What to Know About Inpatient Care While in the Hospital: Five Situations When You Need to SPEAK UP

Posted on March 21, 2023

Perhaps there is nothing more demeaning than lying in a hospital bed. More times than not the patient have very little control of what happens next. By the very nature of lying in the bed the patient is less than equal to those treating and overseeing care. Lying patiently and with obedience, in a hospital gown, waiting for whatever comes next.

Note: For purposes of ease in reading, I use the term “patient,” whenever possible. While reading, keep in mind the patient may be yourself, a beloved family member, or a trusted friend.

Perhaps there is nothing more demeaning than lying in a hospital bed. More times than not the patient have very little control of what happens next. By the very nature of lying in the bed the patient is less than equal to those treating and overseeing care. Lying patiently and with obedience, in a hospital gown, waiting for whatever comes next.

Doctors, nurses, technicians and others whom the patient has relinquished autonomy to, attempts to be ever-present, in spite of the circumstance that has placed her/him in that bed. You trust those looking down at you to make the right (most appropriate) decisions, all the while they speak over the patient, and in a language that is difficult to follow, much less understand.

Following hours of waiting, even languishing in said bed, the doctor or nurse visit is over in a matter of mere minutes, decisions made, brief explanation of next steps are shared. Asked if any questions, sometimes while exiting the room. Then you wait, and wait for whatever is to happen next.

Let’s be honest.

The healthcare journey, even in the best of situations is much harder than it needs to be. Particularly in the hospital. The primary challenges are the desire to be heard, and to effectively express concerns in a way that elicits a back-and-forth conversation so that both parties are sure each has been heard. For any patient, it is hard to understand the conversation doctors and nurses are having while lying in the bed.

This journey is not by choice. Once diagnosis, prognosis and next steps are known, choices can be made. The second challenge is in not knowing or understanding the complex, often fragmented workings of the healthcare system, nor should you – unless you’re (often unexpectedly) attempting to navigate and attempt to comprehend what is happening to – yourself or someone you love.

For this reason, advocacy is of primary importance. Otherwise, how is the patient to get the information needed to make informed decisions. A strong reason to have a care partner or other person along with, someone who will hear what the patient is not hearing (people remember 10% of what they hear, 20% of what they read . . .[i]), ask questions, take notes, provide advice and support, when not be in position to do so yourself.

In this circumstance and situation there are two important things to keep in mind, The first and often the most difficult to do is to Speak Up. Secondly recognize this is going to be uncomfortable.

The 5 times when you must speak up while in the hospital:

1. Speak Up for Plain Speak: Remind your Doctor You Didn’t Go to Medical School. Speaking with a doctor, any doctor can be overwhelming. Sometimes even the most well-meaning doctor can present too much information, too quickly and in complex terms.

People just tend to nod their heads and listen -- but leave feeling confused and no better informed about their own health and care!

Suggestions about what to say if your doctor seems to be “speaking Greek” to you:

a. Should I be worried about this?[ii]

b. I need you to “dummy” this down so that I can absorb and understand what you are telling me.

2. In the Hospital . . . remember these are public places; germs are everywhere and patients’ immune systems are not 100%. In fact, most are very low.

a. Hand washing is the #1 way to prevent common viruses (they circulate like crazy) and infections such as MRSA (methicillin-resistant Staphylococcus aureus) is difficult to treat because of resistance to some antibiotics & C diff (Clostridiodes difficile, causes diarrhea and colitis.

Preventing infection is everyone’s job: Simple hand washing with soap and water, or an alcohol-based cleanser goes a long way toward protecting every patient in the hospital.

In patient rooms and all areas of the hospital including Emergency Rooms, Walk- in Care Center’s - Remind Everyone, not to come near your loved one - unless they have washed their hands or used the alcohol based cleanser. [iii]

Do not take their word for it – you want to see them WASH THEIR HANDS. It is that important.

b. Hospital-Acquired Pneumonia Is Killing Patients. Yet There Is a Simple Way to Stop It. NVHAP (non-ventilator hospital-acquired pneumonia) a risk for virtually all hospital patients, is often caused by bacteria from the mouth that gathers in unbrushed teeth and is aspirated into the lungs. Patients face a higher risk if they lie flat or remain immobile for long periods, so NVHAP can also be prevented by elevating their heads and getting them out of bed more often.

