Jordan Ellis
Being admitted to the hospital can be a stressful experience, especially for those unfamiliar with the process. There are two main types of hospital admissions: emergent and elective. Emergent admissions occur when a patient is seen in the emergency department and subsequently admitted to the hospital. Elective admissions, which make up the majority of cases, happen when a doctor requests a bed reservation for a patient on a specific day, allowing the patient to check in at the admissions office without going through the emergency department. During the admission process, patients should play an active role in their healthcare decisions and be involved in discussions with medical staff. This includes asking questions and providing relevant information to the admitting doctor or emergency department physician.
| Characteristics | Values |
|---|---|
| Types of admissions | Emergent, Elective, Emergency, Direct Admit, Transfer, Scheduled Admit |
| Who can admit you? | Your personal doctor, an emergency department doctor, an "on-call" physician, a hospital physician with admitting privileges, a hospitalist or specialist physician |
| What to bring | Items not included in your electronic medical record, leave valuables at home |
| Types of services | Inpatient, Outpatient |
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What You'll Learn
Emergent vs. elective admissions
There are two major types of hospital admissions: emergent and elective. Emergent hospital admissions usually occur when a patient, presenting at the emergency department with symptoms like pain, difficulty breathing, or bleeding, is subsequently admitted to the hospital. This is typically the most common route of admission. Elective admissions, on the other hand, are scheduled in advance and occur when a doctor requests a bed reservation for a patient on a specific day. The patient then checks in at the admissions office, bypassing the emergency department. Examples of elective admissions include knee surgery and minor surgeries. Elective admissions constitute the majority of hospital admissions, although this percentage varies across hospitals.
The distinction between emergent and elective admissions is important for billing and insurance purposes. Emergent admissions are often associated with higher mortality rates, longer hospital stays, and higher costs compared to elective admissions. In the context of surgery, the term 'elective' refers to the date and time of the procedure, rather than the procedure being optional. For instance, a patient with a tumour may consider the surgery to be necessary, but it is classified as elective if the patient can elect when to have the surgery.
Urgent admissions fall between emergent and elective admissions. Urgent admissions are required for medical conditions that could become emergencies if not treated promptly, but the patient's condition is stable enough to withstand a short delay. Generally, urgent admissions should occur within 14 days, and the patient is accommodated as soon as possible. Transfers from one hospital to another are often classified as urgent admissions, as they indicate the patient requires a higher level of care.
Direct admissions are a subtype of elective admissions, where a patient is directly admitted to the hospital without going through the emergency department. This can occur when a doctor's office deems the patient to be sufficiently ill during an appointment or phone conversation. Direct admissions can also occur when a patient is transferred from a free-standing urgent care centre or ER to another hospital with specific capabilities, such as a cath lab for heart attack treatment.
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Who decides if you're admitted
The decision to admit a patient to a hospital is typically made by medical staff, including the patient's personal doctor or an emergency department doctor in consultation with the hospitalist or a specialist physician. In some cases, a patient's doctor may request a direct admission to a specific hospital, particularly if they have a relationship with a doctor at that hospital.
Elective hospital admissions, which make up the majority of hospital admissions, occur when a doctor requests a bed reservation for a patient on a specific day, and the patient checks in at the admissions office without going through the emergency department. This type of admission usually involves scheduled surgery, also known as elective surgery, where the term 'elective' refers to the date and time of the procedure rather than its necessity.
However, in cases where patients seek emergency care, the decision to admit them is often made by an emergency department doctor in collaboration with the hospitalist or a specialist physician. This decision is based on the patient's condition and the level of care required. Factors such as the availability of beds and the current load in the emergency department can also influence the admission process.
It is important to note that patients who are mentally competent have the right to refuse admission for any reason, although it is recommended to obtain the best available information before making such a decision. Additionally, patients or their caregivers should inquire about their inpatient or outpatient status during their hospital stay, as this affects billing and reimbursement under Medicare, Medicaid, and insurance plans.
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Inpatient vs. outpatient services
Inpatient and outpatient services refer to the type of care you receive at a hospital or other medical facility. The main difference between the two is that inpatient care requires an overnight stay at a hospital or other care setting, whereas outpatient care does not.
Inpatient care is typically required for more serious ailments, treatments, or trauma that need monitoring, repeated or continual treatment, and recovery time. Inpatient care is often planned in advance, such as for scheduled surgery or childbirth, but it can also be unplanned in the case of emergencies. Inpatient care usually involves multiple healthcare professionals, such as doctors, nurses, and specialists, depending on the patient's needs.
