Think You Know What Happened to You in the Hospital? Think Again!

If your hospital experience resembles most, you have a very limited and probably somewhat confused understanding of your hospital stay based on some comments from doctors and nurses. This represents a tiny fraction of the real record of your hospital stay.
For your own safety, you should obtain a copy of the official file. This will contain laboratory results, reports on any imaging studies (X-Rays, CT scans, MRI’s, etc.), doctor comments, usually called “Chart Notes,” more detailed reports from your doctors, nurses comments about you, often referred to as “Shift Notes,” and any other information accumulated during your stay. Besides these hospital notes, get the the same kind of information on a periodic basis from any health care provider. Keeping your own file of this information makes it readily available to you in an emergency.
Besides learning in detail how you were treated, you can then correct errors in your medical history. Based on considerable experience, both trivial and serious errors probably appear in your record. These could come from transcription errors. Typically, doctors dictate their reports of each encounter to a digital recorder, and a medical transcription later transfers this information to written or electronic format. In an electronic system, the doctor may type in or dictate them information directly. If the doctors do not take time to proofread the end result, perhaps because they are too busy, your history may be flawed. Based on personal experience, errors occur in most records, ranging from trivial to potentially harmful.
Another significant cause of error comes from doctors simply not listening carefully enough during an interview, particularly in emergencies. Whatever the reason, inaccurate information could come back to haunt you. For one example, in an office visit a patient with significant “white coat” hypertension, that is, blood pressure that rises sharply in a doctor’s office, had a doctor check his blood pressure. It was 190 over 96. The patient said, “It is much lower at home.” Later, when the patient obtained a copy of the doctor’s note, he found that according to the doctor, his blood pressure was “much higher” than this at home. It is easy to see how in a later emergency, someone reading this could be misled. In addition, should this misinformation make it into the patient’s medical insurance file, it might affect his coverage options. The HIPAA act gives the patient the right to correct errors in the medical record as well.
Fortunately, the passage of the Health Insurance Portability and Accountability
Act in 1996 granted patients the right to see and obtain copies of their medical files as well as control, in a number of areas, who can see this information. The law provides strict rules about the process of records release including a timetable. In most cases the information must be provided within 30 days unless you are given a reason, in which case the period may be extended for another 30 days. The only reason for refusing to surrender the records at all is when the doctor feels the information might endanger you or others. In this case, the medical provider must give you the name of a third party arbitrator. For more information, see the Health Information Privacy information sheeet on the Health and Human Services Web site.
To get their records, patients complete a form authorizing release. Although standard forms are available on the Web, most medical institutions, clinics, hospitals or private practice situations have their own versions. Request a copy of the form from the office or medical records department in a hospital.You can see a typical release form here. This is provided as an example only. Use an approved form from your provider.
In the section specifying the specific information requested, describe this as broadly as possible or else the medical agency has the right to decline release of part of the information. For example, you might say, “All information covering the dates of treatment including laboratory studies, chart notes, nurses shift notes, specialists reports, imaging studies, and all other information contained in my medical file.” You may have to pay a fee but it is limited to the cost of copying and supplies.
The informed patient will have a better chance of staying healthy and playing an important role in their own health care. Understanding what has been said about you and accurately knowing what happened to you in a hospital or under some other type of medical care is vital to this purpose.

“Let’s Get an IV Started”

