Hospitals

There are so many ways. If you did not receive the x-ray your doctor ordered for you while in the hospital, you can summon your primary care nurse (the RN that is responsible for your daily care) and tell her your concern and ask her to follow up with your doctor. You can also call your doctor's office and speak to him/her or to his/her nurse about your concern.
You can also put a note in your chart asking the doctor to be sure to speak to you about this when he/she arrives for rounds.

The best way to prevent errors during a hospital stay is to be involved in your own care. If you are able to monitor and oversee your own hospital patient care, then get a notebook and write down your doctors' names and contact info, primary nurses' names and contact info, which tests, procedures, surgeries etc. you are to have done, on which date and by whom, your current list of medications, dosages, over-the-counter medications and supplements, allergies to medications. Keep this with you at all times. You will create your own form of a patient safety checklist while you are in the hospital and repeat it each time you encounter a medical professional.
For example, if a medical professional is about to give you medication, you might ask, "What is the name of that medication? The dosage? What is it for?" And then repeat your name, date of birth and what you are in the hospital for.
You are simply double-checking what each medical professional is going to do with you before they do it.
If you are unable to implement this type of strategy because you are ill, sedated, or recovering, ask a loved one to act as your advocate and do this for you. One person may not have the time to be with you most of the time. If this is the case, you can ask two to three loved ones to share the tasks, called an Advocate Team. There are so many ways. If you did not receive the x-ray your doctor ordered for you while in the hospital, you can summon your primary care nurse (the RN that is responsible for your daily care) and tell her your concern and ask her to follow up with your doctor. You can also call your doctor's office and speak to him/her or to his/her nurse about your concern.
You can also put a note in your chart asking the doctor to be sure to speak to you about this when he/she arrives for rounds.

The best way to prevent errors during a hospital stay is to be involved in your own care. If you are able to monitor and oversee your own hospital patient care, then get a notebook and write down your doctors' names and contact info, primary nurses' names and contact info, which tests, procedures, surgeries etc. you are to have done, on which date and by whom, your current list of medications, dosages, over-the-counter medications and supplements, allergies to medications. Keep this with you at all times. You will create your own form of a patient safety checklist while you are in the hospital and repeat it each time you encounter a medical professional.
For example, if a medical professional is about to give you medication, you might ask, "What is the name of that medication? The dosage? What is it for?" And then repeat your name, date of birth and what you are in the hospital for.
You are simply double-checking what each medical professional is going to do with you before they do it.
If you are unable to implement this type of strategy because you are ill, sedated, or recovering, ask a loved one to act as your advocate and do this for you. One person may not have the time to be with you most of the time. If this is the case, you can ask two to three loved ones to share the tasks, called an Advocate Team.

Excellent question. Administrators that patients will most likely encounter are those in the records departments, receptionists, lab personnel, etc. There are many, many administrators -- a good number of whom are nice and easy to get along with. For these types of administrators, communication is easy. It is important to be polite and cooperative.

However, if there is an unsavory administrator, such as someone in the records department refusing to send records to a particular doctor (even after you have given your permission), then you have the right to employ what I term civil disobedience and speak up. Assert yourself to that administrator and refuse to be bullied. Report him or her if possible.

Do not tolerate abuse; if an administrator is badgering you or is uncooperative with your reasonable needs, then you need to speak up. I have refused to cooperate with unreasonable personnel. In one case, during a particular hard time in my medical life, a receptionist called me up to her desk and announced in front of everyone in the waiting room that I owed money.

I told her that I did not want to discuss this issue now, as I didn't know whether I had a recurrence of cancer. I also told her that she was never to talk with me like that again.

It really does depend on how administrators treat you. Be polite at first, but then speak up if you sense an injustice is being done to you. Excellent question. Administrators that patients will most likely encounter are those in the records departments, receptionists, lab personnel, etc. There are many, many administrators -- a good number of whom are nice and easy to get along with. For these types of administrators, communication is easy. It is important to be polite and cooperative.

However, if there is an unsavory administrator, such as someone in the records department refusing to send records to a particular doctor (even after you have given your permission), then you have the right to employ what I term civil disobedience and speak up. Assert yourself to that administrator and refuse to be bullied. Report him or her if possible.

Do not tolerate abuse; if an administrator is badgering you or is uncooperative with your reasonable needs, then you need to speak up. I have refused to cooperate with unreasonable personnel. In one case, during a particular hard time in my medical life, a receptionist called me up to her desk and announced in front of everyone in the waiting room that I owed money.

I told her that I did not want to discuss this issue now, as I didn't know whether I had a recurrence of cancer. I also told her that she was never to talk with me like that again.

