Let's face it. Before COVID-19 became a household word, we all knew our health-care system was broken. We've heard the stories of heroes on the front lines doing so much to save lives, yet with so few resources. The United States of America, the richest country in the world, is falling behind other countries in our ability to handle the strain of the virus on the already overburdened and dysfunctional health-care system. 

Before COVID-19, there was another threat to Americans' health. It's commonly referred to as "health-care acquired conditions" or "HAC's." In Texas, where I hail from, you know if something has an official title, it's a real thing!

An HAC is something you didn't go to the hospital for, but acquired because of being hospitalized. Most commonly this would be considered medication mix-ups, patients falling or being dropped, insulin mismanagement, decubitus/pressure ulcers, and many others. Some HACs are so common they have their own titles. There are hospital acquired infections (HAI's), and more specific types of infections such as central line associated blood infection (CLABSI) or catheter acquired urinary tract infection (CAUTI).

There is evidence that having a loved one in the room with a hospitalized patient will make them less anxious and is beneficial to their treatment because another person is there to ask clarifying questions and assist the care team in understanding the patient's medical history. When it comes down to it, the family in most cases knows the patient better than the doctor. Family members are aware of the patient's pre-existing conditions, medications, health history, and risk factors that could affect a treatment plan. In fact, a study of ICUs that had less restrictive visitation policies determined that higher quality care was delivered to the patients.  

The root causes of HACs have been associated with certain risk factors, like overworked staff, limited resources, communication errors, and too many patients. COVID-19 amplifies these root causes and puts patients at even greater risk for being harmed by an HAC. Doctors and nurses are already working 12-hour shifts with few or no days off, finding any opportunity they can to rest between patients. A system that normally suffers from handoff and communication errors at the best of times is now strained to the breaking point, making family involvement both preferable and necessary to keep patients safe. 

Don't get me wrong. Health-care workers on the front lines of this pandemic are heroes. Most are doing everything within their means to care for sick and dying people. However, even the CDC has said that hospitals should prepare to "potentially care for a larger number of patients in the context of an escalating outbreak while maintaining adequate care for other patients." 

One way hospitals are limiting risk of exposure for patients and health-care workers is by limiting the number of visitors that a patient may have while in the hospital. Although these restrictions are currently on a hospital level, some hospitals have lowered the number to one or two visitors per day, while some have prohibited visitors altogether. 

With hospital staff stretched so thin, it could fall to the families of sick patients to advocate for their family members to be sure they are receiving adequate care. But now, families may not even be allowed inside, or if so, their visits will certainly be limited.  

The sicker a patient is, the more at-risk they may be. The patient could be confused due to sickness or fever, mentally impaired under heavy sedation or pain medication, unable to communicate while hooked up to a breathing machine, elderly and immobile, or simply too sick and scared to ask the right questions or correct a mistake. 

Considering limited or no visitation, hospitals should have additional protocols in place to ensure that families can stay involved and informed, even if not in the room. This will help relieve some of the pressure on doctors who remain responsible for knowing patient histories and accurately charting the patient's treatment, as well as nurses who frequently run from room to room caring for patients. Family members will have to be even more vigilant about staying involved as much as possible and assisting health-care workers in providing the best care possible for their loved ones. 

Here are a few suggestions for how you may be able to keep your loved one safe in the hospital even if you cannot physically be present. 

1. If possible, leave a clean, disinfected smartphone with your hospitalized loved one. If they are lucid, ask them to call you any time a physician comes into the room so that you can hear the advice being given and ask questions.
2. Ask the nurse to write your cell phone on the whiteboard in the patient's room with a note stating your relationship, such as "husband" and to "please call at each shift change or upon change of condition."
3. Write down all your loved one's prescriptions and chronic medical conditions. Try to get an e-mail or even a fax number to send this information so that it can become a part of the patient's chart. Be sure to write in bold any medication allergies you are aware of. 
4. Find out who the "quarterback" is. There may be many doctors consulting on the case, and you need to know who is in charge. See if you can get that doctor's cell phone number. You must promise to not be a pest or overbearing, only use the number in case of emergency.
5. Get the phone number to the nurse's station. If you are unable to reach anyone, you can usually get someone to answer the phone at the nurse's station; they will know who the nurse on duty is, and they will call you.

The main takeaway is to try to get a plan up front. Get clear expectations about how often you can expect to hear from someone, who will be contacting you, and at what intervals. See if you can find out when the shift changes are and when certain doctors usually do their rounds, and ask to be called when doctors make rounds, nurses change shifts, or when there is any change of condition or new orders issued.

Keeping families present in the treatment of their loved ones, even if they can't be present in the room, will help lower the risk of medical errors in the face of exhausted health-care workers, packed hospitals, and patients on respirators who are unable to speak for themselves. Coming together as a team, between health-care workers and families, can protect the most vulnerable of us from harm with a few simple protocols and open communication. 

Please do not take my advice in any way as trying to add to your worry or as an extra burden to already overburdened health-care workers. We truly are all in this together, and if you find yourself in the hospital, or with a loved one in the hospital, I hope my small gesture of advice will help to keep you safe and on the road to recovery.

Kay Van Wey is a medical malpractice attorney based in Dallas, Texas, who is most recently known for her work on behalf of the "Dr. Death" victims.