don't know if having been an RN was a help or a hindrance !

Believe me being an RN was a big help:) Dee

Of course you're right, Dee! ; ). I spent some time early on as a nursing instructor and sometimes I thought I might have been expecting too much.

Because I work in the non-profit health sector I hear stories that would curl your hair, almost on a daily basis. Physicians ignore drug allergy information, ignore drug interaction warnings, ignore the "do not give this drug to these patients" warnings. It's made me very wary and triple cautious when visiting the doctor. Entering a hospital without an *informed* advocate is like playing Russian roulette. I've heard a dozen stories of hospital staff taking ID off medic alert tags and totally ignoring the medical information. I go with my husband and stay with him, but he's not well enough to do the same for me, and I have no one else to call on. It's terrifying.


I cannot imagine anyone's thinking that a checklist is "unscientific". What planet are they from?

I am a huge believer in checklists (I recall how baffled I was when the study on medical checklist use was released several years ago) AND in hand washing.

I am particularly appalled when people lick finger or thumb to sort paper - especially money - and then want to hand it to me. Gahhh!

I don't think anyone escapes hospitalization without a story, a minor one if they're lucky.
I've only been in the hospital twice so I guess I'm lucky right there.
In 1976 I was only in overnight after a tonsillectomy but the dietary staff complied with my liquids only diet. Unfortunately they sent grapefruit juice. Luckily the nurse was there and she went stomping out to get something that wouldn't rip my throat up.

In 1991, I was in another hospital clear across the country for a hysterectomy. The staff forgot to remove my IV and I too awoke with a balloon arm.
I count my blessings I'm healthy but will follow your advice.

I always ask what the medication is for when I am in the hospital or in rehab after a friend of mine was nearly given medication that would surely have caused her death had she taken it. When a nurse presented her with a pill my friend asked what the medication was and after hearing the name knew it was not something she had been taking. Then she asked what is was for and it was not for her illness. When she told her doctor about it, he was horrified at the near error that could have been disastrous. The nurse had mixed her name up with another patient.

This is so valuable. I'll never forget my MIL almost being prescribed a medication that had almost killed her before, because the doctor had overlooked the warming on her chart. My husband caught the mistake.
I read that article in the New Yorker when it came out and found it very impressive. And I will save the list and use it.
Thanks.

To me it is surprising that there are not more errors in hospitals. Most nursing staffs work 12 hour shifts, really 13+ with shift overlap. Many nurses have family responsibilities and go home to the “second shift”. Therefore, chronically tired staff are caring for patients. Staff/ patient ratios - hospitals will gladly pay multimillions for the latest technology to generate income but will skimp on staffing. Hospital design – rather than have a quiet place to prepare medications, the trend is for the nurse to prepare medications in the hospital corridor. So you have a tired, overworked nurse trying to concentrate in a busy environment.
I second Ronni’s recommendation of Atul Gawande; a terrific writer on current medical practice.

On top of what I've experienced and what I've heard, I read an article somewhere about the alarmingly high percentage of elderly patients who, once hospitalized, never go home again. I will fight a hospitalization with every resource I have, and I won't submit without a knowledgeable, assertive advocate at my side. Hospitals can be hazardous to your health!

The handwashing expectation is certainly correct, but in my hospital experience the patient can't see a sink or where anyone washes their hands. As a therapist, I always do it before I go into a patient's room as I expect a doctor does. If the patient asks, they'll just have to take the doctor or therapist's word for it.

I've appreciated Dr. Gawande's books, his other writings and recall reading about his "check list" experience. Seemed like hospitals adopting such a list would be wise but I haven't heard of any doing so, except for whatever individual medical personnel may carry around in their head.

A big concern with hospitals today are the super bugs that are highly resistant to ordinary antibiotics i.e. MRSA and some even more serious.

Older people can be more susceptible to those bugs just as they may be more prone to dying in a hospital because they have more medical problems on admit to begin with.

Frankly, I think hospital and skilled facility nursing staffs have been understaffed for quite a few years which increases risk for mistakes. That's all the more reason why patients need to be their own advocates or have someone with them who can advocate for them.

One help can be a rehab. therapist if they're needed and on the medical team. I've often had patients speaking up to me, then find they've never told their nurse of some symptom or concern. My experience is one of being mutually supportive of both patient and nursing to aid in minimizing some mistakes.

Surprising to me has been how many patients are reluctant to speak directly to nursing and have to be empowered to do so.

This topic reminds me that numerous people who live alone can have a problem having an advocate present when needing to make a sudden unexpected trip to the hospital.

I learned I had to be vigilant when my husband was hospitalized several times in one year. I would give them a complete printed list of the medications he was on to the staff in the ER. When he was on the ward I had to check what was ordered against my list of medications as often the admitting left off necessary meds. We learned this the hard way when he had a wedge lung resection. They did not prescribe his prostate medication and when they pulled the catheter he could not pee. The consulting urologist had to order the medication started again and had to recath him until the next day. After that I always verified the orders and had the RN obtain the necessary order for all his medications. It is very difficult to advocate for yourself when a patient in the hospital. Any time there is an invasive procedure there is a big risk for infection. Stay out of hospitals if at all possible.

Check!

What a great post. I decided to stay out of hospitals if at all possible after getting a staph infection following the removal of one of my ovaries in 1990. I was sick prior to the operation.....but demonstrably sicker following due to the staph!

Good health and long life to you, Ronni....to us all.

You don't have to be an "Elder" to benefit from this list. We have a young friend who is getting out of the hospital today after a two month stay due to a sudden aneurism and a resulting stroke. Thank God and wonderful surgeons he survived.

I'm pretty sure I read of a US hospital that was prevented from using a check list based procedure such as this, because it hadn't been clinically tested, even though it had major and provable benefits.

Tiredness is one thing, but bureaucratic inflexibility combined with stupidity is a lethal combination. The downside to checklists is that they are often produced by a bureaucracy, and the stupid cling to them like a lifeline.

Large corporations depend for their existence on adherence to procedure. Independent judgement and practical common sense are a threat.

So long as health care is delivered by anonymous corporations rather than skilled practitioners we will have these problems. Big is not better, small is beautiful.

I'm late coming to the party, but if it hasn't been said already...

I agreed 100% when I heard someone on Oprah say that if you have any choice at ALL, do NOT have that advocate be your husband! More than likely, men just aren't any good at that kind of thing and I'm 99% sure that my husband would fit into that group. :)

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