How to Get Out of the Hospital Alive !

15 November 2006  Source unknown  (updated 5 January 2008)

Patients imagine hospitals as havens from illness and accidents, but they're also home to bacterial booby traps and medication mistakes. Here's how to leave healed, not hurt:

Don't wait until the paramedics are wheeling you into the medical equivalent of Merle's Lube & Tire to worry about your care. By then, it may be too late. Arming yourself with information now is the first step to surviving a hospital stay when the time comes. Sooner or later, it will.

While You're Still Healthy

• Download a Health Dossier
• Doctors are health detectives, so give them as many clues as possible by gathering all your medical data.
  
• At the very least, you need a list of medications you're taking (including dosages); your medicalhistory, immunizations, and allergies; the name and phone number of your doctor; lab reports; and copies of recent EKGs and MRIs.
• You can create a file with paper copies and laminated sheets of the EKGs – or carry it all on your key chain:  
• "Make electronic files and scans and save them on a portable USB drive," says Kevin Pezzi, M.D., a former emergency-room physician and the author of True Emergency Room Stories.
• The best way is to save everything as PDFs, which can be read by virtually any computer.
• When you're finished, label the USB drive "medical info," so doctors can spot it in an emergency.

• Will this be time consuming? Absolutely, but here are just a few reasons why it's worth it:
• Knowing what and how much medication you're taking can help doctors come up with a speedier diagnosis. "Some medications can have the side effect of causing fainting," says James Giglio, M.D., chief of emergency medicine at New YorkPresbyterian Hospital. "If someone's been fainting, a medication history may prevent us from embarking on a lengthy and expensive search for the cause."
• It helps provide context for emergency physicians.
  
• By providing instant unfiltered access to everything that's ever been committed to paper or printout about your health, you'll remove one of the E.R. staff's biggest handicaps to helping you.
• "If an E.R. doc runs across a patient who has a heart murmur, the patient often won't know what type it is, how long they've had it, if it's new or old," Dr. Pezzi says.
• Listing your doctor's contact information will help save critical seconds in the event that he needs to be reached for a quick consultation on something in your file. "A patient may say he sees Dr. Smith in Salt Lake City. You can imagine how difficult this person would be to track down," Dr. Giglio says.
  

• Identify the Best Hospital
• The time to decide where you want to be treated in a non-emergency situation is now -- not when you're coping with a cancer diagnosis or wrestling with the reality of a blocked artery.
• Start by visiting http://www.qualitycheck.org to see which hospitals in your area have been vetted by the national health-care watchdog group the Joint Commission on Accreditation of Healthcare Organizations.
• Another good tactic: click here, for a list of the 100 most-wired hospitals, which are probably using the latest information technology that helps reduce medical errors.
  
• If a particular hospital isn't on the list, call to  see if it has one key advance: bar-coded processes for dispensing medication.
• With this system, nurses scan the medication bottle and the patient's wristband to confirm that the correct drug is being given -- a huge step in decreasing medication errors.
  
• Last step: Find out the patient-to-nurse ratio. Ideally, it should be four to one, according to new research in the Journal of the American Medical Association.
• For every additional patient a nurse needs to tend to, the risk of dying on that nurse's watch increases by 7 percent.

Before You Head to the E.R.

• Call Your Doctor
• What you may perceive  as being E.R. urgent may be something that your primary-care physician can handle in his office, or something that can be taken care of in a less-crowded immediate-care center.
• The exception is chest pain. "There's nothing an office-based doctor can do to be of the slightest assistance in treatment of a heart attack," says Dr. Giglio.
  
• Well, actually, there is one thing he can do: Meet you at the E.R., which will probably get you faster attention than if you were wheeled in alone. Call 911, then call your doctor.

• When You Speak with the Triage Nurse

• Be Descriptive
• You'll be seen sooner, diagnosed quicker, and fixed up faster if you can articulate exactly what's wrong to the triage nurse, who signs patients in, takes their blood pressure and temperature, and sets the order in which they're seen based on severity of symptoms. 
  

•  Most important:
  
• Pinpoint your pain's location and describe it using analogies (e.g., "It feels like a knife in my chest"). The alternative? "I saw a man sit outside with a dislocated shoulder for 3 hours. That's a triage-nurse error," says Susi Vassallo, M.D., a professor of emergency medicine at the New York University school of medicine."

• Be specific
• 'Dizzy' can be a very vague term," says Dr. Giglio. "It might mean they feel like they're going to pass out, it might mean they feel offbalance, or it might describe a foggy feeling. Dizziness can be a common medication side effect, or it could be a sign of a heart attack or stroke."

