After her hysterectomy in an Ohio hospital, Rebecca Strunk couldn’t eat or drink for days, and she had severe pain in her upper abdomen.
When Strunk mentioned her discomfort to her caregivers, whom she assumed to be nurses, they said this was normal following a hysterectomy. Everything was fine.
Everything wasn’t fine. During the operation, Strunk’s intestine had been punctured, allowing her bowel to leak into her abdomen. The problem wasn’t detected until Strunk went into shock three days after her surgery.
By then she had a massive abdominal infection, and her kidneys had failed. Two days later she was dead.
Strunk’s infection should have been caught sooner, says Richard D. Lawrence, a malpractice attorney in Cincinnati who represented Strunk’s husband in a suit against the hospital.
Part of the problem was that much of Strunk’s care was delivered by patient-care technicians who didn’t understand her symptoms, Lawrence says. Patient-care technicians may have as little as four weeks to six weeks of on-the-job training.
“Strunk wasn’t consistently monitored by a registered nurse,” he says.
As hospitals reduce the size of their nursing staffs to save money, the number of patient-care technicians, who may also be referred to as aides or patient-care assistants, is increasing.
In the past, each registered nurse in a medical or surgical ward was typically responsible for four patients. Today an R.N. may have more than twice that many.
Despite these problems, it’s still possible to get top-notch care. Here are some tips on making your hospital stay safe and trouble-free.
– Pick the right hospital. Even if your doctor recommends a particular hospital, she may have admitting privileges at others in your area. And while health plans often limit your choices, they can be flexible if you can make a case that you’d be better off in another hospital.
Where will you get the best care? Good community hospitals do an excellent job of treating most routine medical conditions, but consider a university hospital if you have a life-threatening condition. Studies suggest that death rates are lower at large teaching hospitals in big cities than at other hospitals.
Teaching hospitals do have their drawbacks, however. Because they’re staffed in part by doctors-in-training, you may be asked to undergo more examinations, including some by students.
Make sure the hospital is accredited by the Joint Commission on Accreditation of Healthcare Organizations. Write to the commission at 1 Renaissance Blvd., Oakbrook Terrace, Ill. 60181, or call 630-916-5600.
– Time it right. If you have a choice, avoid weekends and holidays, when hospitals may run on skeleton staffs. You could end up waiting longer for care, which wastes your time and increases your risk of catching an illness from another patient.
If you’re planning elective surgery at a teaching hospital, pick a time other than early summer. Every July 1 the medical staff rotates, as medical students are promoted to interns and interns become residents, so many of the staff will be new to their jobs.
– Check out the staff. Anyone who’s ever been hospitalized knows that nurses provide most of the care. Ask your doctor how many patients each R.N. is responsible for. And don’t assume anyone wearing a white uniform is a nurse.
– Question surgery. Many operations are done for less-than-appropriate reasons. Consider getting a second opinion if a doctor recommends an operation. Your health plan will pay for it, and you may avoid procedures you don’t need. If you can, see a physician who is affiliated with a different hospital.
– Make sure you’re in good hands. If you’re having an operation, obviously you’ll need a qualified surgeon. You can find out whether a doctor is board certified, which means he’s had advanced training and passed a special exam, by calling the American Board of Medical Specialties at 800-776-CERT.
Ask your surgeon about his track record. How frequently does he perform this type of surgery? What’s his complication rate? If you’ll be in a teaching hospital, will your surgeon be operating or simply supervising more junior doctors?
– Demand facts–politely. You have a legal right to know your diagnosis, proposed treatment and prognosis. You also have a right to refuse any recommended treatments.
If you don’t understand why you’re having a certain procedure or you have questions about your illness, ask for an explanation. But be polite and respectful because you don’t want to compromise your relationship with the hospital staff.
– Lower your infection risk. More than 2 million hospital-acquired infections, such as pneumonia and blood poisoning, are reported in the U.S. each year, according to the Centers for Disease Control and Prevention in Atlanta. These infections kill 19,000 people annually.
Many could be prevented if hospital workers washed their hands between patients. But a recent study found that intensive-care workers failed to perform this simple task 62 percent of the time, with doctors the worst offenders.
It’s a good idea to simply ask your doctors, nurses and therapists, “Have you washed your hands?” Another study found that when patients posed this question, hand-washing increased by 34 percent.
Another way to reduce your infection risk: Avoid unnecessary intravenous lines and catheters, which can carry germs into your body.
– Beware of drug errors. Ask for a complete list of the medications you’ll be given. Find out what each one is for, what it looks like, what side effects are possible, how often you should receive it and in what dose.
If a nurse brings you a pill or hangs an IV bag that doesn’t look familiar, point it out. I once worked at a hospital where, after the morning’s medication, a nurse realized she had a pill cup left. She had gone through the ward giving every person the pills intended for his or her neighbor, and no one had said a word.
– Don’t leave until you’re ready. To save money, insurance companies and managed-care plans are pressuring doctors to get patients out of the hospital as soon as possible. Discuss this with your doctor before you’re admitted. If you need a longer stay than your insurance company deems necessary, will your physician go to bat for you?
