Pulse: Health: Medical Mix-Ups

Some advice for leaving a hospital no worse than you came in

Remember the inexplicable blood transfusion snafu at Duke Medical Center, the overdose of chemotherapy at Dana Farber, and the woman who had the wrong breast removed? These weren’t isolated hospital mistakes. A patient safety report issued this past July claimed that nearly 200,000 hospital patients die annually in the U.S. as the result of preventable medical error. That’s the equivalent of a jumbo jet crashing every single day with no survivors — and double the number of deaths cited five years ago in a bombshell Institute of Medicine report on hospital errors.

It’s not that hospitals aren’t paying attention to their mistakes. Quite the contrary. Last June, Pennsylvania became one of 22 states to mandate that hospitals report all “serious events” and “incidents” to Pennsylvania’s Patient Safety Authority, an agency established in 2002 to identify problem areas and help hospitals fix them. (Unfortunately, it isn’t easy for the public to find out about hospital blunders.) At Jefferson and Penn, the shift from a reactive to a proactive stance has created departments devoted solely to ferreting out weak links in patient care and fixing them. At Penn, for example, when an investigation found that at-risk post-surgical patients often didn’t receive enough of a blood thinner, the dosage was reevaluated, and the incidence of blood clots dropped nearly 50 percent. Nevertheless, P.J. Brennan, an infectious disease specialist who three years ago took on the post of chief of health-care quality and patient safety at the Penn system, admits, “It’s a slow process. Look how long it took the FAA to improve airline safety.”

More pessimistic is Charles Inlander, president of the advocacy group People’s Medical Society, who pegs the number of avoidable deaths at closer to 400,000. “There is a lot of talk and smoke and mirrors,” he says, “but I’ve seen no data that shows improvement on an overall basis.” His advice? “Don’t count on hospitals. Take charge yourself.”

The majority of errors can be traced to communication problems, which could be alleviated by adopting the patient mantra “Nothing about me without me.” Medication mistakes lead the pack, so question everything, and say no to anything that doesn’t look right. Why am I getting this pill? Who ordered it? This isn’t the medication you gave me yesterday. Why am I having this test? Did you check my name-tag bracelet against the order? What were my earlier test results? What’s in that IV bag, and why do I need it? Keep a notepad by your bed to jot down questions when you think of them, and don’t be afraid to badger people until you get an answer you understand. Nurses often change daily, and Nancy who cared for you yesterday can morph into Sally who knows little about you. The inconsistency of care is one of many reasons to know your medications and, whenever possible, to have an advocate by your side.

While patients are notoriously uncomfortable putting doctors and nurses on the spot, Inlander says studies show assertive patients really do get better care. Since the squeaky wheel gets the grease, don’t be afraid to squeak loudly and often. This is especially true when it comes to hand-­washing. The National Center for Infectious Diseases says half of the 100,000 annual deaths from hospital-acquired infections could be avoided if patients simply insisted that everyone who enters the room wash his or her hands. Finally, get discharged as quickly as you can. The longer you linger, the greater the chance you’ll leave sicker than you came.