You as a patient, and/or your patient advocate(s), need to participate in your care in hospital in order to maximize your chances for a good healing experience and to minimize chances for a bad experience.

The following steps will help maximize your time in a hospital.  Each step is each described in another section of this article.

• Do what you can to avoid infections and medical error.
• Learn what is supposed to happen on a day-to-day basis and overall.
• Get the care you need when you need it.
• Review your daily nursing schedule.
• Become acquainted with the staff.
• Encourage visits from guests.
• Keep in touch with your primary care physician.
• Take steps to permit sleep.
• Do not put up with unnecessary pain.
• Complain when you don't get what you need.
• If you are going to have surgery, take the steps you can to prevent surgical error.
• Understand the common words professionals use in a hospital.
• Think about how you look.
• Ask for spirituality care if you want it.
• Do what you can to avoid identity theft.
• If you are hearing or vision impaired, or if english is not your first language, ask for help.
• Know your rights.
• Execute a Health Care Power of Attorney and consider executing other Advance Directives.

To make life easier when you return home, start planning for life after you are let go ("discharged") from the hospital. 

Make your needs known. Interpreters must be provided to assist you so that you can exercise your rights throughout your hospital stay.

For instance, before any tests and treatments can be performed, you must give informed consent. In order to be informed, the tests or treatments must be  explained in a method you can understand. Translations and/or transcriptions of important hospital forms, instructions and information must be provided if you feel you need them. 

If a hospital doesn't have the necessary translator in the hospital, appropriate services can be accessed by telephone, internet or video hookup.

It is your right to be informed. Learn what is supposed to happen with your medical care on a day-to-day basis. If you don't know, you cannot monitor to be sure that what is supposed to happen actually happens. It is also important to know what should not happen so that you can guard against it.  

Every day your nurses receive a "plan of care" outlining your treatment schedule for the day. This list includes all scheduled tests, ordered meals and special instructions from your doctor.  The nurses also receive a separate list indicating all medications that have been ordered for you.

Every day, ask the nurse in charge of your care to let you or whatever family member or friend acts as your patient advocate review both lists.  Make notes of all relevant orders.  This knowledge will go a long way in preventing medical errors, such as obtaining a wrong test or treatment, or receiving the wrong medication, no medication at all. 

This information is not generally provided to patients, so you or your advocate will have to ask for it.

When reviewing the list, there is likely to be medical short hand. To help understand common words, see: Understand The Common Words Professionals Use In A Hospital

If you don't understand any part of the list, ask the doctor or another medical person to explain it. If you still don't understand, ask that the person to say the explanation in a way that someone with your background and education level can understand.

To be sure you understand, you can say something like: "Please let me be sure I understand what you are telling me by allowing me to repeat it to you in my own words."

If your doctor or nurse don't have time to explain something, ask if the hospital has a doctor known as a hospitalist - a doctor who manages a patient's entire hospital experience from admission to discharge. More and more hospitals have a hospitalist . 

If you are in intensive care, ask to speak with an "intensivist" -- a specialist who manages your case while in the intensive care unit.  

As a patient, you want the nurses, technicians and other caregivers to view you as more than just another face on the ward. A personal connection with the people who are involved in your care increases the odds you'll get prompt care and attention. While the doctor treats your illness, the people around you treat you.

• Take the time to get to know the people who work with you, including what the person does (the person's role).
  • Ask their name (even if it is on a badge). 
  • Ask what they do.
  • Make "small talk." Ask about their weekends, their families or special interests.
• Offer sweets or other snacks. Many people who work in a hospital work long, hard shifts and don't have time to take a break and get a snack. 
• Introduce them to your friends and loved ones. 
• Express your appreciation for their good care. 

While our hospitals are among the best in the world, errors and serious infections can be picked up that can even be deadly.

There are steps you can take to minimize both errors and the risk of infection. To learn what they are, click here.

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It turns out that guests are more than good for your spirits.

Studies show that patients get better attention from nurses when guests are around. 

Experience indicates that the more guests a patient has, the better the overall treatment a patient receives from the nursing staff.

NOTE: For people who cannot visit in person, consider using a device which connects to the internet and set up a free account permitting video visits. For example, Skype . Most hospitals have free wifi connections for patients. 

You should expect a timely response to reasonable requests and questions. 

If you are not getting timely care, be politely insistent. Even though you may not be feeling well, a smile, even a weak attempt at one, can go a long way.

If no one answers your call bell, rather than wait and wait and wait pick up your phone and call the hospital operator. Ask to be connected to the nursing station on your floor. When the phone is answered, politely say you need attention in your room -- immediately.  If you're in a semi-private room, consider enlisting the help of your roommate. 

If you can afford it, you may wish to consider hiring a private duty nurse.  You will receive undivided medical attention, which may result in better compliance with medical orders and minimize your chance of medical error. However a private duty nurse may not be as skilled in all aspects that require attention, as a regular
room nurse is. 

