Navigating The Hospital

Cardiac surgeon Dr. Jeffrey Rich at work during heart surgery to repair five blockages in a patient, James Walls, at the Sentara Norfolk General Hospital.
Jeffrey MacMillan for USN&WR
Foreign, overwhelming, frightening, a hospital is a place where you turn your body over to white-coated authority figures and try not to let your thoughts drift to what they plan to do to it. All you have to do is hear the words "you need surgery," says patient safety guru David Nash, chair of the department of health policy at Jefferson Medical College in Philadelphia, "and your IQ falls by 50 percent."

But a little familiarity with hospital people and processes can quiet your restless mind and lessen the fear factor. Even better, this grounding will tell you what you need to know to help keep you safe, shorten your stay, and hasten your recovery.

Using the links below, we'll lead you through the steps you would follow at a typical hospital if you needed surgery, starting when the procedure is scheduled and ending when you go home. The showcase operation will be coronary artery bypass surgery; it is commonly performed in hospitals of all sizes and calls for both skill and teamwork.

We went through the steps via a patient's-eye tour of Sentara Heart Hospital, a 112-bed facility on the campus of Sentara Norfolk General Hospital in Norfolk, Va. Sentara Heart is considered a high-volume center, performing 905 bypass procedures in 2005. Its mortality rate, adjusted for patients' health status, was 1.6 percent, a nice step below the 2.2 percent national average.

From admission to discharge, Dr. Bernadine Healy preps patients and their families for major surgery
Name, please. Sentara is also on the leading edge of a burgeoning hospital safety and quality movement. By the time one 69-year-old patient was about to be wheeled into open-heart surgery last month, the retired engineer from Manteo, N.C., had already been asked over and over, by a string of nurses and doctors, his full name, his date of birth, and the surgery he was to have. "My name's Thomas Adams and I was born yesterday," he joked after the umpteenth repetition.

It wasn't because none of his caregivers had made notes in his chart or could be bothered to remember who he was. Rather, it demonstrated the hospital's safety focus, helping to prevent such medical errors as performing the wrong procedure (or performing it on the wrong side of the body) or giving a medication to the wrong patient.

In a facility that faithfully follows guidelines issued by the Joint Commission, the hospital accrediting body, the number of people who go through the name/birth date/surgery drill during your stay will seem comical at best and annoying at worst. But if you're not asked before a nurse, technician, or doctor does or administers anything, you need to speak up.

As the person donning that humiliating gown, you have the right to participate actively in your care. Politely and assertively asking questions of your caregivers may be the most important thing you do, even in the best of institutions with the most risk-averse staff. Face it, says Nash, a hospital is a whirlwind of activity - a "hurly-burly, rock 'em, sock 'em place." The goal is to get well, and not to get socked.

Scheduling SurgeryPreadmissionCounting DownPre-OpFinally, The ERThe Surgical ICUOn The FloorHeading Home

By Sarah Baldauf