Dangers in Hospitals

Certainly, nobody wants to get sicker in the hospital. Despite the best efforts of doctors, nurses, and other healthcare professionals, there are dangers in hospitals that pose risks to patients. These hazards lurk in hospitals and increase your risk of infections, complications, and even death.

How common and serious are dangers in hospitals?

For starters, preventable errors, accidents, and infections at hospitals are the third leading cause of death in the US. Importantly, medical errors are responsible for an estimated 20,000 avoidable deaths every month.

And according to the CDC, healthcare acquired infections account for an estimated 1.7 million infections every year in US hospitals.

Additionally, research by the Office of the Inspector General found that 25% of Medicare patients experienced harm in a hospital in October 2018. These harms vary from mild (such as dangerously low blood pressure) to serious (such as strokes and sepsis) to fatal.

Alarmingly, these statistics are from the time before COVID-19. Unsurprisingly, since the arrival of COVID-19, safety events increased across every type of hospital unit.

A decline in safety culture at US hospitals.

Unsurprisingly, since the arrival of COVID-19, safety events increased across every type of hospital unit. Press Ganey, a well-respected healthcare quality company, issued a report in 2021 which showed a significant decline in “safety culture” scores at hospitals across the US.

Why? As you can imagine, COVID-19 led to widespread staff burnout, turnover, and staffing shortages. And with staff focused intently on COVID-19, safety lapses occurred.

Importantly, Press Ganey found that in 2020, safety culture declined in two important categories. Firstly, they found a decline in “Prevention and Reporting,” which measures staff’s beliefs in their hospital’s dedication to improve patient safety and whether staff feels free to raise safety concerns.

Moreover, they found the largest decline in “Resources and Teamwork,” which includes communication and collaboration between doctors, nurses, and others, overall staffing levels, and job stress. Importantly, communication breakdowns, plus understaffing and employee stress, are considered “rapid and persistent drivers of safety problems and extremely dangerous to patients and to staff“.

Adverse events are too common.

In a retrospective study, researchers assessed the frequency, preventability, and severity of patient harm in a random sample of 2809 admissions during 2018 at 11 Massachusetts hospitals.

Their analysis found that 23.6% of admitted patients experienced at least one adverse event. Among these 978 adverse events found, 32.3% were deemed “serious” or higher – meaning they caused harm that led to substantial intervention or prolonged recovery. Importantly, seven deaths were associated with these adverse events, including one which they determined was preventable.

Many of these adverse events were preventable.

Among these 978 adverse events found, 22.7% were deemed preventable. But overall, a preventable adverse event occurred in 6.8% of all admissions. Furthermore, a preventable adverse event considered at least “serious” occurred in 1% of all admissions.

What kinds of adverse events occurred?

The most common adverse events found were as follows:

• 39% – Medication related.
• 30.4% – Surgical or other procedural events.
• 15% – Patient-care events, defined as events associated with nursing care, including falls and pressure ulcers.
• 11.9% – Health care–associated infections.

Additionally, in a separate study, researchers from the US Centers for Disease Control and Prevention (CDC) found a significant increase in healthcare-acquired infections and ventilator events in 2020.

It’s not all bad news!

In November, 2022, Leapfrog Group, a hospital watchdog organization, reported that over the past 10 years, US hospitals collectively improved patient safety measures.

For instance, there was an average of a 25%+ reduction in both injuries from patient falls and in the number of times an object is accidentally left inside a patient after surgery.  Additionally, there were reductions in 3 types of healthcare-acquired infections.

Also, the group identified improvements in staffing strategies, culture, and technologies.

What can you do about dangers in hospitals?

Understanding the dangers in hospitals can help you reduce your risk of harm.

This post, and its companion post, are based on information provided by ECRI, a nonprofit organization dedicated to improving the safety, quality, and cost-effectiveness of care across all healthcare settings. As part of their mission, ECRI compiles a list of dangers in hospitals and other healthcare settings based on millions of reports healthcare events that have caused patient harms.

For this post, I referenced these reports:

• 2022 Top Health Technology Hazards.
• 2020 Top Patient Safety Concerns.
• 2020 Top Health Technology Hazards.
• 2019 Top Health Technology Hazards.

