The Patient Safety Anthology
Patient Safety Services & Products -
Healthcare Optimization for Business & Families -
- Medical Error Avoidance Monitoring -
Welcome to PULSE of Florida's
Patient Safety Anthology
A compilation of kibbles, bits, kernels and pearls
to help inform and protect you and loved-ones
during every phase of healthcare
This collection contains wisdom, information, facts and opinions from patients, families, healthcare providers, authors, safety experts,
lawyers and professional patient safety advocates. Enjoy.
This information should not be considered medical or legal advice or a recommendation.
It is general information or opinion. Always consult a medical or legal professional.
1.No one is hurt by doing the right thing - Hawaiian Proverb
No one is hurt by doing the thing right - PULSE of Florida Proverb
2. Getting the best care isn't really just a function of how much money you have. You need something more important, information.
And the best information is insider information.
3. Simply, the way most people go about choosing a doctor is all wrong.
And it is one of the costliest errors you can make. Did you research your cell phone plan more than you researched your physician or surgeon? You need not take the physican who is assigned to you, you should choose your physician.
Qualifications aren't enough, you should truly trust and like the doctor as a person.
4. Your primary care physician should be supervising all aspects of your medical care and ensuring that all members of your healthcare team blend together to provide the best care for you. Try to always be cared for by a physician who is Board Certified.
5. The days of doctor appointments consisting of show up and shut up are over. Seek a physician who is compassionate, not over-worked, not burned-out,
listens to what you are saying and includes you as a partner in your care.
Ask yourself: Do I feel rushed, Are the doctor's thoughts about wellness similar to mine, Do I feel comfortable in his or her presence, Was I treated courteously by all the doctor's office staff, Were my questions answered honestly and without being evaded? Trust your instincts.
6. This just in: Doctors are human!
7. Second opinions: choose a doctor other than one recommended by the first doctor. Research the second opinion physician as you should the first physician. Don't tip your hand about the first doctors provisional diagnosis. Ask for a complete workup not just a rubber stamp second opinion.
Bring your medical record with results of recent tests you don't want repeated.
8. Be evaluated, diagnosed and treated by a physican, not a Physician's Assistant, Nurse Practioner or office nurse. If you call the doctor's office ask to speak to the doctor. If the doctor doesn't return your call within 24 hours, get a new doctor.
9. If something doesn't seem right, Speak Up.
10. Try to schedule your doctor appointments for first thing in the morning before all the appointments are running late. Take someone with you to the appointment to be your second set of eyes and ears. Ask if you can make an audio or video recording of the appointment for review purposes. If your doctor refuses.......
11. More on choosing the right doctor:
Avoid doctors who cannot explain things well and who get defensive when you ask a question - Avoid doctors who order a battery of tests without first taking the time to listen to your concerns and have taken a detailed medical history. -
Avoid doctors who don't touch you - Many primary care physicians have taken the role of being only a prescription writer.
12. Tips to get the best care from the doctor's office staff:
Enter with a smile - Learn their names - Bring offerings such as coffee shop gift cards - Say thank you and mean it - Send a card.
13. Tips to help your doctor make the correct diagnosis:
Before seeing your doctor, write down all facts so you don't forget any symptoms - Decide what the key issue is, prioritize signs and symptoms - Write down when the symptoms first appeared and what makes them better or worse or changes at certain times of day - Let the doctor ask questions after the intial information is given (the trick is don't get interupted before you get all the initial information out) - Mention your concerns earlt in the appointment - Don't be afraid to mention anything that may seem unrelated to the main complaint - List all medications, suppliments, herbs and alternatives your taking - Be honest about your level of pain - Be sure to mention if you've had these signs and symptoms before.
14. Your doctor works for you. If you feel like you're not part of the decision process or you're being pushed into a treatment path with which you don't agree,
ask for a conference to make your wishes known - Change doctors if needed.
15. How to confront a healthcare professionals about unacceptable behavior:
Not by yelling or becoming hostile - Explain what happend - State how you feel and the reason for that feeling - Explain what you want to happen - Listen to the other side and be ready to negotiate (you may want to bring an advocate with you if you think you may be intimidated, there are 2 sides) - Change providers if you are not satisfied with the results of your discussion - If the issue involves a crime or negligence, seek professional advice.
16. From the March 2001 Institutes of Medicine report, Crossing the Quality Chasm - Poor quality healthcare is not confined to any one group but is pervasive throughout the system.
17. Evidence-based Medicine Guidelines (EBM) - are set up to help limit inappropriate care, decrease the magnitude of geographic variations in the way doctors practice, and ensure that health care resources are used for maximum benefits of patients.
