4 reasons why hospitals can be very dangerous places to be

Hospitals are commonly thought of as the safest place to be for sick people.

Patients have around-the-clock access to skilled care teams. Their vital signs are continuously monitored. A physician stops by every morning to check on them.

While it all sounds safe, a hospital can be a very dangerous place to be. Here are four frightening risks hospitals pose, along with their causes and some easy-to-implement solutions that could save hundreds of thousands of lives each year:

1. Hospital stays may cause psychological harm. Hospitals are intended to maximize the health of sick people. But the ways that hospitals are designed can severely disorient patients.

Beaming florescent lights, beeping machines and loud hallway conversations disrupt natural sleep patterns. Patients are routinely awakened at night for status checks and early in the morning for blood draws. Food is withheld while doctors await tests – and is often unappealing whenever it’s served.

These deviations from day-to-day norms can disrupt any patient’s psyche. But hospital stays can be particularly devastating for elderly patients.

The combination of sleep deprivation, poor nourishment and sedative medications can produce progressive deterioration in a patient’s mental status.

Each year, 20 percent of elderly patients in hospitals develop delirium and 1 of 6 die as a result.

2. Hospital stays can lead to physical harm. 
The risk of physical harm runs through even the safest hospitals as patients are given powerful narcotics or sedatives, which cause confusion and make it difficult for them to walk safely. One study found patients who fell during their hospital stay were nearly three times more likely to have received a sedative.

Meanwhile, individuals on mandated bed rest face the risks of significant muscle weakness, even among the youngest and healthiest patients. Lack of regular physical activity during bed rest increases the risk of bone fractures, stiffened joints and, in some cases, contractures (where stiff joints become permanently bent).

But not all physical risks are external. Germs that can cause serious infectious diseases are prevalent in hospital environments. Worse, they often prove to be resistant to even the most potent antibiotics.

3. Hospital stays increase the risk of avoidable conditions. 
Over a decade ago, the Institute of Medicine reported that up to 98,000 people a year die in hospitals because of medical error. These deaths can occur from the wrong patient receiving a medication, a patient receiving the wrong medication or a miscalculated dose.

This alarming statistic did not include the patients who experienced other complications as a result of their hospital care. Such complications may include developing a pressure ulcer, falling on the way to the bathroom, or acquiring a systemic infection through an intravenous line. These kinds of complications affect as many as 4 to 5 percent of all hospitalized patients.

Yet one of the more common medical errors is also one of the most avoidable. Patients who transmit infections to others in a hospital may do so as a result of doctors, nurses and other hospital staff failing to wash their hands.

This can result in the spreading of the bacterium Clostridium difficile or “C-diff,” which can produce severe abdominal symptoms and diarrhea, damage the bowel itself, require surgery and even result in death.

Alarmingly, C-diff can contaminate surfaces in hospitals and remain infectious for up to six months. This makes sterilization of hands, rooms and hospital surfaces an absolute necessity. Over the past decade, the incidence of this problem has doubled and 1 of 14 infected patients die as a result.

4. Hospital stays sometimes result in problems after discharge. 
Many patients suffer ongoing physical and mental ills after discharge with some unable to regain their prior mental acuity or muscle strength.

This is most severe for those who stay in the hospital for prolonged periods, particularly with complex conditions. The elderly are especially at increased risk for falls, may no longer be able to care for their own basic needs and may have difficulty managing the details of their treatment regimen.

In addition to the health issues, many patients face ongoing financial woes after hospital discharge.

When hospital-acquired complications prolong in-patient stays by days or even weeks, patients may owe large amounts of money, experience lost income from missed work and face prolonged disability.

Small changes can bring about big improvements 

While some facilities have taken major steps toward lowering or eliminating risks, the majority of hospitals are ripe for improvement. While many hospitals require complex overhauls to minimize error or change clinical practices, the following small steps could reduce patient complications, speed up their recovery and help them avoid readmission.

To reduce the risk of psychological harm, hospitals should reduce noise and illumination at night. Let patients sleep through the night unless awakening them is essential for their medical care.

Some physical risks can be confronted easily, as well. Ambulate all patients every day, even the sickest. Physical movement reduces muscle wasting, improves breathing, and decreases the incidence of confusion and delirium.

Physical and psychological risks can be tackled together by minimizing the use of sedatives and powerful pain medications, particularly among elderly patients. Physicians should consider prescribing medications with less impact on cognition and ambulation.

To reduce medical error and the spreading of germs and bacteria, hospitals should make sure all care providers wash their hands every time they enter and leave a patient’s room. Several companies are already pushing technologies that can help hospitals monitor and promote employee hand washing.

And to avoid the trauma and dislocation of a hospital stay, hospital leaders and clinicians should consider offering high quality alternatives to an in-patient stay. Such alternatives may include ambulatory, palliative and hospice care programs. In addition, when clinically appropriate, physicians can look for opportunities and offer patients the option of going home earlier in their stay, even if only the evening before.

When hospitals overlook these simple yet significant changes, they become very dangerous places to be. But the result of these changes can be as powerful as the most sophisticated technology or the most potent medications.

