A hospitalization from hell: a patient's perspective on quality

Ann Intern Med. 2003 Jan 7;138(1):33-9. doi: 10.7326/0003-4819-138-1-200301070-00009.


Patients usually cannot assess the technical quality of their care; however, examining a hospitalization through the patients' eyes can reveal important information about the quality of care. Patients are the best source of information about a hospital system's communication, education, and pain-management processes, and they are the only source of information about whether they were treated with dignity and respect. Their experiences often reveal how well a hospital system is operating and can stimulate important insights into the kinds of changes that are needed to close the chasm between the care provided and the care that should be provided. This article examines the case of a patient admitted for ankle arthrodesis due to severe hemophilia-related arthritis. The surgery was successful, but the hospital stay was marked by inefficiency and inconveniences, as well as events that reveal fundamental problems with the hospital's organization and teamwork. These problems could seriously compromise the quality of clinical care. Unfortunately, most of these events occur regularly in U.S. hospitals. Relatively easy and inexpensive ways to avoid many of these problems are discussed, such as reducing variability in non-urgent procedures and routinely asking patients about their experiences and suggestions for improvement.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Ankle / surgery
  • Arthritis / etiology
  • Arthritis / surgery
  • Arthrodesis
  • Hemophilia A / complications
  • Hospitalization*
  • Hospitals, University / standards*
  • Humans
  • Middle Aged
  • Nursing Staff, Hospital / standards
  • Nursing Staff, Hospital / supply & distribution
  • Pain, Postoperative / prevention & control
  • Patient Admission / standards
  • Patient Discharge / standards
  • Patient Satisfaction*
  • Quality of Health Care*
  • United States