18. Nothing in medicine works all the time in every patient. However, EBM advocates prefer that providers not provide treatments that have been shown to be inneffective, harmful or have poor value.
19. We cannot assume that our individual physician has done the right thing. Medicine is just too complex. Doctors need help. You can ask your doctor to use EBM guidelines. If your doctor's treatment plan for your condition conflicts with EBM guidelines, ask why, If your not satisfied with the answer, get a second opinion.
20. Important Screening Tests for Men: BP, colonoscopy, prostate exam, skin exam, cholesterol, C-Reactive Protein, dental exam, UA, CBC, STD, EKG, testicular exam, FBS, eye exam.
21. Important Screening Tests for Women: BP, PAP, colonscopy, clinical breast exam, mammogram, dental exam, bone density, skin exam, cholesterol, C-Reative Protein, TSH, UA, CBC, STD, EKG, FBS, eye exam.
22. Recheck positives to rule out False Positives. If the results are on CD, for example a CT scan is often recorded on a CD, ask a specialist to read and report on the results.
23. Hospitals: Where you are admitted is just as important as who is treating you.
All hospitals are not equal - for example the services delivered - The more surgeries of a certain type a hospital does the more successful - Specialized care units are vital for successful recovering - In case of an injury, go to a Trauma Center - Having Hospitalist and Intensivists on the staff is a positive sign - Do a thorough research of the hospital - See HealthGrades.com.
24. See www.HealthGrades.com for consumer oriented source for data on 5000 hospitals. For example, How does this hospital rank in comparison to others for a particular surgery. The death rate is 3 to 5 times higher at a one-star versus a five-star hospital.
25. Internet sites to research your hospital:
26. The LeapFrog Group states the following are the minimum number of surgeries per year. Coronary Bypass=500, Angioplasty=400, Carotid Endarterectomy=100,
Pediatric Heart Surgery=100, Protate Surgery=55, Mastectomy=25, Repair of Abdominal Aneurysm=30, Pancreatic Cancer Surgery=10, Heart Transplant=9
27. Admission to a hospital when most of the beds are already full can be deadly to patients, according to a University of Michigan Health System study showing high occupancy increases the risk of dying in the hospital by 5.6%.
Medical Care, Vol. 48, No. 3, March 2010
28. Errors made by doctors, nurses and other medical caregivers cause 44,000 to 98,000 deaths a year. Hospital infections, many considered preventable, take another 100,000 lives. And mistakes involving medications injure 1.3 million patients annually in the U.S., according to the Food and Drug Administration.
29. "We know just punishing human error does not improve safety," says St. Mary's Dr. Byrne. "But we have to separate unavoidable error from reckless behavior and unjustifiable risk."
30. Improve your chances for a better outcome:
Choose a teaching hospital, they have more support services -
Request volume information and death rate data from the surgeon and hospital -
If the surgeon or hospital resists giving you information, seek a different surgeon and hospital - Research the hospital on the Internet, check news stories about the facility too - If the surgical volume is low and the death rate is high, go elsewhere -
Go to a Trauma Center for accidents even if you have to transfer after becoming stable.
31. Even if there is a piano in the lobby, hospitals can be dangerous:
100,000 die each year from preventable mistakes made in hospitals -
This number does not include outpatient settings which are just as dangerous -
About 2,000,000 get infections while in a healthcare facility, 90,000 die as a result.
32. The CDC estimates that 70% of bacteria that cause nosocomial infections are resistant to the most common antibiotics. One day in the near future we won't have any anitbiotics left to treat these resistant bacteria.
33. Nosocomial infections are most commonly caused by not washing hands.
34. Twenty five percent of all hospital deaths or injuries to patients are attributed to the nursing shortage - Having 6 versus 4 patients reuslts in 14% increase in deaths,
Having 8 versus 4 patients results in a 31% increase in death.
35. Bathing trauma patients daily using cloths containing the antiseptic chlorhexidine may be associated with a decreased rate of colonization and infection by methicillin-resistant Staphylococcus aureus (MRSA) and other difficult-to-treat bacteria, according to a report in the March issue of Archives of Surgery.
36. Doctor's Office and Medical Errors:
Outpatient care is complex and less regulated than inpatient care so the risk of errors is substantially higher - Gaps in knowledge and skills accounted for only a minority of errors - More than 80% came from administrative or system errors - Such as lapses in patient follow-up, mis-filings, never documenting results, miscommunication among hospitals, physicians and patients.