• Most of all, be honest
  
• To decrease your risk of adverse drug interactions, come clean about everything you've been dropping down your gullet.
• "You'd be surprised how many people don't tell the truth -- what medicines they might have already taken and what things they take regularly, like illegal drugs, or ones for bodybuilding, or Viagra," says Dr. Vassallo. 
  

• <>While You're Sitting in the E.R. Waiting Room

• Stay On Their Radar
• This summer, a 49-year-old woman complaining of chest pain died in an E.R. waiting room outside of Chicago.
  
• To make sure you see a doctor this decade, bring a friend or family member as an advocate and who can nudge when necessary. "He or she can also let the nurses know if your condition changes," says Richard O'Brien, M.D., a spokesman for the American College of Emergency Physicians. Plus. 
  
• That person can ask critical questions about your diagnosis and treatment that you may forget to ask.

• Don't Read the Magazines
• If you have kids with you, tell them to keep their hands off any toys littering the waiting room.
  
• When British researchers recently swabbed the surfaces of 12 toys in an intensive-care unit, including items brought into the hospital by patients' families and friends, they found 50 percent of them swarming with various strains of bacteria, including Staphylococcus aureus.
•  Bacteria and skin cells  from patients are easily transferred to inanimate objects, which, unlike medical equipment, are infrequently cleaned, says lead authorJacqueline Randle, Ph.D.
  

When You Speak with the E.R. Doctor

• Create a Timeline
• Telling the doctor when your symptoms started (and subsided) is almost as important as relaying what they felt like. "The time sequence can provide clues to the diagnosis," Dr. Giglio says.
• For example, if a sudden numbing, tingling, or shooting pain in your back started months ago as a little tweak, the E.R. doctor needs to know.
  
• "Our job is to find the relatively small number of people who have back pain due to a serious infection or metastatic cancer," says Dr. Giglio

• Discuss Your Vital Signs
• Sometimes a man will enter the E.R. with a high ankle sprain and exitwith high blood pressure. That's because, even if you have a straightforward injury, a nurse will check your vital signs, opening up the possibility that a hidden condition will be detected.
  
• "Men should always follow up with their doctors after an E.R. Visit," says Dr. Giglio.
  

• Include the Minutiae
• Divulge details that aren't in your medical-info file, such as dentist visits and recent trips. Why? Dental work exposes patients to infection, and travel increases the odds of a blood clot or an unusual disease.
• "If a patient doesn't tell me they went to Brazil last month, there are going to be infections that won't even cross my mind," says Dr. Giglio.
  

• Take a Whiff
• Emergency rooms are fast paced, so it's hard to know when a doctor's or nurse's hands last saw a sink. "If I don't have time to wash, there's an antiseptic foam used in emergency rooms that kills bothbacteria and viruses," says Dr. O'Brien. "You'll know someone used it, because it smells like cheap gin."
  
• Insist that anyone touching you or instruments used on you have washed thoroughly both their hands and their instruments.
  

When You're Admitted:

• Research Your Doctor
• Maybe you already know and trust the doctor handling your case. And if so, great. But if he's a stranger, run a basic background check to make sure he practices medicine, not mayhem.
  
• Go to http://www.docboard.org/docfinder.html, a site that provides links to every state's medical board or health department, and look for its database of physician profiles.
• In addition to basic info on education, most of the sites also list disciplinary actions and malpractice claims.

• Enlist a Drug Pro
• You've probably never heard of a clinical pharmacist, but having oneon your case can reduce the risk of medication errors and adverse drug reactions, according to a study review in the Archives of Internal Medicine. "They improve patient care by monitoring high-risk drugs, interacting directly with patients, and providing comprehensive medication instructions after discharge," says lead author Peter Kaboli, Ph.D.
  
• If the hospital doesn't employ a clinical pharmacist, ask if a staff pharmacist can perform some of the same functions.
  

• Men-Use a Condom
• A condom catheter, that is. University of Michigan researcherssurveyed 75 men who had been catheterized using either an indwelling catheter or a condom catheter, which has a silicon sheath that fits over the penis.
  
• Not only were the condom catheters more comfortable, but the men who used them were half as likely as their counterparts to develop urinary-tract infections. They come in five sizes, so be picky about fit.

• While You're in a Hospital Bed
• Flash Your Doctor
  
• Grab your camera phone and take a photo of your physician.
  
• In a recent Mayo Clinic study, researchers found that patients with a  snapshot of their doctor were better able to identify him.
  
• This in turn may help cut down on the number of medical mistakes caused by giving information to the wrong medical personnel. (See "Know Who's Who," below.)