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You can hear these lines, or variants thereof, in hundreds or perhaps thousands of hospital emergency rooms even as you read this blog post. IV, or Intravenous, lines provide a fast way to get live-saving fluids, usually a saline solution, to a patient through a tube inserted in a vein. They offer an easy way to inject drugs such as antibiotics or painkillers. IV lines also can make patients very ill or even kill.
When hospitals continue IV fluids such as hypotonic solutions overly long, often when admittance to the hospital follows, or as a patient recovs from surgery, a condition of “over hydration” may occur. Water saturates the body beyond the amount excreted, and the body’s normal sodium level becomes diluted, leading to hyponatremia. Possible results include digestive problems, behavioral changes, brain damage, seizures, coma—even death.
Symptoms may include confusion, drowsiness, shouting, delirium, blurred vision, muscle cramps and twitching. Sudden weight gain occurs from edema, or swelling, particularly in the lower extremities. Less serious cases may show only this swelling and some elevations in systolic blood pressure as well as lowered sodium levels in a blood test called a “metabolic panel.”
According to a study titled, “Avoiding common problems associated with intravenous fluid therapy,” published in the Medical Journal of Australia, 2008 Nov 3;189(9):509-13 (available though the U.S. National Library of Medicine):
“Inappropriate intravenous fluid therapy is a significant cause of patient morbidity and mortality and may result from either incorrect volume (too much or too little) or incorrect type of fluid. Fluid overload has no precise definition, but complications usually arise in the context of pre-existing cardiorespiratory disease and severe acute illness.”
Several similar reports in the National Library of Medicine database put the estimated number of cases of over hydration at 2 percent of hospitalized patients. According to the American Hospital Association (AHA), in 2009 there were 37,479,709 admissions in U.S. registered hospitals (those meeting the AHA’s standards). This does not include short-stay community hospitals. If 2 percent develop hydration problems, this equates to 374,797 people with potentially serious problems.
What follows is a real example of hospital-neglected developing over-hydration, fortunately with only annoying, not lethal results.
Reason for hospital admission: Cholecystectomy (gallbladder removal)

Length of stay: Seven days

Event: Doctor ordered (or simply hospital protocol) for post-operative recovery: IV supplementation with 0.9 percent saline solution at the rate of 150 ml per hour (25.2 liters over seven days.)
Hospital staff awareness of problems developing: Nurse on third day of IV comments, “Are your legs always this thick?” Lab tests show blood sodium level results below minimum levels. Systolic blood pressure rises to 169 from normal 126. Urinary output is significantly below input from IV. However, since the original order for this level of IV supplementation is still in place, staff cannot alter it. Note: Interestingly enough, a typical first line of treatment for newly diagnosed high blood pressure is a diuretic to reduce fluid levels, not add more fluids.

Result: : Patient left the hospital, despite no solid food for seven days, weighing 32 pounds more than on entry and with significant swelling in feet, ankles, legs, thighs, lower abdomen and other appendages. 

Lesson learned: Patients, at all costs, must be more proactive in their own defense, refusing to accept first level staff responses. Insist upon seeing superiors until you get to the doctor who first ordered this level of supplementation and/or a patient representative.

This Will Set the Stage . . .

Based on compilations of data from sources including U.S. government health statistics and peer-reviewed journals in the medical field, in the 1990s the estimated annual deaths of hospital patients from iatrogenic (physician or health establishment related) causes were 783,936. Contributing to these numbers were such things as adverse drug reactions, 106,000, bedsores, 115,000; infection; 88,000; medical errors, 98,000 and unnecessary procedures, 37,136. For more details, see Table of Iatrogenic Deaths in the United States
By comparison, according to the American Heart Association, in 2006 cardiovascular diseases claimed 831, 272 lives. In the same year, cancer caused 559,888 deaths. Unless you assume iatrogenic deaths have gotten markedly less, this suggests the medical system in the United States is at least the second leading cause of death in this country.
Posts and comments to this blog will put a concrete face on these cold numbers. Your examples of illnesses and deaths you believe caused by hospital stays, as either inpatient or outpatient, are welcome.

What We Are About Here

The contents of this blog provide an opportunity for patients who have experienced the worst of hospitals in the U.S. and other parts of the world. It is not a place to brag about great hospitals—there are plenty of Web sites to do that—especially the pages of specific hospitals.

All comments that meet the stated purpose in the first paragraph are welcome. Comments will be moderated but only to remove spam and clearly libelous statements. Commenters can chose to remain anonymous. However, if you refer to a specific hospital, then this information will be included, so do not include the name of the hospital if you do not want it identified. The author of this blog disclaims all responsibility and liability for the accuracy or veracity of any comment.