Older, sicker patients often uncomfortable speaking up about problems during hospital stays, survey finds

Although patients are encouraged to engage with providers by sharing their safety concerns, of nearly 50 percent of patients who reported a problem during hospitalization, 30 percent did not always feel comfortable speaking up, a study published in BMJ Quality & Safety found. 

The cross-sectional study involved eight hospitals in Maryland and Washington, D.C. The researchers used postdischarge patient survey data to understand how comfortable patients felt in sharing concerns related to their care.

Of about 10,000 patients who provided valid responses, 4,958 (48.6 percent) said they had a problem during hospitalization. Of these patients, 1,514 (30.5 percent) said they did not always feel comfortable speaking up.

Predictors of having a problem during a hospital stay included age, health status and education level. The study found patients who were older, those who reported worse overall health, those who reported worse mental health, those who were admitted through the emergency department and those who did not speak English at home were less likely to always feel comfortable speaking up.

Patients who were not always comfortable speaking up also gave lower ratings on nurse communication, physician communication and overall hospital ratings. These patients were significantly less likely to recommend the hospital than patients who always felt comfortable speaking up.

"Patients frequently experience problems in care during hospitalization, and many do not feel comfortable speaking up," the study authors wrote. "Creating conditions for patients to be comfortable speaking up may result in service recovery opportunities and improved patient experience."

These efforts should consider the how health literacy and mental health affect patient engagement with patient safety initiatives, the researchers said.

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