37. A full hospital raises risks of hospital injury and death:
Admission to a hospital when most of the beds are already full can be deadly for patients, according to a new University of Michigan Health System study showing high occupancy increases the risk of dying in the hospital by 5.6 percent.
"The study establishes that there is indeed a connection between hospital occupancy and death rates in U.S. hospitals," says Peter L. Schilling, MD, MSc, a resident in orthopedic surgery at U-M Health System.
Infection Control Today - 3/9/2010
38. Ten Ways to Reduce Hospital Errors and Infections:
Choose a hospital at which many patients have had the procedure you need -
Make sure all your doctors agree on what will be dfone at the hospital -
Make sure all hospital workers wash their hands before touching you -
Make a list of medications you are taking with dosages, show your admitting MD -
Whenever given a medication ask what is is and what's it for, call your MD if needed
Ask a friend or family member to monitor your condition and needs 24/7 -
Ask why a test is being done, call you doctor is needed -
Learn as much as you can about your condition from reliable sources -
Check your hospitals infection control history, change hospitals if needed -
When being discharged, have your doctor thoroughly explain your treatment plan -
39. Surgery:
Surgery is not without risks, no matter how minor, ask about alternatives -
Not all surgeons are equal, research and choose carefully -
Choose a hospital that had done many of the procedures -
Research and choose the anesthesiologist carefully -
Review test results with primary physician and surgeon before the surgery -
Insist on best-practices patient care before and after surgery -
Rehad and physical therapy should be part of the treatment plan -
Resort to surgery only as a last resort -
40. The best surgeon or best doctor to evaluate your probelm may not be in the immediate area, but the drive to the best is well worth the trip.
If your doctor says he would go elsewhere, listen carefully -
41. You don't want to limit your surgery options because of insurance -
If the best surgeon is outside your plan, it's worth it, money is not what it's all about when it comes to surgery -
42. If your insurance plan is limiting you, get the mortality and morbidity statistics data on the hospitals and physicians you need -
Use this to discover the difference between the surgeon you need and the surgeon in your plan - Ask you insurance company how can they refuse you since you will have fewer complications and lower risk of death -
43. Ask you surgeon how many of these particular procedures has he/she done.
Plus, ask what is the surgeon's infection rate.
44. If your diagnosis will involve surgery, internal testing or radiation -
get a second opinion.
45. General surgeons are fine for most surgeries. Consult a specialist surgeon for high-risk or complicated procedures. Be sure the surgeon has experience in the procedure you need.
46. Choosing your anesthesiologist: Talk to your surgeon and primary care physician to choose or rule out a particular anesthesiologist.
Do a thorough physician credential, malpractice and background check as you would for any physician for the anesthesiologist recommended by your surgeon.
The answer: "I'll use whoever is available", is not a good answer.
Choose a Board-Certified anesthesiologist -
Is the certification current, it could be up to ten years between certification renewals
Ask your surgeon, who is the best anesthesiologist and who they would use -
The Joint Commission requires accredited hospitals to keep quality assurance statistics on outcomes per surgery.
It is important to know and trust your surgeon and anesthesiologist.
Arrange for a pre-surgery meeting with the anesthesiologist,no meeting, no surgery.
Be sure your surgeon either sees or takes a thorough medical history -
Voice your concerns and follow your instincts
Ask for a thorough Informed Consent not just the basics.
Follow the pre-op instructions. For example, nothing to eat or drink before surgery.
47. Being informed about your diagnosis and treatment will allow you to make informed decisions and can literally be a matter of life and death -
The patient's attitude and general health play a major role in your care -
Be honest with your doctor - tell all about your medical history, medicines, personal habits and lifestyle - Don't hide information - Talk to you doctor about stopping meds abruptly versus weaning off over time - Ask your primary care physican to visit you at the hospital - Get your primary care physicians office and cell phone number - Know who will be coordinating your care while you're in the hospital -
Make lifestyle changes to improve your outcomes. For example, talk to your doctor about use of alcohol, tobacco use. Plus ask about increasing your activity before surgery, relaxation techniques and hypnosis. Learn about your rehabilitation, physicial therapy and what your care will be after discharge -
Prepared patients usually have shorter hospital stays.
48. Second Opinions: If the first and second opinion conflict, get a third opinion.
Continue until at least two physicians concur about your diagnosis and treatment.
Trust your intuition - Tell your doctors if you don't agree with the diagnosis -
Teaching hospitals may have more up-to-date information and procedures -
The more surgeries the hospital does, the better -
Think conservately, don't rush into a decision.
-- Much more to come --
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