Staffing woes linked to most adverse outcomes
Six percent of respondents to a national survey by Consumer Reports magazine said they developed an infection during their hospital stay or within one week afterward.1 "Knowing a hospital’s infection rate might be a good way to rate the quality of its care," the report states. "But this information, though collected by hospitals and accrediting groups, is not released to the public."
Other groups have suggested public disclosure of infection rates as a quality indicator for the public, but epidemiologists have argued successfully that the information could be highly misleading if the data are not risk-adjusted for the patient population. Indeed, the argument goes, higher infection rates could be found at hospitals that do a better job tracking them through surveillance.
The report emphasizes the availability of hospital report cards in an increasing number of states, but stops short of calling for infection rate disclosure.
"We believe that more information is better — transparency is better," says Joel Gurin, executive vice president for Yonkers, NY-based Consumers Union, the publisher of Consumer Reports. "But there is always the question of wanting to make sure that information is available in a way that can be easily and accurately interpreted by consumers."
A common denominator for bad patient experiences — from unrelieved pain to medical errors — was inadequate staffing. "If you had a lower level of nursing staffing, there were more health complications," says Donato Vaccaro, the researcher who compiled and analyzed the survey statistics. "The infection outcomes mirrored that."
A total of 21,144 readers were surveyed about their own recent hospitalization or that of a close family member. "We only included information from a [family member] if the respondents said they were involved in key decisions in the care and met with doctors and nurses about the relative’s care," Vaccaro says.
While that methodology is a bit shaky by epidemiology standards, the findings echo many widely reported trends in the health care system. Overall, 22% of respondents were "less than highly satisfied" with their hospital stay. Frequent complaints were unanswered calls for assistance, inadequate pain relief, pressure to leave the hospital too soon, or recovery prolonged by complications caused by the hospitalization, the magazine reported. Though reporting an experience below "highly satisfied" doesn’t appear particularly troubling, for example, at a restaurant, such a measure of hospital quality is more serious, the researchers argue.
"You’re never more vulnerable than when you’re in the hospital," Gurin says. "From a consumer’s point of view it is a high-risk situation. A lot can go wrong. The stakes are very high, and you’re in a weakened state. It is really troubling that one-fifth of patients were not highly satisfied with their care."
In other survey findings, 12% of respondents said they were aware of a medication error, misdiagnosis, or similar problem during their stay. For 5% of all respondents, such problems led to serious health complications. Moreover, only 2% of the survey respondents who reported attentive nursing care ended up with a serious health complication, compared with 8% of those who found it more difficult to get a nurse to help them. Just 60% of survey respondents said unequivocally that their hospital was adequately staffed. As a result, only 37% of all respondents reported suboptimal pain relief.
The report recommended the following strategies for patients:
- Make an informed choice of hospitals.
- Bring your own medical history.
- Bring a family member or friend to help.
- Get to know the staff, and make sure they know you.
- Be aggressive about seeking pain relief.
1. How safe is your hospital? Consumer Reports, January 2003:12-18.