“I’ll tell you that today the vast majority of the tens of thousands of nurses in hospitals have no idea that pneumonia comes from germs in the mouth,” Baker (a Sacramento State nursing professor said.)[iv]

Make sure the patient’s teeth are brushed. If that person is do weak, brush those teeth to make sure to avoid pneumonia.

3. Speak Up for Alarms.

In the hospital, alarm fatigue is a very real problem. It refers to times when we tune out noises in order to focus on a task at hand. Constant beeping – medication pumps, monitors, beds, ventilators, vital sign machines, and feeding pumps are alarms that are all too familiar. On busy hospital units, people on the medical team do this, too. They try not to, but it’s a natural reaction to some when they're trying to focus on care tasks at hand.[v] Good questions to ask are:

“If this beeping doesn’t mean anything, then why is it going off?”

“If no one is paying attention to this beeping, then why do I need it?”

4. Speak Up for a Safe Discharge.

Your doctors and nurses want you to go home when you feel it is safe to do so… and to an environment that will support your recovery.

If there is concern the patient is not going to be safe, raise the red flag so that staff will help get the needed support. In the event there is still uncertainty abouts safety if symptoms or concern about continuing services, troubling, there is a code phase to use: “This is not a safe discharge.”

Likewise, if you have a friend or loved one in the hospital and you are worried about their physical, mental or emotional safety – which may include any domestic abuse you know is going on in the home - you can bring your concerns to the hospital staff.

Be sure to use the same words: “This is not a safe discharge for (Patient’s Name).[vi]

5. Speak Up About Patient Status.

Just because a patient is wearing a hospital gown and in a hospital bed (hopefully in a room! and not the ER) and doctors have been at the bedside, it does not mean you are an “Admitted patient”.

Why does that make a difference?

Hospital admission status affects Medicare coverage of skilled nursing services that may be needed after discharge from the hospital -- and it can cost patients BIG $$ if Medicare doesn’t cover it.

Why wouldn’t Medicare cover it if the Doctor said you needed the care? Medicare requires a three-day minimum hospital inpatient stay (counted by midnights) before it will cover the cost of rehab care you may need in a skilled nursing care center. However, observation stays, regardless of length, do not count toward Medicare’s requirement.

Even if not sure if the patient will require rehab or need longer care at a nursing facility, it’s worth fighting for that admission status.[vii]

As ongoing next steps occur, it is also important is to recognize there comes a time when the patient, or care partner needs to ask for HELP - from friends and others.[viii]

With healthcare staffing shortages now the norm since COVID, and with that the NEED to question or intervene by speaking up, patient advocates are seeing an increase in the demand for their services. They advocate for proper care and improve communication between patients and overburdened healthcare staff.

By choosing to access the expert guidance and support a professional patient advocate can provide, you know you will be able to reclaim the time and energy you would have otherwise spent going in circles or living in fear and frustration.

[i] People remember only 20% of what they read… but 80% of what they see. March 27, 2018. iDashboards UK. http://bit.ly/3LEBlPR
[ii] The Care Partner Project. https://thecarepartnerproject.org.
[iii] Ibid
[iv] Kelman, Brett, July 12, 2022. Hospital-Acquired Pneumonia Is Killing Patients. Yet There Is a Simple Way to Stop It. Medscape. http://bit.ly/3IYbPne.
[v] The Care Partner Project. https://thecarepartnerproject.org.
[vi] Ibid.
[vii] Feke, Tanya, MD, August 12, 2022. How does Medicare’s two-midnight rule affect my hospital bills?
[viii] A good source for these and other times in health care when it is important to SPEAK UP, and what to say can be found through The Care Partner Project. https://thecarepartnerproject.org.