This post covers the following dangers in hospitals:

• Alarm, alert, and notification overload.
• Contaminated devices and tools.
• Surgical sponges left in patients.
• Surgical stapler hazards.
• Unproven surgical robotic procedures.
• Discrepancies in EHRs can cause medication timing errors.
• Overrides of automated dispensing cabinets can cause medication errors.
• Confusing dose rate with flow rate can lead to infusion pump medication errors.
• Damaged infusion pumps can cause medication errors.
• Mattresses oozing bodily fluids.

The previous post in this series covers these dangers in hospitals and other healthcare settings:

• Missed and delayed diagnoses.
• Harm from medical devices.
• Patient matching discrepancies in Electronic Health Records.
• Improper use of antibiotics.
• Fragmentation of care.
• Harm from MRI scans due to missing information about patient implants.
• Central venous catheter in at-home hemodialysis.
• Delayed identification and treatment of sepsis.

Note: These dangers in hospitals are not in any particular order.

Additionally, you can learn more about hospital infections by reading How to Protect Yourself from Hospital Infections.

Alarm, alert, and notification overload.

The overwhelming number of alerts and alarms from bedside equipment overwhelms staff, causing them to miss or overlook important alarms.

Where’s all the noise coming from?

Bedside devices and equipment use audio and visual alarms to alert staff when a change in a patient’s condition needs attention. Additionally, providers’ cell phones regularly buzz with calls and texts. And patients’ bedside call systems beep and light up when patients need assistance.

Shockingly, one hospital reported an average of 1 million alarms going off in a single week!

Moreover, the alarms do not consistently indicate danger. In fact, research indicates that 85 – 99% of device alarms do not require clinical intervention.

How does this impact patients?

Clinicians may miss, or ignore, important information, which can clearly cause patient harm.

Furthermore, to prevent the overload, clinicians sometimes change the notifications setting of devices to reduce the volume or frequency of alarms. As a result, clinicians can miss notifications, resulting in patient harm.

What can you do about the risk of missed alarms?

Pay attention to alarms – this is one of the common dangers in hospitals. Additionally, the consequences of a missed bedside alarm can be severe. Therefore, I recommend that a family member, or another trusted adult, stay with the patient whenever possible. This is particularly important when patients are too ill to speak up or call for a nurse themselves.

To minimize the risk of missed alarms, patients and families should learn:

• What monitors are in use and why.
• What the different alarms sound like for each piece of equipment.
• Which alarms are urgent and therefore demand immediate attention.

If an urgent alarm sounds and no clinician appears quickly, seek help by looking for a nurse in the hall or at the nurse’s station.

Contaminated devices and tools.

Contaminated devices and tools is one of several dangers in hospitals that is invisible to the naked eye, making detection tricky. Patients who come in contact with contaminated devices, tools and other items can be exposed to dangerous germs.

Although proper cleaning, disinfecting and sterilization of items can significantly reduce the risk of dangerous germs, not all medical (and dental) offices follow proper sterilization procedures. Furthermore, sterilization is not an easy job – employees must strictly follow processes, with no mistakes.

What kinds of healthcare settings have contamination issues?

Contamination issues can occur in any kind of healthcare facility – from doctors’ and dentists’ offices, to ambulatory care centers and hospitals.

Additionally, it’s important to note that not all facilities have similar resources for infection prevention and control. Large facilities and hospitals usually use central sterile processing departments which can significantly reduce the incidence of contamination.

How common is this issue?

Although the prevalence of contaminated items is unknown, an ECRI report states “the potential exists for this to be an insidious, widespread patient safety risk.”

What’s the impact of improperly sterilized devices?

Improperly cleaned devices and instruments can lead to serious patient harm, including death. For example, sterile processing failures can lead to surgical site infections, which overall have a 3% mortality rate.

What can you do?

Because contaminated items can look clean to the naked eye, it’s almost impossible to notice any contamination. Although if you see an item that looks dirty, definitely speak up!

Unfortunately, patients have no control on how well a hospital or facility sterilizes their instruments and other items. But, if you need a procedure that will involve the use of invasive instruments, you can ask your doctor how they keep their instruments contamination-free.

