Plan for a smooth admission

Errors in medication are a leading cause of preventable injury to hospital patients in this country, and research suggests that mix-ups are especially likely during "care transitions," when patients are admitted, are transferred from one ward to another, or are discharged from the hospital.

But it is estimated that less than 2 percent of hospitals in the U.S. have comprehensive electronic records systems that make patient information readily available anywhere in the hospital. That means that you'll have to be your own record keeper. Rita Kobert, 51, of Fredericksburg, Va., who has a seizure disorder, learned that lesson long ago. "If I fall from a seizure or something and have to go to the hospital, I already have a printout of medications, past surgeries, things like that," she says. "If you smack your head, you're out of it for a little while sometimes."

Everyone should follow Kobert's example. Keep an up-to-date list of your current medications and dosages, including over-the-counter drugs and dietary supplements, in your handbag or wallet at all times. (Include your emergency contact information and your primary-care provider's.) Nurses in our survey said that's one of the most important things you can do to help ensure better hospital care.

If you have a chronic condition or a significant medical history, take a written summary with you, including dates of significant events, treatments, and tests, so you can fill out forms accurately.

Patients with a limited command of English should call ahead to make sure the hospital has doctors or staff who speak their language or interpreters and translated documents.

If your hospital admission is planned, pack a small bag of personal items, including some family pictures to comfort you, and books, magazines, and a portable music player with headphones to help pass the time. Check with the hospital about cell phones and laptop computers. They're usually OK except in or near intensive-care units, where they might interfere with sensitive equipment. Ask whether there's a secure place to keep them when you're away from your room.

For safety reasons, hospitals prefer to supply all medications, says Bona Benjamin, director of medication-use quality improvement at the American Society of Health-System Pharmacists. If you're concerned that your particular medicines might be unavailable, call the hospital in advance and ask to speak with its pharmacist. If you're being hospitalized by someone other than your primary-care doctor, remember to let him or her know that you're going to the hospital. And when you get there, be sure to fill out forms authorizing the hospital to send records of your stay to your primary-care doctor. Make sure you have an "advance directive" (available at www.caringinfo.org) that gives your preferences for care in the event you are ill with no prospect of recovery and unable to express your wishes.

You might be surprised to discover that you've never met the doctor who will actually take care of you in the hospital. A new breed of physician known as a hospitalist, a specialist trained specifically to practice in-hospital medicine, might be in charge of your care. "It's likely that over half of Medicare fee-for-service patients in the U.S. are cared for by hospitalists," says Mark V. Williams, M.D., professor and chief of the division of hospital medicine at Northwestern University Feinberg School of Medicine. Although off-site doctors might come to check on patients only once a day, hospitalists are available around the clock.

Lingering trust issues remain. An editorial in the April 2009 issue of the Journal of Hospital Medicine said hospitalists are often portrayed as doctors who work "for the hospital and not the patient, an employee focused on efficiency and rapid discharge rather than continuous medical care." To allay any concerns, feel free to ask the hospitalist to consult with your regular doctor before you agree to have particular tests or procedures and to keep the lines of communication open.

If you, like 41 percent of our respondents, enter the hospital through the emergency room, expect a more difficult experience all around. ER patients and families were far less satisfied than non-ER patients with every measure of staff attentiveness, including pain control, nurses' responsiveness, having their questions answered promptly, and getting explanations of medications and tests.

Waiting time is the top cause of patient dissatisfaction, says Howard Blumstein, M.D., medical director of the emergency department at Wake Forest University Baptist Medical Center and a vice president of the American Academy of Emergency Medicine. "The longer we make you wait, the more dissatisfied you will be."

If you have a chronic condition that lands you in the hospital occasionally, try to avoid going through the ER. But don't hesitate to call 911 if you have a true medical emergency, such as severe physical trauma, difficulty breathing, sudden chest pain, serious loss of blood, a possible broken bone, a sudden inability to use one of your limbs, a loss of vision, unexplained seizures or convulsions, or a severe headache.

Summing up

• Take a list of medications and a brief health history to the hospital.
• Speak with the hospital pharmacist about special medications.
• Keep your regular doctor in the loop.
• Understand the hospitalist's role.
• Avoid the ER except for genuine medical emergencies.