Guides

Hospitals & facilities

Hospitals can be hazardous. Here’s how to avoid harm.

Harm in the hospital, or “hospital-acquired conditions (HAC),” includes medication errors, falls, pressure ulcers, blood clots, obstetric adverse events and healthcare-associated infections
A recent study of 11 hospitals in Massachusetts found that serious preventable harm occurred in about 1% of hospital admissions
A “National Scorecard” on HAC details how often each type of problem occurs

Hospital patients are sicker than other people and hospital germs are more resistant to treatment than germs outside healthcare facilities
Surgical sites, urinary catheters, “central lines” and ventilators all provide ways for germs to enter the body
As a result, hospitalized patients are especially vulnerable to infection and to sepsis, a life-threatening response to infection

Patients and families can take steps to control infections such as enforcing staff and visitor handwashing; disinfecting surfaces, especially high-touch surfaces; and seeking prompt removal of urinary catheters
Patients and families should also be alert for signs of infection or sepsis, a life-threatening response to infection
A mnemonic for detecting sepsis is TIME: Temperature, Infection, Mental decline and Extremely ill

Errors involving medication are one of the most common types of inpatient errors, with children at significantly higher risk than adults
Patients and families can help ensure the “rights” of medication administration (right medicine, dose, patient, time, route, documentation, reason and response)
“High-alert” medications such as blood thinners, insulin and narcotic pain medicines require special vigilance

Patients are more likely to fall in the hospital than at home
Reasons for an increased risk include drugs that cause dizziness, drowsiness or confusion and dizziness when standing up after an extended period in bed
Patients can take steps such as being extra careful getting out of bed, asking for help if dizzy or unsteady, and wearing slippers with nonskid soles

Blood clots are the leading cause of preventable death in hospitals
Signs of a clot include swelling, pain and tenderness in a leg, increased warmth in a swollen or painful area of a leg, and red or discolored skin on a leg
Signs that a clot has broken free and traveled to the lungs include shortness of breath, chest pain, a racing heart and unexplained coughing
Devices to improve blood flow and medications to thin the blood can help prevent clots

Bed sores can form when skin is under pressure, for example when a person is bedridden
They can become infected and/or take months or years to heal
Bed sores can be prevented with inspection, repositioning, padding, and care of the skin

The US has high rates of maternal injury and death compared to other developed countries
Patients and families can help protect themselves by checking in advance whether a hospital has recommended procedures in place to detect and manage hemorrhage (excessive blood loss), severe high blood pressure and blood clots
Starting in Fall 2023, patients and families will be able to check whether a hospital qualifies as “Birthing Friendly” under a new quality and safety initiative from the Centers for Medicare and Medicaid Services

Signs of a rapidly declining patient include changes in mental status, shortness of breath, acute pain, and the patient stating that something is wrong
In this situation patients and families should ask to see a physician immediately
If necessary patients and families can call the hospital operator and ask for the administrator on call

Discharge from the hospital involves risks such as confusion about whether to continue pre-hospitalization medications and gaps in care between discharge and the next appointment with a physician
Patients and families can speak up if a discharge seems unsafe and appeal any decision by Medicare or another insurer to stop paying for care
Medicare’s Care Compare can help locate and evaluate nursing homes, home healthcare, inpatient rehabilitation and long-term hospitals