NOTE: While we suggest that you insist on what you need, keep in mind that complaining frequently or too aggressively about minor delays and inconveniences can work against  you. As they say: "Pick your battles."

Ideally, your primary care physician will stop in and see you once a day.  Your primary physician knows you and your overall medical situation. He or she may spot potential problems that are not apparent to specialists who are focusing on one particular situation.

If your primary care physician doesn't stop in, ask the resident to contact with your primary physician and bring him or her to date. Follow-up by asking the resident your doctor's reaction to what he or she was told. 

Feel free to call your primary care physician with updates or questions.

Sleeping in a hospital can be very difficult. You are in a strange and sometimes noisy environment.  To make matters worse, patients are often awakened every few hours for medications, blood pressure checks and IV adjustments.

To improve the chances to get a good night's sleep:

• Ask your doctor or nurse if nighttime tasks can be combined in one visit.  Making prior arrangements permits better coordination of your care and will result in less interruption. 
• Speak with your doctor about leaving a standing order for sleeping medication in case you need it.  Without a standing or "p.r.n." (as needed) medication order, the nurses can't provide you with any sleeping medication.
• Consider using a sleeping mask and earplugs. You can even consider bringing in your own white noise, such as a machine that makes sounds like a waterfall. 
• At bed time, ask the nurse to shut the door and turn out all unnecessary lights.  
• Be sure that your blinds to your room are drawn so you are not awakened by dawn's light -- especially if you are light sensitive.  

Under federal law, patients have rights. A copy of the rights is included in our article about your rights in a hospital. 

Most hospitals give you a copy of your rights when you check in.

The patient's Bill of Rights is also generally posted on a wall on each floor housing patients. The Bill is usually in poster form making it easy to read and use. 

You can also ask for a copy of the Patient's Bill of Rights from any nurse on your floor, or the admitting office.

NOTE: If you want spiritual care, ask for it. Accredited hospitals provide it. (The Joint Commission on Accreditation of Healthcare Organizations requires that all hospitalized patients get spiritual care if they request it.) 

There is no need to feel unnecessary pain.  Adequate pain management promotes healing and helps prevent stress and depression. 

• Your doctor can leave what is known as a "standing order" for pain relief. With a standing order, the staff does not need to check with the doctor each time you need relief.
• Assess whether you are getting relief from a pill or injection at suitable times after each intervention. For example, if you are given pain medication by mouth (Oral administration), assess the relief after an hour. If you are given pain medication any other way (parenteral drug therapy), you can assess relief within 15 to 30 minutes.

If you are in pain, speak up. The staff will not always anticipate your needs. If you don't speak up, the staff may believe that your pain is being adequately treated. 

Some doctors are very conservative in their approach to pain management out of fear you will become addicted, even though studies indicate that the fear of patient addiction is not realistic.  Adequate pain management during hospitalization rarely, if ever, leads to subsequent abuse of pain medications.

If you aren't getting enough pain medication, let your doctor know that you are not worried about becoming an addict. That it's more important to relieve the pain than to worry about what could happen.

Pain management may include the use of morphine or other opiates. There are also newer options that hospitals and surgeons do not necessarily offer unless they are requested.  One option is epidural anesthesia, which controls pain by injecting a nerve-blocking drug into the spine.  For certain operations, such as joint replacement, this type of nerve blockage may actually be preferable to opiates because it does not make you groggy. 

Most hospitals now have patient-controlled intravenous analgesia (PCA), which allows you to self-administer your medication by pushing a button on a computerized pump.  If a PCA is appropriate to your pain management, ask that you be given proper training before and after surgery.  

If you are in pain be persistent with your nurse.  Ask your nurse to consult with your doctor or the resident in charge of your team to have pain relief prescribed.   If you know that a particular pain killer works for you (such as Tylenol or other over-the- counter drugs), let the nurse know.  

When describing pain, be precise about the pain, for instance:

• If pain is on a scale of 1 to 10, with 10 being the most painful, what number are you experiencing?
• Where does the pain show up? It is helpful if you can point to the exact spot that hurts, 
• How does the pain show up? For instance, is it throbbing? Sharp? Like needles? 

A FEW PRACTICAL TIPS:

• If you are sensitive to needles, you can ask for a small amount of local anesthetic such as Lidocaine. The needle used is tiny.
• Paper or plastic surgical tape to secure bandages and IV lines is gentler on the skin than silk tape.

If you have a problem or are not satisfied with your care:

Step 1.Complain to the offending party or his or her supervisor.

• To more effectively deal with possible complaints, request the name of the nurse who is in charge for each shift. In addition to your room nurse, each floor has a head nurse for the floor.  Each nurse in turn has a nurse supervisor who answers to the hospital administrator.  
• If you have serious complaints or questions about your nursing care, you may wish to obtain the name of your case manager. Your case manager is the nurse responsible across the board for all shifts.  His or her assistance can be invaluable in resolving nursing problems

Step 2. If the matter isn't resolved, ask to speak with the hospital's patient representative, also known as a patient advocate or ombudsman. 

