Stay vigilant for problems

Just because a hospital looks clean and well run doesn't mean it is. It's estimated that more than 100,000 patients die needlessly every year in U.S. hospitals and health-care facilities, infected because of the staff's sloppy compliance with cleanliness policies or injured because simple safety checklists were not followed. In our patient survey, 7 percent said an infection developed during or within a month of their hospital stay. Of those, 41 percent said the infection extended their hospital stay; the median was six days.

Little progress has been made implementing key measures to protect patients. That's why patients and watchful family members and friends must do what they can to guard against preventable errors.

For instance, our surveyed nurses confirmed serious problems in hygiene. Twenty-six percent reported observing hand-washing lapses.

"It seems like a simple little thing, but doctors and nurses pick up a lot of nasty germs and then transmit them to other patients," Blumstein, of Wake Forest, says. "By far the best way of preventing that is to wash your hands. But it's easy to forget. So you might want to pay attention to whether or not the doctor or nurses wash their hands or use that alcohol-based hand-sanitizer stuff." (For effective ways to broach the subject, see Wash up, Doc.)

Mistakes don't stop at hand-washing lapses. Eleven percent of surveyed nurses said that in their most recent work week, they observed "incorrectly administered medication or dosage," and 9 percent said doctors had prescribed the wrong medicine or dosage. (We didn't ask whether the nurses intervened.)

Patients should take steps to protect themselves. Forty-six percent of nurses said it would help very much if patients checked the medications being administered to them during their stay. But only 28 percent of the patients and 35 percent of the family members (31 percent overall) in our survey said that they did so.

Patients we interviewed said it sometimes took a lot of persistence to get answers. "You really have to be your own patient advocate," says Duane Rayford, 50, of Desert Hot Springs, Calif. He's on kidney dialysis, he says, and has been in and out of three hospitals since October 2008. "We had to constantly ask questions like, 'What about this?' 'What happens if this happens?' 'Is there another way to do this?' 'What else can we do?' " Rayford says. Eventually he got the information that he needed.

Summing up

• Make sure caregivers wash their hands.
• Check medications and doses before you take them.
• Be insistent if you're unhappy with your care or don't understand something.