Additionally, you can look up healthcare-acquired infection rates on Medicare’s Care Compare website and on The Leapfrog Group’s website.  But beware – these sites don’t provide data on infections from medical instruments. However, you can get a sense of how a hospital rates on other infection control measures.

Surgical sponges left in patients.

When surgical staff accidentally leave sponges inside a patient, infections and other serious complications can arise, including the need for secondary operations.

Although it is standard procedure to manually count the sponges before finishing a procedure, errors still occur. Available data suggests that every year, thousands of US patients could experience a retained surgical item, with surgical sponges the most common item left inside a patient.

What can you do?

Fortunately, technologies that supplement the manual counting process are effective when used correctly. Ask your surgeon what processes he/she uses to make sure nothing will be left inside you.

Surgical stapler hazards.

Surgeons use staplers to close large wounds or surgical cuts. Additionally, surgeons use staplers internally during surgery for:

• Removing part of an organ.
• Cutting through and sealing organs and tissues.
• Creating connections between structures.

These staplers are complex devices that require skillful, careful techniques.

But sometimes the staples fail and sometimes doctors misapply them. Patients can experience blood loss during and after surgery and/or tissue damage. In some cases, patients can die.

What causes stapler problems?

An ECRI report indicates that the way doctors use the stapler, not the device itself, is responsible for most of the problems. Possible errors include choosing the wrong staple size and stapling tissue that is too thick or too thin.

How common is this problem?

Although the overall rate of issues is quite low relative to the frequent use of surgical staplers, problems are regularly reported. In fact, a recent FDA analysis found 412 deaths, 11,181 serious injuries, and 98,404 malfunctions since 2011.

What can you do?

Importantly, surgeons need effective training and hands-on practice to avoid stapler errors. It can’t hurt to ask your doctor what kind of training and practice he/she has had with the stapler that he/she will use in your procedure.

Unproven surgical robotic procedures.

Surgeons use robotic systems to help them perform a wide range of minimally invasive procedures. And the list of procedures involving robots continually grows.

The benefits of surgical robots.

The benefits include motion scaling (when the surgeon’s large hand movements translate into smaller movements of the surgical instrument), improved dexterity, and a reduction in hand tremors.

What’s the problem?

Although using surgical robots can improve and advance medical practice, there are downsides as well. According to an ECRI report, the limitations of surgical robots can “lead to injury or unexpected complications and the potential for poorer long-term outcomes.”

For example, the robots may not provide tactile feedback regarding the forces placed on tissue, leading to potential harm. And in some cases, the complications from robotic procedures can take years to appear.

What can you do?

First, don’t assume a robotic procedure is better, or worse, than a traditional minimally invasive procedure. Every surgical procedure has risks and benefits, so ask your doctor about the pros and cons of possible options. And get a 2nd, or even 3rd, opinion whenever possible.

For information on reducing your risk of surgical complications and harm, read The Dangers of Robotic-Assisted Surgery.

Discrepancies in EHRs can cause medication timing errors.

Patients in hospitals take a lot of medication. And sometimes, the timing of a medication is critical. However, when the EHR generates a list for nurses of medications to be dispensed, the dosage time might not coincide with the doctor’s intentions. And this can result in a missed or delayed dosage.

An example scenario.

For example, let’s say a doctor sees a patient mid-morning – after the usual morning medications are dispensed – and enters a new 1x/day medication into the EHR. Since the EHR defaults to an early morning dosage time for medications taken 1x/day, this new medication might not appear on a nurse’s list until the next day. Therefore, the patient misses the first dose – which can have significant impact on a patient’s health.

What can you do?

Importantly, if a doctor prescribes a new medication after you’ve already taken your morning medications, ask the doctor if you need the medication immediately or if you can wait until the next day. If you should start the medication immediately, notify the nurse and make sure you get it.

Overrides of automated dispensing cabinets can cause medication errors.

Most hospitals and many other healthcare facilities use “smart” automated dispensing cabinets (ADCs) to dispense medications. Although ADCs have greatly improved medication safety, they’re not perfect.

