By Oliver Warren, Bryony Dean Franklin and Charles Vincent

Going Into Hospital

Going Into Hospital

Being a patient is challenging. Hospitals are familiar to us from television dramas, films and documentaries, which provide astonishingly detailed descriptions of even major surgery. But very little of this information tells you how the hospital actually works, or how you are likely to feel while you are there. Even for people who are usually very confident, being a hospital patient can be a difficult experience. For a start, you're ill (and none of us concentrate so well when we are ill, even with a head cold!), but beyond this, the environment is 'foreign', complex, and can feel confusing even to people who work there. Some experiences feel embarrassing and some conditions or treatments change the way you look or feel, sometimes permanently. It is not unusual to feel overwhelmed by the whole experience.

New technologies are continually pushing the boundaries of what can be achieved in investigations and treatments. New ways of viewing the internal organs of the body (such as CT or MRI scanners) allow rapid diagnosis of disease in a way that was unthinkable 20 years ago. Conditions that were previously rapidly fatal have been turned into 'chronic conditions' which patients live with for many years. Operations that used to require a two week hospital stay may now be done as a 'day case' with the patient going home that very evening. In the future, care will become more and more 'personalised', with treatments chosen based on your genetic profile.

Each individual hospital doctor knows more and more… about less and less. Medical knowledge is so vast, and is changing so quickly, that no one can fully understand even a small proportion of it. This means that hospital doctors and other professionals have to specialise and concentrate on particular diseases and treatments. Surgeons used to carry out a wide range of operations on all parts of the body. In one day the same surgeon might have performed bladder, bowel and thyroid surgery. Today this would involve three different surgeons in three different operating theatres with three different specialist teams.

Teams, not individuals, deliver healthcare. The days of the single all-knowing consultant standing at the end of the bed are over. Teams made up of many professionals, including therapists, pharmacists, dieticians and nurse specialists are now essential and almost certainly offer higher standards of care. However information has to be passed between all these people to ensure that everyone remains informed. Patients have to see many different healthcare professionals and discuss their care with many more people than in the past.

The patient is a key member of the team and has more responsibility for their own care than ever before. Hospitals have moved on from treating patients as passive recipients of care, decided for them by all-powerful consultants, and modern healthcare now involves the patient much more in decision making and self-care. This is very good for patients and families. However patients now need to participate and work with their doctors, nurses and others as partners. This in turn requires a better understanding of concepts such as 'risk', 'benefit' and 'consent'. It can involve making some important decisions, sometimes when you're already feeling unwell, nervous or daunted.

You should be aware that doctors, nurses, pharmacists and other healthcare staff are human beings who can and do sometimes make mistakes. Patient safety is a priority for all hospitals and health professionals, but mistakes do occasionally occur. This is not really surprising; there are millions of patient visits to hospital every year in the UK alone. But there are steps you can take to help. Know your own list of medications and why you take them. Keep a copy of any medical records or letters you are sent or given, so you can show them to anyone looking after you. You may have your hospital number checked and be asked your name, date of birth and about any medications and allergies many times. This can seem repetitive and boring but is an essential safeguard against errors so very worthwhile. And if patients or their loved ones think that something isn't quite right, they should let a member of staff know of their concerns.

Patients can have a big impact on their own well-being, recovery and safety. There are many different ways in which patients can 'help themselves'. Research you r condition and treatment options and have any queries prepared before seeing a specialist (where possible - sometimes emergencies catch us all out!). Read all the instructions given to you about why you are going into hospital - failure to do so may result in your test or operation being cancelled, which is always very disappointing.

There are many different types of hospital ward. While most wards look similar and are arranged in a relatively standard fashion, they have different purposes and may care for very different kinds of patients. Patients may be moved around the hospital on numerous occasions during their stay. This is to ensure that they receive the specialised care they require at each point in their recovery. There are acute admissions wards, intensive care units, high dependency units and specialised wards for people with specific conditions, such as heart attacks or kidney failure.

Patients and their visitors can help prevent hospital acquired infections. Most medical organisations invest a lot of time and effort in trying to prevent hospital-acquired infections such as 'MRSA' [meticillin-resistant Staphylococcus aureus] and 'C.Diff' [Clostridium difficile] because the consequences to patients can be serious. The good news however is that patients and visitors can help drastically reduce these by following a few simple precautions. Clean hands are the key to infection control, and patients and their visitors should be scrupulous about washing and cleaning their hands especially if touching each other or moving to other parts of the ward or hospital. Most staff are very good at hand washing but they may occasionally forget - you should always feel free to politely remind them to wash or use alcohol gel on their hands before seeing you.

Planning to leave is as important as planning to be admitted. Planning to be discharged from hospital at the very start of an admission, or even before, can seem strange to people who are unfamiliar with hospital. However, this focuses both the clinical team and the patient on the key goal: getting better and going home! Think about how you will get home, who will pick you up and support you, and make sure you understand any new tablets, treatments or instructions you've been given. If you're not sure, ask for written copies or information sheets and finally make sure the hospital has your GP's details so that your GP can be kept informed and aware of your progress.

Going into Hospital? A guide for patients, carers and families, by Oliver Warren, Bryony Dean Franklin and Charles Vincent (Eastdown Publishing), is out now, priced £14.99 (paperback) / £9.99 (e-book). Visit www.goingintohospital.co.uk

AUTHOR BIOGRAPHIES

Oliver Warren is a consultant in general and colorectal surgery at Chelsea and Westminster Hospital in London and an honorary lecturer in the Centre for Patient Safety and Service Quality at Imperial College London. Since graduating in 2001 he has worked in a variety of hospitals, ranging from big central London teachinghospitals to smaller local hospitals, and in many different specialities, including emergency medicine, trauma and orthopaedics, cardiothoracic surgery and general surgery. He has also worked outside the NHS, in a large hospital in Sydney and in a non-clinical role in the UK government.

Bryony Dean Franklin is a pharmacist by background, and has been based in hospitals for most of her working life. She is currently Professor of Medication Safety at University College London School of Pharmacy, Visiting Professor at Imperial College, and a hospital pharmacist at Imperial College Healthcare NHS Trust in West London, where she is also Chair of the Centre for Patient Safety and Service Quality.

Charles Vincent trained as a clinical psychologist and worked in the NHS for several years before becoming a researcher. Since 1985 he has carried out research on medical error and risks to patients, and studied how to improve the safety and quality of healthcare. He became a Professor of Psychology at University College London before moving to Imperial College London in 2002. He has written many scientific papers on risk and safety in healthcare and a book on Patient Safety (2nd edition 2010). For ten years he worked in the Department of Surgery and Cancer at Imperial College London and was Director of the Imperial Centre for Patient Safety & Service Quality. He is now Professor of Psychology at the University of Oxford.