Hospital Admissions: Your Rights And What To Expect

Being admitted to the hospital can be a stressful experience, but understanding the hospital admission procedure can help reduce anxiety. There are several ways to be admitted to the hospital, including emergency admission, direct admission, and transfer. Emergency admission is the most common route, where patients present to the emergency department with symptoms such as pain, difficulty breathing, or bleeding. Direct admission occurs when a doctor determines that a patient is too ill during an office visit or phone consultation and decides they need to go to the hospital immediately. In some cases, patients may be transferred to another hospital that has specific capabilities or services required for their care. It's important to know the distinctions between inpatient and outpatient services, with the former requiring an overnight stay or an extended admission, while the latter allows patients to return home on the same day.

Reasons for admission: serious or life-threatening problems, less serious disorders, labour and delivery

Hospital admissions are often unplanned and occur due to emergency situations that require immediate medical attention. These situations can be life-threatening, such as strokes, trauma, or eye injuries, wherein the patient is transported to the hospital by ambulance. In less urgent cases, patients can be driven to the emergency department by private car. Once at the hospital, the patient is cared for in the emergency department until a hospital bed becomes available.

Serious or life-threatening problems that require hospital admission include severe trauma, such as car accidents, strokes, or injuries to the eye. Additionally, cancer patients often require hospitalisation for surgery, chemotherapy, or other treatments. Respiratory distress resulting from chronic obstructive pulmonary disease (COPD), including chronic bronchitis and emphysema, is another reason for hospital admission. Severe complications from diabetes, such as diabetic ketoacidosis or organ failure, may also necessitate hospitalisation. Mental health disorders, like severe depression, bipolar disorder, or schizophrenia, can lead to acute episodes that require hospital care. Acute and chronic kidney diseases, particularly with complications like kidney failure, are also among the serious disorders that require hospital admission.

Less serious disorders that may require hospitalisation include labour and delivery. The process of labour and delivery typically involves three stages, starting with regular contractions and ending with the delivery of the placenta. During labour, it is recommended to have a support person, such as a family member or friend, by your side. Upon arrival at the hospital, expectant mothers usually go through a triage process, where they are assessed by a midwife. If labour has progressed or complications arise, they are admitted and taken to a birthing suite. The length of stay in the hospital varies depending on the type of delivery, with C-sections typically requiring a longer stay due to being a surgical procedure.

Admission procedures: doctor's assessment, admission letter, pre-admission questionnaire, hospital instructions

Admission procedures

Doctor's assessment

Before being admitted to the hospital, you may be asked to attend a pre-admission assessment (PAA), which may be conducted by a nurse or doctor, or over the phone. During the PAA, you will be asked about your health, medical history, and home circumstances. You may also be screened for MRSA and assessed for your risk of hospital-acquired blood clots. The outcome of the PAA will determine whether you are suitable for a day procedure or require a hospital stay for your operation.

Admission letter

Once your hospital appointment is booked, you will receive an admission letter containing important details such as the date of your admission and the ward you will be on. The letter will also include specific instructions to follow before your treatment, including information on whether you can eat or drink beforehand.

Pre-admission questionnaire

Upon arrival at the hospital, you will need to fill out an admissions form and provide emergency contact details.

Hospital instructions

The admission letter may also include other instructions, such as any items you need to bring with you. This could include a small amount of money for snacks or drinks, proof of entitlement to free prescriptions or travel, and any changes to your personal details. If you have any special needs or require a translator, it is important to contact the hospital in advance.

Inpatient and outpatient services: surgical and non-surgical inpatient stays, outpatient day procedures

Hospitals provide both inpatient and outpatient services. Outpatient services do not require admission, and patients typically return home on the same day. Inpatient services, on the other hand, involve an overnight stay, which can extend to several nights or even months. Inpatient services can be further categorised into surgical and non-surgical stays.

Inpatient Surgical Stays

Inpatient surgery is often associated with open surgery, which is the conventional surgical procedure. Open surgery involves a single large incision, sometimes several inches long, to access the surgical site. The surgeon may need to move tissue or muscle to gain full access to bone, ligaments, or organs. After the procedure, the patient will stay in the hospital overnight for monitoring and supervision. The medical team provides round-the-clock care to monitor for complications, bleeding, and infections, which are possible after open surgery.

Inpatient Non-Surgical Stays

Inpatient non-surgical stays are often required for intensive care, round-the-clock care, or treatment for a serious illness. This could include emergency admissions for situations that are not immediately life-threatening but still urgent. For example, a patient could arrive at the emergency department with symptoms such as pain, difficulty breathing, or bleeding. If the emergency physician determines that the patient's condition requires further treatment, they will be admitted to the hospital.