Unfortunately, it’s usually easy for healthcare workers to override the system, allowing them to dispense medications without a pharmacist review. This can lead to dangerous, even deadly, medication errors as patients can receive the wrong medication or the wrong dosage.

Why do these cabinets allow overrides?

Overrides can save lives when patients need medications in emergency situations, leaving no time to consult a pharmacist. However, nurses and other medical staff use the override capabilities in non-emergency situations as well.

What should you do?

Unfortunately, medication errors are common in hospitals. A 2016 report estimates that preventable medication errors impact more than 7 million patients across all care settings, including patients at home.

The good news is that you can take steps to reduce your risk of medication errors in the hospital. You must pay attention to medication when you or a loved one are hospitalized. Keep a bedside list of what medications should be taken and when. Check for discrepancies at medication times. And if something seems wrong, speak up!

For a detailed list of steps to reduce your risk of medication error, read Medication Errors in Hospitals – How Can You Protect Yourself?

Additionally, you can look up your hospital on The Leapfrog Group’s website to see how your hospital rates for medication errors. Although the reports do not include information on overrides, they do provide insight to how well the hospital handles medication ordering and dispensing.

Confusing dose rate with flow rate can lead to infusion pump medication errors.

Many medicines are administered through an infusion pump, including chemotherapy. Staff must program infusion pumps for each patient to ensure each patients gets the right dosage at the right speed. However, the process is error prone, and staff can make mistakes that cause patient harm. For instance, staff can confuse intended flow rate with dose rate, causing patients to receive too little or too much medication – a potentially dangerous error.

Unfortunately, these programming errors are fairly common. And “smart pumps”, designed with dose error reduction systems, don’t completely eliminate the problem.

Why do these errors occur?

The design, layout and required programming sequence on pumps contributes to these errors. Additionally, there is usually a lack of procedures to verify programming accuracy.

Can you reduce your risk of a medication error? 

Unfortunately, there is little you can do to reduce your risk of this type of harm. But there are a few things you can consider.

Since auto-programming infusion pumps can reduce the risk of manual-entry errors, try to use a facility that uses auto-programming pumps. And always can make sure the provider double checks your name, your medication, your dosage, and your flow rate.

As mentioned above, you can look up your hospital on The Leapfrog Group’s website to see how your hospital rates for medication errors. Although the reports don’t have information on infusion pump errors, they do provide insight to how well the hospital handles medication ordering and dispensing.

Damaged infusion pumps can cause medication errors.

This is another of the “hard to spot” dangers in hospitals. Damaged infusion pumps can lead to dangerous, potentially fatal, medication errors, but it can be hard to identify pump damage. Not only might the damage not be visibly apparent, but the damage may not trigger an alarm.

What causes pump damage?

Damage can be caused by several things, including wear and tear, mishandling, misuse, poor pump design, improper cleaning agents or methods.

How can damaged pumps harm patients?

Damaged pumps can alter the speed at which it dispenses medication – leading to the patient receiving too much or too little medication. And in some cases, the medication may stop flowing altogether. Certainly, each of these conditions can lead to patient harm.

What can you do?

See the information provided in the section above.

Mattresses oozing bodily fluids.

To me, this is the grossest of all the dangers in hospitals. Even after routine cleaning, blood and other body fluids can remain on, or within, mattresses and mattress covers. As a result, subsequent patients can be exposed to previous patients’ fluids and can develop an infection.

Shockingly, there have been reports of patients lying on an apparently clean bed or stretcher when blood from previous patients oozes out of the surface! Yuck!

How does this happen?

Mattress covers protect the mattresses, not the people on the bed. If a cover isn’t properly cleaned and disinfected, or if its integrity is compromised, patients could come into contact with infectious materials.

Importantly, facilities do not clean or disinfect the mattresses themselves between patients. And making matters worse, some mattress cover suppliers do not recommend which cleaning products to use to maintain the cover’s integrity. If staff use the wrong cleaning agent, weak spots can allow leaks.

What can you do?

It goes without saying – if you see blood or any other fluid on your bed, speak up immediately!

NOTE: I updated this post on 2-27-23.