Full disclosure: Many of the changes described above have been implemented at Kaiser Permanente hospitals throughout Northern California. As a result, my colleagues and I have seen reductions in sepsis mortality and the incidence of pressure ulcers, delirium, and C-diff infections, along with other hospital dangers. 

Robert Pearl is a physician and CEO, The Permanente Medical Group. This article originally appeared on Forbes.com.

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  • guest

    Groundbreaking stuff! /sarc

    Most people are quite aware that hospitals are deathtraps and to be avoided at all costs.

  • NewMexicoRam

    Huh.
    As a resident, I remember most of the patients leaving in better condition than they came in.
    Guess I was fooled.

  • PoliticallyIncorrectMD

    I wonder who is running The Permanente Medical Group while Mr. Pearl is so actively engaged in stating the obvious?

    • http://onhealthtech.blogspot.com Margalit Gur-Arie

      Keeping people out of hospitals by all means necessary, and if they end up there, kicking them out sooner, carries financial rewards from CMS now….

      • PoliticallyIncorrectMD

        Making very much sense. As always, you can see behind the smoke screen.

    • chaplaindl

      The problem is that too many hospitals are unwilling or unable to do the obvious no matter how many times it is stated. If you have had privileges in any hospitals, think about them. Have they all done the things suggested in the article? If so, that’s very good news.

      I know of hospitals that are still noisier than they need to be, that waken patients at all hours of the night, that keep patients from eating and drinking for hours or even days, to accommodate scheduling and rescheduling of procedures. There are certainly clinicians who do not wash their hands when they should. Patients still acquire hospital-based infections.

      Dr. Pearl is reporting that there are some simple and humane changes that will will help keep patients from falling prey to the ills of the hospital. If what he writes were really that obvious wouldn’t everyone have implemented these practices already? And if the financial advantage of doing this under the new reimbursement system adds an additional incentive to do things that will be good for patients anyway, so much the better. Your comment seems like an attempt to be clever rather than thoughtful or caring.

      • PoliticallyIncorrectMD

        It is ironic, that Mr. Pearl has decided to state what the medical community known all along exactly when it could give him “financial advantage of doing this under the new reimbursement system”.

        I do not dispute the need to make hospitals as safe and accommodating as possible. But this is not what the purpose of the original article is. In fact, it is exactly the opposite. Using your words, it is an attempt to maximize the profits rather then being thoughtful and caring. This what Mr. Pearl’s job is! Now that it is becoming more profitable because of misguided financial insentives to kick patients out of the hospital earlier (frequently before they are ready), many healthcare bureaucrats engage in the PR campaign to justify such approach and scare people into staying away form the hospitals. Unfortunately, this is frequently done without any regard to patients’ benefit and usually by vilifying the healthcare providers, who usually are the true patient advocates. Apparently, the campaign is working, because it makes people like you to believe that medical professionals are “unwilling or unable to do the obvious”, they “keep patients from eating and drinking for hours or even days” and “do not wash their hands when they should”.

        P.S.: Please, let my patients decide if I am “thoughtful or caring”.

  • NormRx

    I remember several years ago when there was a movement to have new mothers and their babies go home sooner. Then the backlash started and we heard about “drive by deliveries.” For years I have been telling new mothers that the most dangerous place they can be is in the hospital. GO HOME QUICKLY!!!

  • Patient Kit

    We patients hear, every time we have major surgery, how much better it is for us to go home asap — the same day or the next day if at all possible. Hospitals are full of sick people and infections, we are told. While I don’t doubt the infection threat, I always thought this outpatient surgery push was mostly about insurance companies saving money. To me, keeping us overnight for one day and watching us for 24-hours post-surgery seems reasonable. Sending us home the same day often seems unreasonable and I wonder how it effects the readmission rate.

    Also, I am curious: If hospitals really are such unsafe places for patients, how safe are hospitals for all the people who work in them?

  • Patient Kit

    What doctors and patients consider to be “major” can feel different. Almost a year ago, I had a total hysterectomy with an ovarian cancer diagnosis. I can’t tell you how major that felt to me. My surgery was done roboticly/minimally invasively, officially on an outpatient basis at 7:30am on a Tuesday morning. The official plan was for me to go home later that day. They kept me in recovery for hours watching my blood oxidation level and I ended up being moved up to a room and going home from the hospital the next day instead. My surgery went well, no complications, my GYN oncologist is awesome and I am one lucky woman because it turned out to be early stage ovarian cancer. It most definitely felt like major surgery to me. But maybe it’s not considered to be major surgery by insurance companies and hospitals. I do, however, know the difference between major and minor league baseball. ;-) And I have no desire to stay in a hospital any longer than necessary. Just saying that doctors’ and patients’ perceptions about what is major can be very different

  • medicontheedge

    All of these “side effects” of hospital” stays, except for the diseases spread by inadequate handwashing, can be minimized by MORE STAFF. More nurses and techs to provide monitoring, un-rushed medication reconciliation and delivery, more environmental staff to keep the place cleaner, etc.

  • Judith Johnson

    Florence Nightingale wrote a century and a quarter ago about the need for simple interventions and good thorough nursing care. The good thorough nursing care by highly educated nurses is what can prevent LOTS of these problems but of course, HIRING ENOUGH NURSES TO CARE PROPERLY isn’t something hospitals are prepared to do.