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 better."
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.
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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 repeating yourself.
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 this risk.
Will my surgery put me at risk for pneumonia? Find out what you can do to reduce your risks. Ask about breathing exercises.
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 expectations.
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.