Outpatient Day Procedures

Outpatient surgery, also known as same-day surgery, allows patients to enter and leave the hospital on the same day. This type of surgery is made possible by minimally invasive surgery (MIS), which often requires only 1-3 small incisions or, in some cases, no incisions at all. After outpatient surgery, patients can recover in the comfort of their own homes, reducing disruption to their daily lives and childcare plans. Outpatient surgery is ideal for patients in good general health who require a straightforward procedure. It also offers advantages such as less scarring, minimal bleeding, and a lower risk of infection. Examples of procedures that can be performed as outpatient surgery include oral surgeries, mole removal, Lasik eye surgery, ACL surgery, and endoscopies.

Hospital experience: stress and confusion, tests and procedures, staff support, privacy and consent

Being admitted to the hospital can be a stressful and confusing experience. Patients may experience delirium, a sudden change in thinking and awareness, which can lead to confusion, memory problems, and even hallucinations. This is often caused by too much stress on the brain due to illness, environmental changes, or other factors, and it is more common in adults over 65. It is important to take steps to reduce stress and prevent confusion, such as listening to music, staying hydrated and well-nourished, getting enough sleep, and limiting environmental changes. Hospitals can also be busy and overwhelming places, with various tests and procedures being carried out. Support staff and medical office assistants are on hand to help prepare patients for examinations, schedule appointments, and provide general assistance and education.

In terms of privacy and consent, hospitals must adhere to strict regulations, such as HIPAA in the US, which protect patient confidentiality. For example, hospitals must obtain consent before releasing any personal health information (PHI) or posting identifiable patient information or images. Patients are also asked for their preferences regarding visitors and notifications upon admission and their consent for disclosures to religious figures. Additionally, when disposing of medical records and prescription labels, hospitals must shred or incinerate the documents to protect patient privacy.

Furthermore, staff are trained to support patients emotionally and practically throughout their hospital stay. Licensed practical nurses provide nursing support to physicians and assist with intake, documentation, and patient discharge. They work under the supervision of registered nurses, who primarily care for patients in outpatient settings. Additionally, physician assistants and nurse practitioners work independently and in conjunction with physicians to provide evaluation and management services, especially in outpatient and research settings. This comprehensive support system aims to guide patients through the hospital experience and ensure their comfort, privacy, and understanding.

Overall, while being admitted to the hospital can be a challenging experience, hospitals have comprehensive procedures and dedicated support staff in place to assist patients through the process, ensuring their privacy and providing the necessary emotional and practical support.

Discharge: extra help after leaving, family involvement in decisions

When you are preparing to leave the hospital, it's important to ensure that you have all the necessary support in place, especially if you require additional assistance or have ongoing care needs. Here are some key considerations for discharge planning and the role family members can play in this process:

Assessing Your Post-Discharge Needs:

Start by understanding your current health status and the specific needs you may have after leaving the hospital. This includes considering any ongoing medical issues, potential complications, and the level of care and support required. A thorough assessment will help identify the type of assistance needed, whether it's in-home care, rehabilitation, or simply help with daily tasks.

Involving Family in Discharge Planning:

Family members can play a crucial role in your care and recovery after a hospital stay. Involve your family early in the discharge planning process. Share information about your health status and the potential challenges you may face. By doing so, you can collectively make informed decisions and develop a realistic plan for your post-discharge care. Discuss the level of involvement and specific tasks each family member can take on. For example, a family member may assist with transportation to follow-up appointments, help with medication management, or provide emotional support during your recovery.

Communicating Your Needs and Preferences:

Be clear about your needs, preferences, and concerns regarding your care. Discuss your expectations for involvement with your family. For example, you may want a family member present during discharge planning meetings or when important decisions are being made. This ensures that your wishes are respected and that your family understands the role they can play in supporting your recovery.

Developing a Comprehensive Care Plan:

Work collaboratively with your healthcare team and family to develop a detailed care plan that outlines the specific tasks and responsibilities for your post-discharge care. This plan should include information on medications, follow-up appointments, required therapies or treatments, and any necessary lifestyle changes. By involving your family in the development of this plan, you can ensure a coordinated approach to your care and reduce the risk of misunderstandings or gaps in your support network.

Accessing Community Resources:

In addition to family support, there may be community resources and services available to assist with your transition from the hospital. These could include home health agencies, social services, or local support groups. Your healthcare team can help identify and coordinate these resources, ensuring you have the necessary support in place before leaving the hospital.

Remember, effective discharge planning involves open communication and collaboration between you, your healthcare team, and your family. By involving your family and clearly outlining your needs and preferences, you can ensure a smooth transition and maximize the support available to you during your recovery.

Frequently asked questions