What You Can Do to Improve Care Transitions in the Hospital: Learn 6 important questions to ask your doctor and nurses

We don’t have to board a flight with a flight advocate, but we do need to enter the hospital with a patient advocate.  This is because health care works best when it’s Team Care.  And, teams are complete when patients, and if not possible, their advocates are also members of the team.

Approximately 200,000 lives are lost in US hospitals, and 3,000,000 worldwide each year due to medical errors.   Human errors are due to lack of mindfulness and the human errors become medical errors and sometimes fatal due to lack of proven procedures.  Implementing evidence based processes like the Actionable Patient Safety Solutions on the PatientSafetyMovement.org web site can eliminate preventable deaths.  Many hospitals are working towards implementing these processes, but regardless patient advocates can play a key role in minimizing preventable harm.

One of the challenges addressed by the Actionable Patient Safety Solutions is Hand-off Communications, also referred to as Care Transitions. This includes transfer of patient-specific information by one healthcare professional to another with the purpose of providing a patient with safe, continuous care. Inadequate care coordination and care transitions are responsible for $30-$54 billion in wasteful spending1. Approximately 57% of providers report things fall between the cracks when transferring patients from one facility to another.2 Approximately 50% of hospital related medical errors are attributed to poor communication during transitions of care.3 Chronically ill patients will see an average of 16 physicians per year.4 Hand-off failures occur when:

  • The sender omits vital patient information from their report
  • The receiver fails to understand or properly record vital information given by the sender
  • The Sender and/or receiver fails to understand or manage the subject information in a complete, accurate and timely manner

Since we don’t want to be part of these tragic statistics, we need to partner with our clinicians and when we are not at our peak state, we need our patient advocate to provide a second set of eyes and ears (and voice) from initial exam to discharge.

The role of a patient advocate

“Patient Advocates that understand the patient and illness well can partner with clinicians on behalf of the patient.  We have some work to do in eliminating preventable deaths in hospitals. The goal is to make sure hospitals have the necessary patient safety processes, we call them Actionable Patient Safety Solutions or APSS, in place so that mistakes are minimized and do not end in mortality,” said Dr. Michael A. E. Ramsay, President of the Baylor Research Institute.

Don’t be afraid to respectfully ask questions

Many of us are instilled at an early age with an unquestioned respect (if not fear) of those with highly trained expertise. We don’t want to ask too many questions and be seen as a “difficult patient.” A common theme of those that have lost a loved one to a preventable hospital error is that they wish they had been more informed and spoken up sooner.

“We see better outcomes and satisfaction when the patient and their advocate are engaged and become part of their healthcare team,” said Dr. David Mayer, Chief Executive Officer of the Patient Safety Movement Foundation. “Patients and their loved ones need to feel comfortable asking questions. It’s important to appreciate that patient advocates not only provide support for their loved ones but also serve as an important team member in ensuring safe care during their hospital stay.”

Before you enter a hospital, you and your patient advocate should familiarize yourself with the PatientAider mobile app.  You or your patient advocate should never hesitate to ask your doctor or nurse questions about your care. The key is to state things in a respectful and kind manner and not giving up until your questions are answered. In addition to asking if  they have washed their hands, keep these 6 questions handy:

“As clinicians, it is our sworn duty to protect our patients from any preventable harm. The World Health Organization statistics for Europe alone reveal that infection associated with health care affects 1 in 20 hospital patients every year. Sadly, not all hospitals are on an equal footing when it comes to fostering a culture of safety or implementing safety processes,” said Jannicke Mellin-Olsen, MD, DPH, Anesthesiologist at the Baerum Hospital in Oslo, Norway & President-Elect of the World Federation of Societies of Anesthesiologists. “It is important for everyone to become an informed patient and advocate for their loved ones.”

The Centers for Medicare & Medicaid Services (CMS) is hosting a National Care Transitions Awareness Day Summit on April 16, 2019 to increase awareness. To download the Patient Safety Movement APSS on Hand-off Communications free of charge, please visit https://patientsafetymovement.org/actionable-solutions/challenge-solutions/hand-off-communications/. You can keep up-to-date on patient safety issues by subscribing to our free newsletter on www.patientsafetymovement.org or following us on Facebook (@patientsafetymovement) & Twitter (@0X2020).


1 “Health Policy Brief: Care Transitions,” Health Affairs, September 13, 2012. Numbers adjusted to 2018 dollars using Consumer Price Index for Medical Care, https://fred.stlouisfed.org/series/CPIMEDSL

2 “Hospital Survey on Patient Safety Culture: 2018 User Database Report,” Agency for Healthcare Research and Quality, 2018, https://www.ahrq.gov/sites/default/files/wysiwyg/sops/quality-patient-safety/patientsafetyculture/2018hospitalsopsreport.pdf

3 Improving Care Transitions: Optimizing Medication Reconciliation, March 2012, American Pharmacists Association & American Society of Health-System Pharmacists, https://www.pharmacist.com/sites/default/files/files/2012_improving_care_transitions.pdf

4 Bodenheimer, T, “Coordinationg Care-a perilous journey through the health system,” New England Journal of Medicine, 2008; 358(10):1064-1071