Hospitals 2005: Getting the Best Care

10 tips for getting the best care at a hospital

1. Select a good primary-care doctor and ask about specialists and hospitals. If the doctor recommends one or two specialists, ask why, and ask which hospital he or she go would go to with your medical problem.

2. Your surgeon or medical specialist will be your most important advocate when you are hospitalized and will determine to a large extent how well you will fare. When you first talk to this doctor, inquire about his or her experience. Does the doctor take a real interest in you? Your judgment about this will ultimately rely as much on intuition as reason, but it is important that you trust that this doctor will be on your side.

3. The old medical adage "the more you do, the better you are" may not always be true, so don't rely on a hospital's volume of routine procedures as an indication of excellence. The Leapfrog Group, formed to improve the quality of healthcare, considers volume very important, but it doesn't recommend it as a criterion across the board. Rather, it says, patients with "certain high-risk surgeries and conditions" can reduce their risk of dying from them by 40 percent by going to a hospital with extensive experience in these areas.

4. If it is likely you will be cared for in an intensive care unit, find out if the hospital's ICU is covered by board-certified intensive care specialists. Also find out what the ICU nurse-to-patient ratio is. One nurse for two patients is the accepted standard.

5. If you are having surgery, ask what the hospital's nurse-to-patient ratio is on the surgical floors. Officials know the answer. The ratio can vary because fewer nurses are usually on duty at night, but the ideal ratio would be in the range of one nurse to four patients.

6. Before you go, consider calling the hospital and asking if it has a computerized prescription system and if it uses patient bar codes to ensure that patients get the correct medication. If not, ask what kind of safeguards the hospital has in place to prevent medication errors.

7. Once you become a patient, be pleasant but persistent. It's not impolite to ask a nurse what a medication is for, and you can even ask that the dosage be rechecked. When you go to another hospital department, such as radiology, ask your doctor or nurse why you are going. When you arrive there, make sure the nurse or technician in that department knows your name and why you are there. This can help prevent "handoff errors" that occur when patients move from one hospital department to another and information gets lost.

8. Ask the names of the people caring for you, and always introduce yourself by name.

9. If you have a nurse or house staff doctor you don't like or don't trust, ask that someone else replace that person. If necessary, demand it. If nothing else, your demand will put the hospital on notice that you do not believe you are getting adequate care.

10. Many times you will not be able to advocate for yourself, so have a family member with you as much as possible to act on your behalf. Even better, try to have a family member in your room at all times if your condition warrants it. If you can afford it, hire a private nurse for night duty.

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