Patient safety requires a commitment from top management

One of the greatest risks I faced from surgery to repair a macular hole in my eye was from a hospital acquired infection. But when I tried to find data on the performance of various hospitals in New York City, there were no ratings for Manhattan Eye, Ear & Throat where I would have my surgery. My doctor had moved from a prestigious New York City hospital to Manhattan Eye, Ear & Throat to start a new ophthalmology center, and he assured me the hospital was fine for eye procedures. In an earlier blog series, I shared my frustrating experience searching for and reviewing available hospital ratings and patient satisfaction scores in particular. At the end of my investigation, I had concluded that the metrics available to me would likely produce fuzzy answers anyway.

There are always ways to game one’s infection rate numbers, and what do they mean anyway?  A high rate could mean the hospital is a germ factory, or it could mean the hospital is looking hard for cases of infection and honestly reporting them. A low number could mean it’s doing a great job or not looking very hard. Still, surgical patients should want to know what their risks are.

So when I was admitted just a few weeks ago, I resorted to my favorite reporting technique—observation. You’ll be surprised at what you can learn just by looking and asking questions.

As an investigative journalist, I had observed practices at both good and bad nursing homes and advised other journalists that one way to determine good care is to watch how the staff interacts with the residents. You can easily tell if management has set a high bar for good care. Why wouldn’t the same apply to hospitals? Since my eye doctor’s office is in the hospital where I would have my surgery, I had the chance to test my thesis.

Right off the bat I saw that Manhattan Eye, Ear & Throat paid serious attention to infection risk. Hospital higher-ups seemed to be fostering a culture of cleanliness. Hand sanitizers were everywhere, and staff used them. Computer screen savers reminded practitioners to wash their hands. Outside visitors cleaned their hands too.

When I could not remove a small earring that had been in my ear lobe for years, I learned how serious the staff was. “No jewelry,” said the nurse, and returned with a tool to twist it out. Any jewelry could mean germs in the operating room, she explained. “You guys are really careful about this, aren’t you,” I asked the nurse. “Our goal is no infections,” she replied. “Not one.”

At that point, I relaxed and knew I would be okay, especially since another nurse had come to put an antibiotic in my eye. I knew that giving patients an antibiotic an hour before surgery reduces the chances of surgical site infections, which is the standard of care. Sure, things can happen, and they do, but at least I felt I was in a place that was doing what it could to stamp out infections. I was as safe as I possibly could be.

So what’s my take-away for patients? If you’re facing any kind of surgical procedure, find out as much as you can about the hospital’s infection control program. Grill your doctor, visit the hospital, walk the halls, look for hand sanitizers and note if they are used. Trying to observe a culture of safety may be harder than looking up a number on some organization’s website, but surgery is scary stuff, and being an engaged patient means doing all you can to keep yourself safe.

But what if you find the hospital is not up to snuff? At that point, it seems you may have to quiz your doctor and perhaps consider going elsewhere, though that may not be easy given the way our system works with doctors locked into certain hospitals.

My experience also confirmed that safety all comes back to a commitment from top management. Keep pressing your local hospitals to make safety so pervasive that it is evident to people like me and you.

Trudy Lieberman is a journalist and an adjunct associate professor of public health at Hunter College in New York City. She blogs regularly on the Prepared Patient Forum.

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