Consumer Reports ("CR") recently took a “side-by-side” survey regarding the sanitary conditions of hospitals across the country. In 2009 it interviewed 731 nurses who worked in different areas of the hospital (ranging from the E.R. to the operating room), and in 2008 it heard from 13,540 readers who reported their various experiences with staying in hospitals, whether personal or referencing a family member, during 2007. (Note: Consumer Reports admits that their readership is nowhere close to representing a sample of the United States population as “they are especially well-insured.”)
Regardless, CR found the conclusions of their little survey “startling.” Why?
Why is CR so surprised to find that one’s perspective on a hospital visit – and more so, hospital sanitation – depends on one’s role within the context of the hospital environment? Its article states, “About 4 percent of patients said they saw problems with cleanliness, compared with 28 percent of nurses. Thirteen percent of patients said care wasn’t coordinated properly, while 38 percent of nurses said that was a problem. Five percent of patients—but 26 percent of nurses—said hospital staff members sometimes did not wash their hands before approaching a patient.” Why is this so shocking? Certainly the numbers are a bit surprising, and upon first glance it appears as though they speak for themselves.
Let’s attempt to look at this data objectively for a moment, however. First , the pools are not even remotely close to being the same size. In this survey, the nurse pool is less than 6% the size of the patient pool. If this was intended to measure anything, what really should have happened here is CR should have interviewed X number of patients from hospitals W, Y, Z, etc. Then, the nurses interviewed should have equaled the number of patients per hospital. So if CR interviewed 20 patients from St. Francis in Hartford, Connecticut, it should have interviewed 20 nurses from St. Francis as well. Yes, the national nurse population is smaller than the national patient population. However, when measuring something like the opinion of hospital sanitation from the perspectives of two distinct groups, those groups should be equal in size so as to provide the surveyor with the most objective and accurate data. If they were measuring something like patient care quality, only then would the national nurse population – and the fact that it is altogether smaller than the patient population – come (hugely) into play. As it stands now, the patients surveyed could have attended the finest hospitals in the country while the nurses interviewed were working in the worst. There is no proper gauge here to determine the legitimacy of this survey other than CR asking a random number of random people about their experiences.
Second, of course, the nurses see the worst of the circumstances. Patients, while certainly aware of their own treatment, are not aware of the treatment of the other 300 patients in the hospital. A nurse, however, who is exposed to multiple patients per day, would naturally, logically and obviously encounter and be exposed to far more instances of mistreatment and/or mishandled situations than any single patient in the entire hospital. It is like eating at a restaurant. Sure, one out of every twenty customers may be dissatisfied with the service or the food; but, in the end, the waitresses and the chefs are the only ones who know what goes on behind those kitchen doors. Chances are the waitresses and chefs who wouldn’t eat at their own restaurants outnumber the customers who get bad food/service and never return.
But we are not talking about restaurants, we are talking about hospitals, and CR does end its article with some good points on how to improve a hospital stay regardless of where one is located.
CR suggests researching hospitals before one is admitted. Obviously, if one needs to be rushed to the ER, one should go local. But if one is having an operation or an elective procedure done, or is going to be admitted regularly for a recurring condition, this may be good advice (obviously, one should confer with his/her doctors about such decisions). It is wise to have up-to-date information for the important contacts within one’s health insurance’s network. In addition, one should not settle on a hospital because it is around the corner or because it is in one’s health network; one should try to find reports of past user experiences and records of the hospital’s reputation before admittance. While CR’s survey is, by its own admission, not derived from an entirely accurate sampling of the U.S. population, the advice appears to be sound.
CR also makes a good point in mentioning the unreliability of a hospital’s electronic database. With it being fairly easy for a patient who is constantly changing wards within a hospital to have conflicting medications prescribed or to have medications mixed-up, it suggests being one’s own “record-keeper.” While this is difficult to do when unconscious after surgery, it’s beneficial for an individual to have a relative or friend keep tabs on what is going into his/her body while he/she is not coherent.
CR further suggests “avoiding chaotic care,” which apparently means avoiding repeat and unnecessary tests. It makes a point of saying that patients have the option to contact a social worker or patient advocate if the coordination is being mishandled. Further, it suggests staying “vigilant” about problems and making sure one understands the plans for one’s discharge.
While these points seem obvious, they tie together nicely to support CR’s major concern: one should approach one’s hospital care very carefully, ensuring that the institution he/she selects is safe, reliable, and in a condition in which one feels comfortable, suiting one’s specific needs.
For more information on the survey, please see: ConsumerReportsHealth.org