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Lessons From America's Safest Hospitals

More than 180,000 people die every year from hospital errors. Here's what the top medical centers are doing to improve your odds

Today the hospital places supplies in patients' rooms and conducts "handoffs" — where information about patients is passed from one nurse to the next — right at the bedside. "It's much safer for the patient and more rewarding for us," says Janet G. Streifel, RN.

Nurses at Homestead Hospital in Homestead, Florida, make regular rounds so they can anticipate patients' needs, rather than waiting to respond to a frantic call button. "That prevents patients from trying to get out of the bed to go to the toilet by themselves," says Gail Gordon, RN, vice president and chief nursing officer. Answering nature's call is a major reason for hospital falls, which affect up to 15 percent of patients and result in serious injury 30 percent of the time.

Finally, nurses at Sentara CarePlex Hospital in Hampton, Virginia, make special rounds to examine the skin of patients at high risk for pressure ulcers, or bedsores, which can cause pain and even deadly infection.

Design safety

When top hospitals get the chance to build a new building, patient safety is key to the design. Take Englewood Hospital and Medical Center in Englewood, New Jersey. The hospital's ER, which opened in 2009, features private rooms separated by opaque sliding glass doors. "The older ER had curtains separating patients," says Bettyann Cifu, Englewood's director of quality development and accreditation. "There was no privacy. When another patient can hear, patients may not confide crucial factors."

In Chicago, patients at the Rush University Medical Center's gleaming year-old facility, called the Tower, stay in private rooms to thwart the spread of infection. And rooms can be negatively pressurized so air from contagious patients is expelled from the building instead of circulating inside.

Significantly, every room is exactly alike. "When you enter a patient's room, you may need to find something quickly," explains David Ansell, M.D., Rush's chief medical officer. "Things like oxygen are in the same place in every single room."

Teamwork and transparency

Doctors have always been at the top of the medical hierarchy in this country, and that, say experts, often makes nurses and support staff hesitant to speak up — even when they see a disaster about to occur. "For 150 years we've taught physicians they're the boss, that they know more than anybody else. In effect we've taught them anti-team behavior," says Leape, of the Harvard School of Public Health. "That doesn't work in 21st-century medicine."

The country's safest hospitals recognize this and have worked hard to change the culture, telling nurses and technicians to speak up when they see a problem. It hasn't always been easy. Early in Virginia Mason's transformation, a nurse there noticed that a cancer patient hadn't received the echocardiogram that is standard protocol before starting chemotherapy. She mentioned it to the patient's doctor. Annoyed, he ordered her to begin the treatment anyway. Instead, she called the head of cancer services, who backed her up. When the doctor yelled at her for going around him, she alerted higher-ups through the patient safety alert system, which resulted in the doctor's temporarily being removed from practicing at Virginia Mason.

The institutional culture is changing, too, albeit slowly, as hospitals become more open about their mistakes. Hospitals earn trust when they admit to errors, says Richard C. Boothman, executive director of clinical safety at the University of Michigan Hospitals and Health Centers. He pioneered the health system's Disclosure, Apology and Offer model, in which patients are quickly told of errors, issued an apology and offered a settlement. To understand just how rare this policy is, consider that hospitals inform patients immediately when a mistake has occurred only about 2 percent of the time, according to a Johns Hopkins study.

Michigan also monitors rates of infection for individual doctors and pulls outliers aside — not for punishment but for retraining. Beth Israel Deaconess Medical Center in Boston displays infection and error rates on its website as a way to stay accountable to the public.

Virginia Mason received a barrage of criticism for Mary McClinton's untimely death, but over time, staff and community members have come to view it as the defining moment when the hospital began to truly change its safety culture. And in a personal vote of confidence, McClinton's son Gerald decided to have his own knee surgery at Virginia Mason two years ago. "It was one of the hardest decisions I've had to make, but they took care of me quite well," says Gerald, who owns a real estate company in Seattle. "As long as they stay set on making the hospital one of the safest in the world, they've got my support."

4 Ways to Protect Yourself

1. Check credentials. Make sure the hospital is accredited by The Joint Commission, the chief hospital accrediting organization in the U.S. (qualitycheck.org).

2. Ask questions. "Overwhelming data show that when patients actively participate in their own care, they have better outcomes," says Peter J. Pronovost, M.D., patient-safety expert at Johns Hopkins.

3. Bring an advocate. Another set of eyes and ears monitoring your care helps. "I slept in a cot by my mother's side for two days when she was in the hospital," says Robert M. Wachter, M.D., associate chair of the department of medicine at the University of California, San Francisco.

4. Be persistent. Make sure providers follow standard procedures for common practices like inserting IV lines.

Next: America's safest hospitals. »

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Video Extra

ONE DOCTOR'S PRESCRIPTION: Dr. Peter Pronovost developed a checklist to help prevent hospital infections and medical mistakes.

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