Consumer Reports Issues Report on Nurse and Patient Concerns About Hospital Care - Highlights Importance of Safe RN-to-Patient Staffing Limits
Check out this new article in Consumer Reports about what nurses and patients are saying about the quality of care in America’s hospitals. The famed consumer advocacy publication makes a special point of highlight the link between RN-to-patient staffing limits and the quality of patient care in hospitals. The bottom line for nurses and patients : if you want safe care, we need safe RN staffing and we need a law to require it, as hospitals will not do this of their own accord.
731 nurses reveal what to watch out for in the hospital
Last updated: September 2009
Do your homework | Plan for a smooth admission | Avoid chaotic care | Stay vigilant for problems | Plan ahead for discharge | Wash up, Doc | Whom to call | Patients can be more satisfied with hospitals that provide conservative care | Highest Ranking Teaching Hospitals for Patient Satisfaction | Lowest Ranking Teaching Hospitals for Patient Satisfaction
You might already worry that hospitals aren't as safe or sanitary as they should be, but nurses say you don't know the half of it. That is the startling conclusion of our first side-by-side surveys of hospital conditions from two very different perspectives: those of nurses and patients.
In the hospital surveys, conducted by the Consumer Reports National Research Center, we heard from subscribers who told us about their own or a loved one's most recent hospital stay, and nurses reported on their most recent week at work.
Their responses show that hospitals look very different depending on your vantage point. About 4 percent of patients told us they saw problems with hospital cleanliness, compared with 28 percent of nurses. Thirteen percent of patients said that their care wasn't coordinated properly, but 38 percent of nurses said that was a problem. Five percent of patients, but 26 percent of nurses, said hospital staff sometimes did not wash their hands.
In spring 2009, we surveyed a national sample of 731 nurses who cared directly for patients in emergency rooms, critical-care units, operating rooms, and other areas of the hospital. For the patient's viewpoint, in spring 2008, more than 13,540 readers told us about their own or a family member's hospital stay during the previous year.
We also collected suggestions from dozens of interviews with hospital officials, doctors, registered nurses, social workers, dietitians, and hospital pharmacists—and patients who were willing to share their experiences with us.
Here's their combined wisdom on how to get through a hospital stay safely and with minimal confusion, from the initial choice of where to go all the way through to your discharge.
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Do your homework
Fifty-nine percent of patients in our survey did not enter the hospital through the emergency room, so they might have had a choice of which hospital to go to. But 65 percent simply went to the hospital their physician recommended or was affiliated with. Forty percent chose a hospital for its location, and 28 percent because it was in their health plan's network. (Respondents were asked for their top three reasons.)
Only 11 percent chose the hospital for its record in treating their condition, and only 2 percent on the basis of the hospital's ratings in books or magazines or online. That's unfortunate, because hospital quality differs, and there's limited but growing public information about it, but you have to find it and make proper use of it. (We've listed some online sources of hospital information in Check up on your hospital.)
If you, like 99 percent of our respondents, have health insurance (our readers are not representative of the U.S. population and are exceptionally well insured), start by getting an up-to-date list of the hospitals, physicians, and specialists in your plan's network. And if you're going to have surgery, don't forget the anesthesiologists. Be sure to understand and observe your plan's coverage rules, especially any preauthorization requirements.
If you or a family member has a chronic medical condition that can lead to frequent hospitalization, such as heart disease or respiratory problems, you might benefit from a hospital check even more than people headed for elective surgery. Nonsurgical patients we surveyed, though generally positive about their experiences, were less so than surgical patients. They had more trouble getting the attention of doctors and nurses and more difficulty getting pain treatment and the information they needed about medications and diagnostic tests.
Patients who need highly specialized or technologically difficult treatments, such as surgery for esophageal cancer, a pediatric heart condition, or a brain aneurysm, should make a special effort to locate a hospital and surgeon with extensive and regular experience in that specific surgery. Research has shown that a key to a good outcome in those difficult cases is the experience of the surgeon and hospital. If you can't find what you need from the public resources we've provided, call doctors or hospitals directly and ask how often they do a specific procedure or take care of patients with your condition.
Another important piece of information that's often difficult to get: the ratio of nurses to patients. In our survey, patients who reported that the staff was responsive to their needs and who were satisfied with their overall nursing care were more satisfied overall with their hospital stay.
Other research has linked higher nurse-staffing levels with greater patient satisfaction scores and lower complication and mortality rates. "They can attend to patients' needs more quickly, respond to issues like pain management, and can probably do a better job of giving discharge instructions, all the things that go into having a more satisfied patient," says Ashish Jha, M.D., associate professor of health policy and management at the Harvard School of Public Health.
To find out the nurse-patient ratio of the hospitals you're considering, call the hospitals and ask, says Cheryl Peterson, R.N., director of nursing practice and policy for the American Nurses Association. Peterson says the association does not advocate any particular ratio, but adds, "If I was going into a medical-surgical unit and I had a nurse with more than five patients, I'd get a little worried." That could happen to you. In our survey, 31 percent of nurses reported that in an average hour on a shift they provided direct care for six or more patients.
• Check your health plan for its rules on hospitalization.
• Research hospitals online.
• Ask about a surgeon's experience with unusual or complex treatments.
• Ask about nurse-patient ratios.
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