• The patient representative is a member of the hospital staff who serves as a link between the patient, family, physicians and other hospital staff. 
• The patient representative is familiar with all hospital services and should be available to answer questions about hospital procedures, help with special needs or concerns, and help solve problems.
• There is no charge for services rendered by the patient representative. 
• Keep in mind that although the patient representative is working on your behalf, he or she is a paid staff member of the hospital. 

Step 3. If the patient representative is unable to resolve your problem, it is time to go to the hospital administration. 

• The person who heads a hospital is usually known as the president or the hospital administrator.
• Go to the highest person you can reach.
• If you call the president, you may not get to speak directly with him or her. However, if you tell the assistant the problem, that person can usually get things moving. 

Step 4. If a serious problem arises between you and your doctor or nurse or social worker, find out how to contact the hospital's ethics committee.

• The Joint Commission on Accreditation of Healthcare Organizations requires that every hospital have an ethics committee which can hear patient complaints. 

Rather than try to summarize this important topic as part of this hospital stay document, please see:

• What you can do to help minimize medical error before surgery
• What you can do to help minimize medical error after surgery

As a patient, you may have a hard time understanding some of the jargon used by doctors, nurses and other hospital staff.   Here are some commonly used terms and what they mean:

• Ambulate means that thepatient is to be taken for a walk.
• BP is your blood pressure.
• Emesis Basin is the pan brought to patients who are sick to their stomachs.
• Force fluids means to encourage the patient to drink lots of liquids.
• HR equals your heart rate.
• IPPB means use an intermittent positive pressure breathing machine to aid breathing.
• IV is an intravenous line (a plastic line attached to a needle inserted in your vein). An IV is used for getting medication and other fluids into your system.
• NPO means that the patient is not allowed anything to eat or drink.
• OOB means out of bed.
• Void is another word for urinate..

Shorthand for how often to give a medication is:

• Qid means four times a day.
• Tid means three times a day.
• Bid means two times a day.
• Qd means every day
• Qod means every other day.
• Qhs means every night at bedtime. 

All accredited hospitals provide spirituality care. This is thanks to the Joint Commission on Accreditation of Healthcare Organizations requires that all hospitalized patients get spiritual care if they request it.

We have never heard of anyone being charged for spiritual care. If you are charged for it, please share the information. 

It may seem odd to see the mention of identity theft in an article on hospitals. However, it can be a problem.

• Your Social Security number is used as your patient identifying number by many hospitals. You can't control the hospital's system or their security systems. However, you can try not to use your Social Security number on your identification band. If necessary black out all but the last four numbers.
• Don't leave blank checks or bank statementes in your nightstand or in any other easily accessible place. It is better to have a relative or friend bring you checks when needed.
• Likewise, there is generally no need to have a credit card in a hospital. If you need one for a specific purpose, ask someone to bring it to you (and take it away when you've used it.)

Little touches can make you feel better when in hospital. For instance:

• Take a daily shower or ask that you be cleaned.
• Keep your hair neat and groomed as much as reasonably possible.
• Men: 
  • Shave on a daily basis or keep your beard neat.
  • Consider trading a hospital gown for a pair of pajamas
• Women: 
  • Consider wearing at least a bit of make-up.
  • Having someone do your hair for you generally provides a lift.
  • Wear whatever makes you feel good that doesn't unduly interfere with hospital procedures.
    • Consider your own nightgowns.
    • Someone can make a hospital gown for you.
    • You can decorate the hospital's gowns by adding ribbons, buttons and the like. (Do not add metal, suede or leather trim).

Sometimes a patient is admitted to a hospital on an "observation status."  While on "observation status" you stay in the hospital, and receive hospital services. However,  you are not considered to be a patient.

"Observation status" is meaningful when it comes to your bill. Medicare and some private insurance charge patients a 20 percent co-payment. There is also no coverage for the cost of post-hospital nursing care or rehabiltation which require a minimum stay as a patient in a hospital before coverage takes effect.

In theory, observation status should not last more than a day or two. However, hospitals are sometimes using it for longer stays to avoid Medicare penalties in case there is a readmission soon after discharge.

If you are on observation status, it is advisable to insist that you be changed to "patient" status as soon as possible.

A Health Care Power of Attorney, Living Wills and other Advance Directives provide a method for telling doctors and other medical personnel what treatments you do or do not want in case you become unable to speak for yourself.

Everyone should have a Living Will and should consider appointing a person to act for you (a "proxy") by having a Healthcare Power Of Attorney. What you put in the documents, or instruct the person who will act as your proxy, is up to you. These documents help assure that what you want is what happens.

Be sure the hospital has a copy of your Living Will, Health Care Proxy and/or Do Not Resuscitate Order if you have these documents.

 

Written with:

Herbert Spiers, Ph.D.

New York, NY