Most Satisfied With Hospital Stays

Savvy Patients Can Avoid Many Common Hospital Problems

From the WebMD Archives

Dec 10, 2002 -- Hospital stays leave one in five people complaining. Some of these complaints, a consumer survey finds, are linked to worse health outcomes.

The survey, appearing in the January 2003 issue of Consumer Reports magazine, collected information from 21,144 readers. Nearly four out of five of these Americans were highly satisfied with either their own recent hospital stay or that of a close relative.

But the 22% who were less than happy had harrowing tales to tell. They complained of grossly inadequate pain relief, of being ignored by nurses, of not being able to talk with a doctor when they wanted to, and of overworked and disrespectful hospital staff. They also complained about billing errors.

"The news is not good," says Joel Gurin, executive vice president of the nonprofit group Consumer Union, which publishes Consumer Reports. "If we were talking about some other consumer service like hotels or restaurants, these numbers would not be alarming. But it's troubling that one-fifth were not satisfied. This is about the most serious customer-service issue any of us will ever run into. If we got bad service in a restaurant, we wouldn't go back there. But here bad service can have really huge consequences."

For example, Gurin says, only 2% of people who reported attentive nursing care had serious complications. But when people had trouble getting a nurse to help them -- something that happened to about half of the patients -- there were four times as many serious complications. Only half of non-surgical patients said their pain was kept under control. And one in eight patients said they knew of a problem or misdiagnosis in their care.

Problems continued even after leaving the hospital. One in 20 people who carefully went over their hospital bills found major errors.

Rick Wade, senior vice president of the American Hospital Association, says he's glad and surprised to see that so many patients and their families had strongly positive experiences. But he also says that U.S. hospitals are working hard to get better.

"We're doing a lot," Wade tells WebMD. "But one glitch in a hospital stay can cause a dim view of the whole thing. And there are these horrific billing systems -- if we set out to design a way to frustrate people we couldn't do a better job. We are looking for ways to improve. A lot of hospitals are looking at the whole continuum of care. We are looking at the whole experience of care from before coming in to the hospital until well after you leave. We are trying to give patients and families the kinds of experiences that will let them have more trust and confidence in us."

Nancy Metcalf, senior editor at Consumer Reports and co-author of the survey report, agrees that hospitals are trying to correct the reported problems.

"They are working very hard on this and we applaud that," Metcalf says. "But people may find themselves in the hospital tomorrow. So the first thing to do is to be careful which hospital you select. Try to pick one with a good reputation. Ask your doctor, ask nurses you may know who work in your area. This kind of information can be hard to come by. That is why we applaud hospital report cards."

Here's the Consumer Reports advice on how to make your hospital stay easier -- and safer:

  • Pick the right hospital. In some areas, hospital report cards rate various institutions. Many of these can be found on the Internet.
  • Plan ahead. Hospitals have plans called "clinical pathways" for most conditions. Ask your hospital for one so you know what to expect. And ask your doctor about plans for pain relief.
  • Carry your medical history with you. Put into your wallet a list of drugs you take (and dosages), special conditions you have, the name of your personal doctor, and insurance information.
  • Bring some help along. The most important thing, many people say, is to have a family member or friend who can be with you to help. Such a person can find a nurse, write down important information from doctors, help you go to the bathroom, and check to see that medical care is appropriate.
  • Know the staff and make sure they know you. Find out who your doctors and nurses are and write their names down. If you don't recognize the people at your bedside, ask who they are and what they plan to do. Make sure they know who you are.
  • Write things down. Keep track of the medicines and treatments you receive. This will help not only during your stay, but afterwards when the bills start to arrive.
  • Double-check medications. Ask what medicines you're being given before taking them. If you aren't sure you should be taking them, ask the nursing staff to double-check.
  • Be assertive about pain relief. Pain isn't good. It can slow your recovery. And it's much harder to get pain under control than it is to prevent it.
  • Keep visitors under control. Many well-wishers don't realize they are tiring the patient. Make sure a family member or friend controls the traffic.
  • Plan your discharge. Start thinking about what you'll need to do when you leave the hospital before you start packing your bags. There are important issues about after-hospital care and medication that are very important to understand.

Another big issue is hospital bills. Consumer Reports recommends that you:

  • Know before you go. Check your insurance coverage to see what you'll have to pay for.
  • Keep good records. Make your own list of major tests, treatments, and medicines you get in the hospital.
  • Keep track of all that stuff that comes in the mail. First to arrive will be the Explanation of Benefits or EOB from your insurance company. It may say "Not a Bill," but don't lose it. If you're on Medicare, this document is called a "summary notice." In either case, it describes which of your treatments is covered by your insurance and how much you'll have to pay. Next will come the bills. If your bill summary isn't clear, ask the hospital for an itemized bill. If there's anything you don't understand, ask the hospital's billing department to explain. You may want a copy of your doctor's orders and nursing notes, which most hospitals provide for a copying fee.
  • Get help. If you still don't understand what your bill is about, ask for help from your insurance company. Ask to speak with the person who reviews questionable charges. There are also groups that perform these services -- but some charge a fee.

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SOURCES: Consumer Reports, January 2003 • Rick Wade, senior vice president of the American Hospital Association • Joel Gurin, executive vice president of Consumers Union • Donato Vaccaro, PhD, Consumers Union research program leader • Nancy Metcalf, senior editor, Consumer Reports • Mandy Walker, associate editor, Consumer Reports.
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