Outpatient care, on the other hand, is typically provided for routine or less severe conditions and can be completed within a single day. Outpatient services include diagnostic tests, treatments, consultations, exams, and some same-day surgeries. Outpatient care may be provided at a hospital, walk-in clinic, outpatient surgery center, or a doctor's office.
The type of care required depends on the patient's condition and the treatment needed. Inpatient care tends to be more expensive due to the overnight stay and multiple procedures involved. Outpatient care is often covered by health plans as part of preventive care, but inpatient and outpatient mental health care options are also available depending on the level of support needed.
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Direct admit
A direct admission to a hospital occurs when a physician deems it necessary for a patient to be admitted immediately without first receiving care in the hospital's emergency department. Direct admissions are viewed as a higher priority than planned admissions but are not as critical as emergency admissions.
A direct admission is usually initiated by a physician who requests that a patient be admitted to the hospital as soon as possible. This could be following an appointment where a doctor finds a patient to be so ill that they need to be admitted to the hospital, or following a phone conversation where a doctor determines that a patient needs to go directly to the hospital. Direct admissions are also common for labour and delivery.
If you are accepted as a direct admit, the hospital will guarantee you a bed relatively quickly, and definitely on the same day. However, it is worth noting that patients requiring emergent care or rapid diagnostic imaging are likely to receive more timely care in the emergency department. For example, conditions such as sepsis, AMI and trauma often require rapid emergency department care to decrease morbidity and mortality.
If you are a direct admit patient, it is important to bring critical items such as medical documents, specific instructions from physicians, a list of medications, drugs, supplements, vitamins, and allergies. This information can also be passed along if a patient is unable to communicate.
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Transfer between hospitals
Transferring between hospitals is a common occurrence and is often undertaken to improve the management of the patient. This could be because the hospital they are currently in does not have the necessary expertise, equipment, or capabilities to treat the patient. For example, a patient may require a specific procedure, such as interventional radiology, but the hospital does not have a radiologist on staff or the equipment to perform the procedure. In other cases, patients or their families may request a transfer if they are dissatisfied with the quality of care being delivered.
If you are considering a transfer to another hospital because you are unhappy with the care you have received, it is recommended to first ask for a second opinion. Most hospitals will have multiple doctors in the same specialty, and another specialist may be able to provide a different perspective on your care plan. If the hospital does not have another doctor in that specialty, you can arrange a telehealth consultation with a doctor at another hospital.
If you still wish to pursue a transfer, you or your advocate should reach out to your hospital case manager or social worker for assistance. These professionals are experts in the healthcare system and can help navigate its complexities. It is important to explain your concerns clearly and calmly so that they can better understand your needs and help you make the transfer.
When transferring between hospitals, it is important to ensure that there is proper communication and documentation. The transferring and receiving facilities should share complete information on the patient's clinical condition, treatment being given, reasons for transfer, mode of transfer, and timeline of transfer. This information should be shared in a written document and include the patient's condition, the names and designations of referring and receiving clinicians, details of vital signs, and any clinical events or treatment given during the transfer. A formal handing over of the patient should also take place between the transferring and receiving teams, including doctors and nurses, to ensure continuity of care.
In some countries, dedicated critical care transfer groups have been established to coordinate and facilitate patient transfers between hospitals. These groups also arrange for appropriate facilities at the receiving hospital. Air or ground transport may be used for the transfer, depending on factors such as the time of transfer, distance to be travelled, and the level of care needed during the transfer.
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Frequently asked questions
There are two major types of hospital admissions: emergent and elective. Emergent hospital admissions occur when a patient is seen in the emergency department and is subsequently admitted to the hospital. Elective hospital admissions occur when a doctor requests a bed reservation for a patient on a specific day, and the patient checks in at the admissions office.
The decision to admit you to a hospital will likely be made by your personal doctor or an emergency department doctor in consultation with your doctor. If your doctor is not on call, another covering doctor can admit you to the hospital.
Factors that may influence hospital admission include the severity of your condition, the availability of treatment as an outpatient, the need for diagnostic testing, and your medical history. Insurance coverage may also play a role in determining whether you will be admitted to the hospital.
Inpatient services refer to when you are admitted to the hospital and require an overnight stay or an extended stay of several nights, weeks, or even months. Outpatient services, on the other hand, mean that you are not admitted and typically go home the same day after receiving treatment.