• Know Who's Who
• "Some patients assume that every man in a scrub suit is a doctor," says Dr. Pezzi, and they pass  information to whoever comes in the room. But that guy could be a clueless med tech, increasing the odds of a medical mistake.
  
• Make sure all people identify themselves, and convey changes in your condition only to doctors and nurses.   
  

• Check for LeaksI
• f someone wears a surgical mask too loosely, air -- and germs -- can escape through the gaps. "Usually it's the doctors doing it, not the nurses," says Dr. Pezzi. Look to see that their masks are snug.

• Demand Clean Hands
• A small percentage of health-care workers are compulsively clean, but "others wash their hands only when they think they've gotten them dirty," says Gail Van Kanegan, R.N., C.N.P., coauthor of "How to Survive Your Hospital Stay".
  
• Ask for a pump dispenser of alcohol-based hand sanitizer and put it on your night table -- the staff will get the hint, as will your friends and family.  But don't just hint.  Tell them to use it.

• Scope Out the Stethoscope
• While he's hearing  your heartbeat, bacteria are hopping on your body. Ask your doctor to sanitize his stethoscope.
  
• Just as effective: a disposable glove over its diaphragm, or an antimicrobial coating called AgIon.
  

• Sanitize Yourself
• The infection risks from sharing a toilet seat with an incontinent roommate are obvious. What isn't so apparent is the risk you pose to yourself.
  
• "More often, organisms that cause infections come from the patient's own homegrown flora," says Larson. Protect yourself by slathering your hands with that alcohol-based sanitizer as if your life depends on it.
  

• Dose Up on Aspirin (but only with your physician's approval
• Swallowing 325 milligrams a day can halve your risk of developing a staph infection, says Ambrose Cheung, M.D., a professor of microbiology at Dartmouth College.
  
• "Aspirin can activate the stress response of staph bacteria (including the superbug MRSA), which keeps it from adhering to your tissue." Ask your doctor and pharmacist before adding a medication to your drug regimen.
  

• Protect Your Bed 
• Tell visitors that if they truly wish you a speedy recovery, they should take a seat in a chair, not on your sheets.
  
• In a study in the British Medical Journal, researchers found that a combination of infection-control strategies that included eliminating visitor contact with a patient's bed was able to stop the spread of MRSA and reduce the number of infections by 70 percent. "This is one measure that patients can really control," says Leela Biant, Ph.D., the lead author.
  

 When The Nurse Comes Knocking

• Pop the Question
• As in, "How long have you been doing this?"
  
• The ideal nurse has been in the same unit, the same specialty, and the same hospital for more than a few years.
  
• Don't assume that an older-looking nurse is the most experienced. "More people are going into nursing when they're 40 or 50, and they may be less experienced," says Sean Clarke, Ph.D., R.N., associate director of the University of Pennsylvania's Center for Health Outcomes and Policy Research.
  
• Because of the current nursing shortage, you may not have much choice in terms of who cares for you, but if you have concerns about inexperienced nurses, talk to the nurse manager or supervisor.
  

•  Rate Response Times 
• It's the most critical part of the nurse-patient relationship: They come when you call.
  
• If no one arrives within 2 or 3 minutes of when you pull the cord or push the button, your care could be compromised in an emergency.
  
• "You can't expect every request  r concern to be acted on immediately, but every patient call needs to be checked out relatively quickly," says Clarke.
  
• As with the issue of experience, discuss slow response times with the nurse manager.
  

• Be Wary of Bling
• When scientists at Rush University medical center in Chicago analyzed the hands of 66 nurses, they found that the ring wearers had 10 times more bacteria than the bare-fingered bunch.
  
• One theory is that\ bacteria colonize in the microscopic space between ring and skin, and are then protected from being washed away.
  
• Scan the hands of doctors, nurses, and anyone else who wants to touch your body, and request that any jewelry come off before a rescrub.
  

• Triple-Check Your Meds
• Do it even if you're being shadowed by a clinical pharmacist. 
• University of Pennsylvania researchers recently found that over the course of just 1 month, more than 25 percent of the 502 critical-care nurses evaluated had made at least one mistake, usually with medication.
  
• A nurse is supposed to double-check to make sure that the patient is receiving the correct medication.
  
• You can provide the triple check by asking what it is and why you're getting it.
  

 When Surgery Is Scheduled

• Run the Numbers 
• If your surgeon seems too eager to operate, check out the Dartmouth Atlas of Healthcare's web site.
  
• There you can compare rates of the most commonly overperformed procedures by region, city, or hospital. 
• "In some places, back-surgery rates are 10 times what they are in others. And it's not because the people there are 10 times more likely to have back problems," says Jon Skinner, Ph.D., a professor of family medicine and economics at Dartmouth College.
  