It really does depend on how administrators treat you. Be polite at first, but then speak up if you sense an injustice is being done to you.

That's a great question! Choosing a hospital is definitely important and can be tricky. Our Prepared Patient feature article on hospital report cards talks about different ways people choose hospitals and offers some tips: http://www.preparedpatientforum.org/finding/reportcards.cfm

Our Prepared Patient 411 also offers some resources:

Hospital rankings and ratings have become more widely available. Although you might not be able to freely choose a hospital if your doctor only has privileges in one place, your insurance only applies to certain facilities or if you can't travel far, it can be helpful to know whether there are any differences in the possibilities available to you.

American Cancer Society
Choosing a Doctor and Hospital
http://www.cancer.org/Treatment/FindingandPayingforTreatment/ChoosingYourTreatmentTeam/choosing-a-doctor-and-a-hospital

Consumers' CHECKBOOK is an independent, nonprofit consumer organization that provides consumers information to help them get high quality services and products at the best possible prices. They produce a National Guide to Hospitals that can be purchased for $22 from their site.
http://www.checkbook.org/hospital

HealthGrades offers free information on how over 5,000 hospital facilities rate on 28 common medical conditions or procedures. More detailed reports on individual hospitals, including safety ratings, the average length of stay in the hospital and cost of common procedures, are available for $9.95 and $2.95 for each additional report in one order.
http://www.healthgrades.com
(303) 716-0041

Hospital Compare is a service from the U.S. Department of Health and Human Services which allows you to search for Medicare-certified hospitals in your area. You can find out about how they rate in terms of quality care such as heart attack, heart failure and pneumonia compared to other hospitals nationwide (where performance data is available). In some cases, patient satisfaction and general medical care ratings are also provided. The site also allows you to compare up to three hospitals side-by-side.
http://www.hospitalcompare.hhs.gov

Quality Check is the Joint Commission's search engine to locate Joint Commission accredited health care organizations in the United States. You can search by city and state, by name or by zip code.
http://www.qualitycheck.org

The Leapfrog Group offers quality and safety ratings online for free. The ratings measure hospitals' performance in areas such as patient safety, technology, high risk procedures and intensive care, rather than specific procedures or diseases. Leapfrog uses information that hospitals report voluntarily, so their ratings may not be available for all hospitals in your area.
http://www.leapfroggroup.org
(202) 292-6713

US News America's Best Hospitals
http://www.usnews.com/besthospitals

(Source: http://www.preparedpatientforum.org/patient411/findingdecentcare.cfm#Choosing) That's a great question! Choosing a hospital is definitely important and can be tricky. Our Prepared Patient feature article on hospital report cards talks about different ways people choose hospitals and offers some tips: http://www.preparedpatientforum.org/finding/reportcards.cfm

Our Prepared Patient 411 also offers some resources:

Hospital rankings and ratings have become more widely available. Although you might not be able to freely choose a hospital if your doctor only has privileges in one place, your insurance only applies to certain facilities or if you can't travel far, it can be helpful to know whether there are any differences in the possibilities available to you.

American Cancer Society
Choosing a Doctor and Hospital
http://www.cancer.org/Treatment/FindingandPayingforTreatment/ChoosingYourTreatmentTeam/choosing-a-doctor-and-a-hospital

Consumers' CHECKBOOK is an independent, nonprofit consumer organization that provides consumers information to help them get high quality services and products at the best possible prices. They produce a National Guide to Hospitals that can be purchased for $22 from their site.
http://www.checkbook.org/hospital

HealthGrades offers free information on how over 5,000 hospital facilities rate on 28 common medical conditions or procedures. More detailed reports on individual hospitals, including safety ratings, the average length of stay in the hospital and cost of common procedures, are available for $9.95 and $2.95 for each additional report in one order.
http://www.healthgrades.com
(303) 716-0041

Hospital Compare is a service from the U.S. Department of Health and Human Services which allows you to search for Medicare-certified hospitals in your area. You can find out about how they rate in terms of quality care such as heart attack, heart failure and pneumonia compared to other hospitals nationwide (where performance data is available). In some cases, patient satisfaction and general medical care ratings are also provided. The site also allows you to compare up to three hospitals side-by-side.
http://www.hospitalcompare.hhs.gov

Quality Check is the Joint Commission's search engine to locate Joint Commission accredited health care organizations in the United States. You can search by city and state, by name or by zip code.
http://www.qualitycheck.org

The Leapfrog Group offers quality and safety ratings online for free. The ratings measure hospitals' performance in areas such as patient safety, technology, high risk procedures and intensive care, rather than specific procedures or diseases. Leapfrog uses information that hospitals report voluntarily, so their ratings may not be available for all hospitals in your area.
http://www.leapfroggroup.org
(202) 292-6713

