When it comes to reducing your hospital risks, questions are key. "Most
patients simply don't ask enough questions," says Carolyn Clancy, MD,
director of the Agency for Healthcare Research and Quality (AHRQ) in Rockville,
Md. "But the enlightened minority who do ask questions in the hospital have
a greater sense of control over their health -- and they just do
You should start asking questions about your hospital risks long before you
check in. Next time you see your doctor -- or meet with your surgeon -- here
are some things to consider.
It's a fact of life: people checking into the hospital face risks. Expecting
to get better, some actually wind up getting worse.
We've all heard the horror stories about hospital risks after surgery.
There's the danger of medical complications, like bleeding or infection. Then
there are the human errors, like getting the wrong drug or dosage. "Even
though you've got a lot of well-trained people in a hospital working very hard,
they're still people," says Fran Griffin, RRT, MPA, a director at...
What do I need to do before surgery? Be specific. "Find out what
you need to do the week before surgery," says Fran Griffin, RRT, MPA, a
director at the Institute for Healthcare Improvement in Cambridge, Mass.
"Find out what you need to do the night before surgery." See if you
need to make changes to your lifestyle, like quitting smoking, at least
temporarily. Find out when you're supposed to stop eating the night before
surgery. Make sure you understand and follow your doctor's advice.
What are the specific risks of this surgery? With any
surgery, you face a number of general risks -- like anesthesia, infection, or
bleeding. But find out the specific complications that can result from the
surgery that you're getting. What do you need to know?
How can I lower the risk of medication errors? Medication errors are
one of the most common hospital risks. So ask your doctor what you can do to
reduce the dangers. Find out what systems are in place to prevent medication
errors at your specific hospital. Before your surgery, go over the medications
and doses that you are likely to need before and after surgery and keep a list
of them with you.
Will I keep taking my normal medication when I'm in the hospital? If
you're already on daily medication, you need to find out whether you should
continue taking it while you're in the hospital. Remember that your surgeon may
have no idea what your regular doctor has prescribed. It's very easy for your
regular medicines to be overlooked.
Could my age or any other health conditions increase my hospital
risks? "Clearly patients who are older and those who have multiple
co-existing medical illnesses are at greater risk of complications," says
Dale Bratzler, DO, MPH, medical director at the Oklahoma Foundation for Medical
Quality in Oklahoma City. So make sure to mention any conditions -- like heart
disease, allergies, or diabetes -- that you have. Don't assume that your doctor
and surgeon necessarily know the details of your health. Don't be afraid of
What kind of anesthesia will I need? Ask your doctor if you can meet
the anesthesiologist before your surgery. Find out the pros and cons of
different anesthetic approaches. Make sure to mention any problems or bad
reactions that you or family members have had with anesthesia in the past.
Do I need antibiotics before surgery? Preventing infection is
crucial, and you may need antibiotics before and after your surgery to lower
your surgical wound infection risks. Find out if you need them, and if so, how
long you'll be taking them.
What else can I do to lower my risk of infection? Infection is one
of the most common risks that people face in the hospital. So discuss other
ways you can lower your risk, like encouraging hand washing.
Will my surgery put me at risk of deep vein thrombosis (DVT)? Ask
whether you need blood thinner to lower the chances of this hospital risk. Find
out what symptoms you should look for, and what exercises you can do to reduce
Should I expect that a health care worker will mark the spot of my
surgery? One common practice to prevent surgical errors -- and to put you
at ease -- is to mark the area to be operated on with a pen. Ask if you should
expect this in your hospital. If not, find out what other precautions are taken
to make sure the correct procedure is being done.
How long will recovery take? When will you be able to get out of bed
and walk around? When will you be discharged? When can you go back to regular
activities of daily living? When can you go back to work? And do you have any
restrictions when you back to work? Make sure you have realistic
What will happen after I'm discharged? The discharge process is
fraught with misunderstandings and errors, says Bratzler. So you need to be
explicit. Make sure you understand when you're supposed to see the doctor next
and how to take your medicine. Find out what complications you should be on the
look out for.
What role should my family play in reducing hospital risks? Given
that you're likely to be groggy or confused after surgery, having family or
close friends looking after you can be important. Ask your doctor how your
family and friends can help. What should they be looking out for? What can they
themselves do to lower your risk of complications?
If I have concerns about my care, whom should I consult? It's very
important that you have a clear idea, before you go into surgery, of where to
turn if you -- or a family member -- have any doubts or concerns about your
care. One person should be in charge, and you must know who he or she is.
SOURCES: Peter B. Angood, MD, vice president, chief patient safety officer,
The Joint Commission, Oakbridge Terrace, Ill.; co-director, International
Center for Patient Safety. Dale Bratzler, DO, MPH, medical director, Hospital
Interventions Quality Improvement Organization Support Center (QIOSC), Oklahoma
Foundation for Medical Quality, Oklahoma City. Carolyn Clancy, MD, director,
Agency for Healthcare Research and Quality (AHRQ), Department of Health and
Human Services, Rockville, Md. Nancy Foster, vice president, quality and safety
policy, American Hospital Association, Chicago, Ill. Fran Griffin, RRT, MPA,
director, Institute for Healthcare Improvement, Cambridge, Mass.