• "It means some doctors like to do back surgery and think it works, while others are moreconservative." Or they're running a scam.
  
• A few years ago, the FBI arrested two cardiologists for doing hundreds of unnecessary bypasses.

• Scrub Off the Bugs
• Five days before scalpel meets skin, start taking two showers daily, washing with an antiseptic cleanser like Hibiclens, which contains the antibacterial agent chlorhexidine gluconate. "Some studies show that it reduces the risk of infections," Larson says.
  

• Opt for A.M. Surgery
• Duke University researchers analyzed data on 90,000 surgeries and discovered that patients whose procedures started near 9 a.m. were four times less likely to have anesthesia complications -- nausea, post-op pain, fluctuating blood pressure -- than those wheeled in around 4 p.m.
  
• Blame fatigue and overbooked doctors arriving late to the O.R.
  

• Empty the O.R.
• Can too much care kill? A new Dartmouth study shows that the more money a hospital spends on a single patient's care, the poorer the outcome of the treatment.
  
• More cash means more physicians per patient, says Skinner, the lead author. "It's hard to get eight or nine doctors to agree and communicate well." Ask that unnecessary personnel, such as medical residents, be kept out of the O.R.

• Get Tucked In
• Before you go under anesthesia, ask for an extra blanket.
  
• The combination of a cold operating room and anesthesia can lead to mild hypothermia, which can slow the post-op healing process.

•  Confirm the Cut
• A few years ago, the Joint Commission on Accreditation of Healthcare Organizations created a new protocol to help reduce the chances of a surgical mistake. It's a smart system -- assuming it's used, and used properly.
  
• Be sure that the mark indicating where to cut is where it should be.
  
• On the incision site.
  
• Don't write, "don't cut here" on a healthy area as it can later look like "cut here" if the ink smudges. 
• Have the surgeon write either the surgeon's initials or "YES", in permanent marker that won't fade after your skin is washed and prepped for surgery.
•  Don't use an X.  IAn X is ambiguous-- it could be read as either "keep out" or "X marks the spot."
  

• Up the H2O
• Hydration equals healing. "In order for your body to heal, the cells must have sufficient amounts of water," says Van Kanegan. "[If you're dehydrated], you're at risk of infection, pressure sores, electrolyte imbalances, heart irregularities, and other complications."
• Shoot for eight 8- to 12-ounce glasses of water a day in the weeks before your hospital visit.
  

When You're Ready to Leave

• Update Your USB  or other  health records you keep.
• Ask for lab results, copies of scans, a list of medications, and other reports.
• (You won't be able to obtain your medical records right then and there, but put in the request now -- in person.
•  When you receive the new information, add it to your portable USB drive or written record.

• Don't Depart on Fatal Friday
• Research has shown that survival rates are lowest among patients who end their hospital stays on Fridays. And even those who live have a higher chance of being readmitted to the hospital within the monththan people released on any other day of the week.
• Scientists suspect that because doctors are swamped at the end of the week, they spend less time providing patients with postsurgery instructions.
  
• The best day to depart if you want to avoid an eternal exit: Sunday.

• Don't be so free with your pee.
  
• Johns Hopkins University researchers recently found that during a typical doctor visit, 43 percent of patients will undergo at least one unnecessary test.
  
• Physicians do this to avoid malpractice suits or, more often, to pad their pockets, says Jon Skinner, Ph.D., a professor of family medicine and economics at Dartmouth College. Here's how we get probed for profit:
• 5 Medical Tests that Do More to Improve Your Doctor's Fiscal Health
• Urinalysis
• The Johns Hopkins study showed that 37 percent of patients underwent an unwarranted urine test.
  
• "It might seem harmless, but a simple urine test can lead to an unnecessary biopsy, which can be painful, inconvenient, and potentially dangerous," says Dan Merenstein, M.D., the study's lead author.
• MRIs
• An abnormality will pop up in MRIs of the back in 64 percent of healthy people, Skinner says, which can lead to "a medical fishing expedition" involving further invasive testing and surgery.
•  Electrocardiograms
• EKGs were the second most commonly overused test performed on healthy patients in the Johns Hopkins study, and previous research has shown that 20 percent result in false-positive diagnoses.
•  X-Rays
  
• An x-ray may not nuke you the way a CT scan can, but it's still radiation. Be on guard if the doctor's office has a machine.
• Full-body CT scans
• They aren't as accurate as advertised, many insurers refuse to cover the cost (they can run you as much as $1,000), and research has shown that the amount of radiation your body is exposed to may increase your cancer risk.