Well, yes and no. The vast majority of folks enter and leave a hospital without injury or illness inflicted by the hospital.  So for most people, then, the answer is yes – their hospitals are safe. But for the unlucky few, the answer is no. I’ll explain.

First, hospitals, by their very nature, harbor difficult-to-treat germs- on the floors, in the sinks, in the corners of the room.  Infections resulting from these germs are rarely seen outside a hospital. Thus, by its very nature, admission to a hospital increases the risk of contracting bad germs – germs that can be exceedingly difficult to treat with antibiotics. Antibiotic-resistant infections in the hospital are called a hospital-acquired infections, and these can lead to serious problems – or worse.  Transmission of these germs happens as nurses, doctors, and, yes, cleaning staff, move from patient room to patient room – a nurse who has just handled an infected patient may forget to wash her hands before entering the next room, or the doctor’s stethoscope may not disinfected between patients, etc., etc.

 Second, all the manipulations and encounters that patients experience (perhaps suffer is a better word), such as being hoisted from bed to stretcher, a midnight trip to search for the bathroom, or being handed the wrong medicine, are situations ripe with opportunities for injury: a fall, a slip, a serious medication error, and many more. As long as there are sick people in a hospital, and as long as the hospital staff are humans and not robots, some bad things are bound to happen.

You can’t bring your risk of injury or infection to zero, but you can reduce that risk by attention, vigilance, and some knowledge of hospital routines. I’ve emphasized these points throughout Surviving Your Doctor. Specifically, chapters 11 (When You Are Hospitalized) and 12 (Coping with ER’s) provide suggestions that can help you reduce the risk in a hospital, as does chapter 16 (How to Complain).

In this essay, I’ll briefly mention some recent improvements in hospital safety as well as and a website that you should know about. Remember that the information below supplements, but does not replace, the advice and resources provided in Surviving Your Doctor.

Improvements in hospital procedures over the last decade have made substantial inroads in the reduction of injuries and errors when patients are hospitalized. For example, doctors and nurses must not veer from rigorous and written disinfection procedures before inserting a central venous catheter (a long i.v. line that remains in place for days and is susceptible to infections). In addition, federal legislation has established guidelines and reporting requirements aimed at improved hospital safety and quality.  Here are a few examples, without the associated jargon that is often associated with such a discussion.

First, hospitals are required to report data on a number of safety measures, including medication safety (did they give the patient the right medicine, in the right dose, at the right time?), the rate and types of hospital-acquired infections (how many patients contracted a new infection while in the hospital?), as well as on issues related to hospital-acquired injuries and adverse events, such as development of bedsores and falls.

Second, hospitals must track how many patients are readmitted for the same problem within 30 days (a sign that the hospital may not have arranged adequate instructions or assistance when the patient is discharged.

Third, and perhaps most important to your safety, financial rewards are now provided to hospitals for high performance on quality and safety issues, and financial penalties are levied on those hospitals that perform poorly.  These government incentive payments to hospitals that are safe and achieve high marks on quality issues are substantial. As are the penalties. This is an effective technique to promote quality improvement.

The scorecards for individual hospitals are published on a government website called Hospital Compare (https://hospitalcompare.io/). Hospitals in the same region can have quite different safety and timeliness of care, mortality scores, effectiveness of care, etc.  Use the link I’ve provided to look your hospitals up and compare it to other hospitals in your region or nationally.

You may also want to review the chapter in Surviving Your Doctor entitled “Who Pays Your Doctor?” The point I make in this chapter is that in healthcare, like in many other things, money talks – so follow the money.   I have personally seen hospitals up their safety game as a result of these government financial incentives. Further, highly-rated hospitals sometimes advertise their good “scores” and compare themselves to other hospitals to in the community that have done less well in the ratings. (this is also done with ratings of hospitals from news organizations).  This benefits patients – hospital financial incentives and patient quality and safety are aligned.

This is not to say that hospitals were festering cesspools in earlier years. Most were trying to do the right thing before financial and reputational incentives and penalties were initiated by the government. They tried, but the data are incontrovertible- hospital safety and quality are better now.

This is good news. So are hospitals safe? Safer, perhaps, than they were. But remember this key takeaway from Surviving Your Doctor: nothing, absolutely nothing replaces vigilance and persistence when confronted with an inherently dangerous situation, including a hospital admission.