How to Make Your Hospital Stay Safer and Cheaper: A Checklist
Elizabeth Bailey made quite a few assumptions when her father developed double vision and needed to see the doctor. She thought that he would receive the proper diagnosis and prescription dosage, to name just two.
Instead, the 81-year-old in “robust health” aside from mild type 2 diabetes — a man who loved to travel throughout Europe, read Henry James and mix a strong martini — went “crazy almost overnight” from an entirely preventable medication error due to a series of lapses in basic doctor-patient communication.
In her recent book, “The Patient’s Checklist: 10 Simple Hospital Checklists to Keep You Safe, Sane and Organized,” Bailey describes the “passive patient” complex that contributed to her father’s health crisis and the simple steps patients can take to avoid some of the most common (and potentially deadly) medical mistakes. The themes throughout: pay attention, ask questions, and never assume that any hospital is error-free where your care is concerned.
As Bailey later learned, the real source of her father’s double vision was probably slowly rising blood sugar levels, which is an easy thing to identify and treat. But instead of checking the routine tests that were run, the doctor ordered a biopsy to rule out a rare disease and prescribed a dangerously high dosage of steroids to prevent surgical complications. After being handed off to a surgeon for the biopsy, vaguely written post-op instructions and no follow-up care led Bailey’s father to believe he was meant to keep taking the pills.
The result was both steroid-induced psychosis and skyrocketing blood sugar levels high enough to potentially trigger diabetic shock resulting in a month long stay at the hospital.
Even then, the Bailey family continued to assume too many things, including that basic care would be coordinated; that medications would always be right and delivered on time; that staff members would follow basic safety precautions and always wash their hands; that a diabetic on a restricted diet would not routinely be served things like pancake breakfasts with maple syrup. Wrong on all counts.
A big part of the problem, Bailey found, was rampant failures in communication between the many physicians and nurses involved in daily care. Her father was treated by many specialists with each focusing on a narrow area of expertise and prescribing treatments, tests, and medications without one physician coordinating overall care.
Feeling helpless, Bailey, a former music video producer accustomed to planning, precision, and order, fell back on an old habit — making checklists.
What’s going into and out of his body today and why?
Who are all his many doctors and nurses and when are their shifts? Are they talking to each other and to the family to coordinate the daily care goals?
Is the room clean? Are basic sanitary practices being followed?
- What are all his medications for? Who prescribed them? What are the side effects? Do they interact with each other?
The supervise-it-yourself checklist model worked for the Bailey family — so well, in fact, that she decided to write a book. “The Patient’s Checklist” doesn’t offer any groundbreaking revelations on ensuring a safe hospital stay. And it’s not supposed to. It’s simply a reminder of the proactive steps families often forget to take in a time of crisis.
Never one to shy away from a good list, Bailey put one together for the NewsHour laying out exactly what she saw as the real dangers (and costs) to patients within our current health care delivery system and why improving patient engagement is a key driver for change.
Bailey: Hospitals — known as centers for healing — are actually places of great risk to all patients. Consider these statistics:
On average, a hospital patient is subject to one medication error per day. Medication errors occurring in hospitals alone, conservatively, amount to $3.5 billion per year because of longer hospital stays and interventions. Cost in human suffering to patients and families: unquantifiable.
Every six minutes a patient dies in an American hospital from a hospital-acquired infection — an infection acquired after admission — usually from a health care worker’s failure to simply wash his or her hands.
Hospital acquired infections add an estimated $35 billion annually to the nation’s hospital costs. Again, the cost of human suffering is immeasurable.
The United States has the most expensive health care system in the world and yet only mediocre results at best.
- Studies have shown that one-fourth to one-third of all hospital patients suffer harm from adverse events during a hospital stay.
Bailey: My father’s illness and long hospitalization was the inspiration for the book because his experience awoke me to the inherent dangers in fragmented, multi-specialist, fee-for-service health care delivery system. Failures in communication and misdiagnosis resulted in a month-long hospitalization for steroid-induced psychosis and wreaked havoc with his diabetes.
Treatment, like my Dad experienced, typically involves many specialists — each playing a role in rampant over-testing and over-treatment — with no one supervising overall care.
Sixty-five percent of identified adverse patient events were found to have communication failures as the underlying cause — it’s not just that physicians aren’t talking to you; they may not be talking to each other either.
- Without coordination of care and clear communication, the patient, at a time of great stress and vulnerability, lacks the critical information to make informed choices about his or her own care. Care is highly complex and technology-driven. Patients feel overwhelmed by tests, treatments and medications without adequate explanation in plain language provided by their physicians and nurses.
Bailey: Checklists, by encouraging patient engagement, can be the patient’s best friend in organizing the many complex details of care because they promote the most important medical component — communication between patient and care team:
A user-friendly, common-sense tool that is already being effectively used by clinicians to reduce errors (e.g. surgical checklists — when used — cut patient mortality rates in half).
Checklists focus on basic safety issues that get overlooked in the frantic pace of the hospital.
Checklists provide a jargon-free framework for patients to understand their treatment plan and monitor that plan.
Checklists encourage patients, by providing a simple framework to begin to ask questions to understand care.
Checklists help patients better partner with the many care providers in a hospital setting.
- Checklists help patients be more engaged in self-care and self-management for chronic conditions and post-discharge.
To learn more about “The Patient’s Checklist,” visit the book’s website.
Coming up on the PBS NewsHour: Betty Ann Bowser travels to Seattle’s Virginia Mason Medical Center to find out what the hospital system learned about improving patient safety while reducing costs from an unlikely source: Toyota’s production line. Tune in for the full report Wednesday, Oct. 24. Online, we continue our coverage with a week-long exploration of why the U.S. health care system is so expensive and some possible solutions to fixing it.
Monday: Why are U.S. health care costs more than two-and-a-half times more than most other developed countries? We talk with Mark Pearson, head of Division on Health Policy at the Organization for Economic Co-operation and Development, about some of the cost-containment strategies that have worked elsewhere in the world.
Tuesday: What steps can you take to make your next hospital stay safer and cheaper? Hari Sreenivasan talks with Elizabeth Bailey, author of “The Patient’s Checklist: 10 Simple Hospital Checklists to Keep You Safe, Sane and Organized.”
Wednesday: We illustrate what the U.S. could buy with the $750 billion wasted in American health care each year, and, in a separate post, our partners at Kaiser Health News examine the “Top 7 Drivers of U.S. Health Care Costs.”
Thursday: In a “Reporter’s Notebook,” Betty Ann Bowser examines Virginia Mason’s decision to eliminate a staple of the American hospital: the waiting room.
Friday: What inefficiencies have you seen in the U.S. health care system? We share some of the first-person accounts submitted by NewsHour viewers.