US News America's Best Hospitals
http://www.usnews.com/besthospitals

(Source: http://www.preparedpatientforum.org/patient411/findingdecentcare.cfm#Choosing)

Negotiating fees are, at this stage, limited to your discussions with hospitals, and providers. Manged care firms negotiate with the buyers of the plans, which are the company or government sponsors of those plans. So, the providers or hospitals with from which you are receiving treatment may be amenable to negotiation depending upon your income and how high your deductibles and/or co-pays are. It's a delicate discussion of course, but you may be able to approach, say, the billing office. The concept of Consumer Directed Healthcare is not to make things easier or more economical for a member/patient: In reality it's just more verbiage used in shifting the costs of healthcare onto the wallets and purses of those members/patients. Negotiating fees are, at this stage, limited to your discussions with hospitals, and providers. Manged care firms negotiate with the buyers of the plans, which are the company or government sponsors of those plans. So, the providers or hospitals with from which you are receiving treatment may be amenable to negotiation depending upon your income and how high your deductibles and/or co-pays are. It's a delicate discussion of course, but you may be able to approach, say, the billing office. The concept of Consumer Directed Healthcare is not to make things easier or more economical for a member/patient: In reality it's just more verbiage used in shifting the costs of healthcare onto the wallets and purses of those members/patients.

You can go to these government websites and find out.
1. Hospital Compare. Find your hospital and get all sorts of info.
http://www.hospitalcompare.hhs.gov/hospital-search.aspx?version=default&browser=Firefox%257C1%257CWin2000&language=English&defaultstatus=0&pagelist=Home
2. Government Watch http://www.dotgovwatch.com/?/archives/14-Find-the-Best-Hospitals-With-Government-Statistics.html

Good luck!
Martine You can go to these government websites and find out.
1. Hospital Compare. Find your hospital and get all sorts of info.
http://www.hospitalcompare.hhs.gov/hospital-search.aspx?version=default&browser=Firefox%257C1%257CWin2000&language=English&defaultstatus=0&pagelist=Home
2. Government Watch http://www.dotgovwatch.com/?/archives/14-Find-the-Best-Hospitals-With-Government-Statistics.html

Good luck!
Martine

When selecting a hospital, make sure that you are comfortable with the physician, medical team, staff, and facilities.

Some of the specifics you should look for when considering hospitals are:

- How comprehensive is the care? How many services are offered that you might need within the hospital (i.e. radiology, reconstructive surgery)?
- How do they coordinate care? Is there one person who is responsible for each patient and what is their availability for questions?
- How many breast cancer patients does the hospital treat?
- What percentage of the surgeon's operations are on breasts?
- Do they have a breast imaging center or do they use an all purpose radiologist?
- How responsive are they? After the first mammogram, how quickly will you receive the results and have follow up testing?
- Is their technology state of the art?
- Do they have a multidisciplinary approach? Do all the specialists meet to discuss the care of each patient before treatment.
- Are on-site counseling and support groups available? Do trained counselors lead the sessions?
- Are their services to assist the patient with insurance and other miscellaneous needs?
- How comfortable do you feel with the procedures and facilities? Such as private dressing rooms, waiting areas, etc.
- Do you feel comfortable with the staff?
- Do they perform cutting edge research and offer clinical trials?
- Do they have access to a genetics counselor? Family history may be a factor in some of the decisions. When selecting a hospital, make sure that you are comfortable with the physician, medical team, staff, and facilities.

Some of the specifics you should look for when considering hospitals are:

- How comprehensive is the care? How many services are offered that you might need within the hospital (i.e. radiology, reconstructive surgery)?
- How do they coordinate care? Is there one person who is responsible for each patient and what is their availability for questions?
- How many breast cancer patients does the hospital treat?
- What percentage of the surgeon's operations are on breasts?
- Do they have a breast imaging center or do they use an all purpose radiologist?
- How responsive are they? After the first mammogram, how quickly will you receive the results and have follow up testing?
- Is their technology state of the art?
- Do they have a multidisciplinary approach? Do all the specialists meet to discuss the care of each patient before treatment.
- Are on-site counseling and support groups available? Do trained counselors lead the sessions?
- Are their services to assist the patient with insurance and other miscellaneous needs?
- How comfortable do you feel with the procedures and facilities? Such as private dressing rooms, waiting areas, etc.
- Do you feel comfortable with the staff?
- Do they perform cutting edge research and offer clinical trials?
- Do they have access to a genetics counselor? Family history may be a factor in some of the decisions.