Hospitals certainly save lives. But sometimes they hurt people. Even kill them. That’s because - like all of us - doctors and nurses make mistakes, and even seemingly tiny ones can cause infections and other medical problems that put lives in jeopardy.
And the toll taken by medical errors in the hospital is bigger than you might imagine.
Deadly hospital infections
How many hospital patients are injured or killed as a result of hospital errors? “We do not really know how many people die or suffer needlessly,” says Dr. Peter Pronovost, medical director of the Center for Innovations in Quality Patient Care at Johns Hopkins University. “We know it’s a lot.”
Infections are a major concern. The CDC estimates that 722,000 healthcare-acquired infections occurred in 2011, and about 75,000 of those patients died.
Dirty hands are deadly
One of the most important tools for protecting patients against hospital-acquired infections is also one of the simplest: washing with soap. Health care providers are supposed to wash their hands immediately before they touch a patient. But how can you be sure there are no germs on the hands of the smiling doctor who just entered your room?
“If you do not see your clinician wash their hands, ask,” says Dr. Pronovost. “They may have washed outside of your room, yet regardless they should welcome your question.”
OK, so doctors and nurses are supposed to clean their hands before (and after) touching patients. But should they be using soap - or alcohol gel? It doesn’t matter. Both have been shown to be effective at killing germs.
Catheters and tubes
Urinary catheters sure aren’t fun, but they are sometimes essential for hospitalized patients. Then again, catheters can give infectious germs a easy route into the body - so they should be kept in place only as long as they are absolutely necessary.
And urinary catheters aren’t the only offenders. “If you have a bladder catheter, a breathing tube, or a vascular catheter, ask every day if you still need it,” says Dr. Pronovost.
Don't take it lying down
When you can’t breathe, being on a ventilator (with a breathing tube) can save your life. But it’s best not to be on a ventilator while lying flat. That can set the stage for a potentially deadly condition that doctors call VAP, or ventilator-associated pneumonia.
Best to be sitting up at least at a 30-degree angle, says Dr. Pronovost. And, he says, the doctor should test every day whether you still need the breathing tube (unless you are very ill).
Is sedation necessary?
Before you or a loved one is sedated, make sure it’s really necessary. “If possible, patients should be awake and able to follow commands,” says Dr. Pronovost. He says often it’s possible to ease a patient’s anxiety or pain without general anesthesia.
ICU need a specialist
If you or someone you love is admitted to the intensive care unit, make sure the care is being overseen by a critical care specialist. Studies have shown that ICU patients whose care isn’t overseen by such a specialist are 30 percent more likely to die.
Primary-care doctors and surgeons are great, but critical care specialists have what it takes to give ICU patients the best shot at survival.
Central line infections
What’s a central line? It’s a catheter placed in a large vein in the neck, chest, or groin that remains in place for extended care. It can save lives, but it can also set the stage for deadly bloodstream infections. In fact, the CDC estimates 41,000 U.S. hospital patients and another 37,000 kidney dialysis patients suffer central line-associated bloodstream infections, a.k.a. CLABSI, each year - and almost all are preventable.
Those numbers are actually a big improvement - down 58 percent since 2001.
What to do if you’re at risk? “Ask if the hospital uses a checklist when doctors place cathers, and what the hospital’s rates of CBABI are,” says Dr. Pronovost. The best-performing hospitals have about one CLABI for every 1,000 catheter days (the standard measure for these infections).
Blood clot risk
Blot clots can kill, and hospital patients are highly vulnerable to them because they spend so much time lying in bed (which can cause blood to stagnate), leading to what’s called deep vein thrombosis, or DVT.
If a clot travels from the legs to the lungs, where it blocks circulation, it can be lethal - a condition known as pulmonary embolism. An estimated 100,000 patients die each year from this condition.
Who’s at greatest risk? People who are hospitalized for surgery, cancer treatment, treatment for trauma - as well as overweight patients.
Fortunately, the risk of DVT can be greatly reduced via special stockings and compression devices that attach to the legs. And doctors have - but don’t always use - heparin and other drugs that can stop clots from forming in the first place.
Screening for clots
Doctors are supposed to follow guidelines designed to reduce the risk of deep-vein thrombosis (DVT). Alas, not all do. That’s why it’s important for hospital patients to ask their doctors about screening. If your condition changes - if you have surgery or become bed-ridden, for example - you should ask to be re-screened.
Used wrong, drugs can be deadly. And drug mistakes are especially common during transitions of care - that is, when you are admitted to the hospital, when you change rooms, and when you are discharged.
One way to reduce the risk of these errors is to bring along to the hospital a list of all the medications you take (including over-the-counter and supplements). And anytime someone begins to give you a new medication, ask what it is and why you are receiving it. When you’re discharged, make sure you know what medicines you need to take.
Talking it out
Communication is essential for patients in the hospital. The people caring for you or your loved one need to know your medical history. And it doesn’t hurt to double-check what the doctor does.
Don’t hesitate to let him/her know what you think is going on with your condition - even if the doctor has access to all your records. And do what you can to make sure all the doctors involved in your care are good about keeping each other informed.