Even the most capable among us is challenged when confronted with the complexity of the modern hospital experience. Being hospitalized, whether planned or unexpected because of an emergency, can be a stressful and confusing experience. Advocating for yourself or your loved one in the hospital is not easy; when we are ill, or fear for our loved ones, we are emotionally vulnerable. The confusion and stress of a hospital encounter is often heightened for older folks.
Most of us will need to go the hospital for one reason or another to obtain treatment and care for an illness or injury. Whether you or your loved one will be going for a planned surgery or an emergency, there are some simple steps to minimize the stress.
Enlist Support
The single most important action people can take before going to the hospital is to identify who will go with them when the time comes. It is imperative to have an extra set of eyes and ears to help absorb information, protect safety and provide answers if the patient is unable to speak up. This “advocate” can be a family member, friend, neighbor or paid worker. If you know a young person (someone from the millennial generation), you can count on his or her ability to access medical info quickly and to speak up without fear. We know that the older generation may have been taught to never question the doctor and this advice no longer holds true. Increasingly, doctors are prepared for informed and questioning patients and their advocates.
Understanding the Emergency Department Process
For better or worse, the most common path into the hospital is through the emergency room. No place in the hospital is as baffling and as stressful as the emergency room (ER, but also called the Emergency Department, or ED). Most people are filtered through the ED unless there is a planned surgery or procedure. It is likely that the first health professional encountered will be the triage nurse. This skilled individual is specifically trained to assess the severity of the patient’s condition. The ED is not a first-come first-served situation; the sickest or most severely injured people are evaluated and treated first. A long wait can be frustrating to a patient who is hurt or feels miserably sick and it is difficult to be understanding and not complain. However, if you or your loved one has experienced a major change in status since arrival, it is important to speak up to the hospital staff. Some examples might be: loss of consciousness, trouble breathing, new chest pain, or major bleeding. At this point, someone—either you or your family member—must let staff know that there has been a change in your condition.
Helping the Care Team Figure Out What’s Wrong
If the illness or injury is not completely obvious to hospital staff, the doctors and nurses will begin the process of gathering clues as to what is troubling the patient and causing the symptoms. You can help this process greatly (and even prevent unnecessary tests and delays to diagnosis) by bringing your medical information with you. Finding out about what health conditions you have is often the key to solving what landed you in the ED in the first place. Sometimes, patients come in with obvious troubles: For example, if a person has been in a motor vehicle accident (MVA) and has cuts, bruises, or broken bones, the problems are evident to the staff and they will know what to do. However, for patients who have symptoms that can be caused by many different kinds of underlying conditions (existing medical illnesses), knowing about your history of illnesses, chronic diseases, or previous surgeries will help guide the medical professional in decision-making about what needs to happen next. For example, patients who have a history of high blood pressure are at greater risk for stroke or heart attack than other people.
So, to eliminate delays, repeated questions and unnecessary work-ups, the patient or caregiver should assemble a “go-packet”: list of current medications and doses, a history of medical conditions past and present, including surgeries, and the names and contact information for the primary care physicians and specialists. Advance directives and health care power of attorney documents should be included in this packet, which can be kept in a wallet, by the front door or stored electronically in a smart phone.
Special Considerations for Older Patients
Remarkably, about 85% of people who go to the ED are sent home. The remainder will stay for observation or be admitted. Older patients, even when not terribly sick or injured are more likely to be admitted than their younger counterparts, simply by virtue of their number of years. Fortunately, many emergency departments are adapting to the special set of needs required for the care of older patients, who may be more frail or require additional attention. Equally, older patients may prefer not to have full aggressive medical interventions. This new movement is called “geriatric emergency medicine” and is characterized by care guided by geriatrically-trained health care providers. There may also be patient navigators to help older patients deal with the ED experience. It is important for the patient to specify what treatment or lack of treatment is desired. This can be done ahead of time with medical-legal documents signed by the patient or the health care power of attorney.
Here is a summary of important tips to guide patients and caregivers in the emergency department and throughout a hospital encounter:
1) Bring a list of medications and list of your current and past medical illnesses and surgeries with you when you go to the emergency department. So much "history" can be gleaned from this information and having it in written form will spare you from repeating it multiple times when different members of the care team try to find out about your existing and past conditions.
2) Ask every hospital provider and staff person to identify themselves and their role in your care.
3) Find out which doctor is in charge of your care. Particularly if you have a complicated medical situation or there is difficulty making a diagnosis, there may be many "consultants" weighing in and giving opinions. However, there will be one doctor who has overall responsibility for you. Remember also that residents -- no matter how knowledgeable, communicative and helpful they may be -- are never in charge of your care.
4) Do not assume that your doctors and nurses are speaking to each other. It is appropriate to confirm (by asking politely) that information about your care is being passed between the different professionals.
5) Observe the principle of "shared decision-making". Tests, procedures and treatments should be made in concert with your health care providers, which means that you are an active participant in this process. It is reasonable for you to ask if there is a less invasive/painful/expensive way to receive treatment or undergo diagnostic testing. This includes surgery.
6) Don't be complacent: medical errors happen. Therefore it is incumbent upon you to be watchful during a hospital stay and to not let down your guard. A prime source of medical mistakes is through infections. For this reason it is always appropriate for you to ask if the provider or staff person touching you or medical equipment has washed his or her hands.
7) Know your rights. You will likely see the "Patient Bill of Rights" posted around the hospital. You have the right to emergency care without regard to the ability to make payment. You have the right to receive respectful care, to be treated without discrimination, to understand your care and to refuse treatment.
8) Knowledge is power! The more you understand what is involved in your care during a hospital stay, the better you will be able to advocate for yourself or your loved one to ensure a safer and more favorable inpatient experience.
Author Sara L. Merwin, MPH, wrote “The Informed Patient: A Complete Guide to a Hospital Stay” with Karen A. Friedman, MD to help people safely and comfortably navigate the hospital experience. The book was published in November 2017 and is available on Amazon and in some bookstores.
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