Within what time period must the physician visit a patient he or she has admitted to the hospital?

There may come a time when you or a loved one may need to be admitted to a hospital. Today's large urban hospitals can be confusing and somewhat frightening for someone not familiar with how they work. In general, there are two major types of hospital admissions, emergent and elective.

Emergent hospital admissions usually happen when a patient seen in the emergency department is subsequently admitted to the hospital. Elective hospital admissions occur when a doctor requests a bed to be reserved for a patient on a specific day. The patient then checks in at the admissions office and does not go to the emergency department. Elective admissions make up the majority of hospital admissions, but this percentage varies markedly with some hospitals.

To get the most out of your hospital stay, the following article provides you information on these vital issues:

• Factors that influence whether you will be admitted to the hospital
• What happens once you are admitted
• Your rights as a patient
• How to improve your or a family member's care during and after the admission process

• If you are feeling very ill, you may seek help at a hospital's emergency department, but for fast and effective care, the illness should be an emergency condition. An emergency condition usually is defined as a life, limb, or body functional-threatening problem (for example, stroke, trauma to a leg or an eye injury, or similar serious problems).
• You may take yourself there (in most emergencies, someone else should take the person to avoid additional problems or injury).
• You should ask family or friends to take you if you are ill.
• You may call 911 for emergency services or ask someone to call 911 or the appropriate number for an ambulance. The decision to call and request an ambulance should be based on the seriousness of the problem and symptoms plus the possibility that the problem(s) may become worse, especially in the time it may take to reach medical help.
• Here are some conditions that might require an ambulance:
  • Chest pain
  • Shortness of breath
  • Palpitations (rapid heartbeat)
  • Weakness or dizziness
  • Heavy bleeding
  • Confusion or loss of consciousness
  • Trauma, unless minor
  • Moderate to severe pain
  • Moderate to severe headache
  • Problems with vision or speech or movement of limbs
  • High fever
  • You require medical care on the way to the hospital
• Your doctor may request or arrange for you to be taken to the hospital; this is usually an elective admission or a subtype termed a direct admission.
  • With elective admission, you require hospital care but may choose to wait for a more convenient time (for example, you may choose a date for elective knee surgery).
  • You are a nursing home or rehabilitation patient and you require admission.
  • Your doctor sees you in the office or clinic and makes a direct admission (this is another quicker form of an elective admission).
  • You transfer from another hospital.
  • Family, friends, or others may take you or arrange for you to go to the hospital for the reasons listed above especially if you cannot make reasonable decisions because of illness.
• The best hospital for you to go to depends on several factors. The most important factor is your current medical condition.
  • Often, if you have time to choose (your condition is not immediately dire), the best choice is the hospital where your doctor practices because your doctor knows your history, has your medical records and usually can direct your care more efficiently, unless a specific specialist is required. However, please note that your doctor may not be credentialed to work in certain hospitals. Each hospital requires a doctor to apply for credentials; in a large city, your doctor may be credentialed at only two of ten hospitals and some doctors have only medical office practices and have not applied for credentials at any hospital. Often, Emergency Medical Service personnel (EMS or ambulance personnel that respond to 911 calls in the US) decide which hospital to take the patient based on the person's symptoms and condition. They are trained to do this, despite the request to go to a specific hospital, for the expedited and appropriate care of the patient. For example, you may want to go to a nearby hospital, but EMS may decide to take you to a hospital with more appropriate facilities and doctors to treat a condition such as a designated stroke center or a trauma center.
• You may go to a hospital other than your doctor's under other conditions:.
  • You are on vacation or outside the area you live in.
  • If you had recent surgery, specialized care, or procedures at a different hospital and your problem is related to that hospitalization. If time permits, call both the doctor that provided the specialized care and your personal doctor and ask where to go.
  • You may be taken to a trauma center or a stroke center, hospitals with facilities and staff specially trained to treat these serious problems.
  • Trauma centers offer specialized care for victims of trauma; they have trauma surgeons, orthopedists, and other specialists available at all times.
  • Minor trauma (such as a cut finger or ankle sprain) does not require a trauma center.
  • Stroke centers have recently been established. They have neurosurgeons and neurologists available at all times to aid in the diagnosis and treatment of strokes.
  • You may, at some time, require the services of a trauma or stroke center but find yourself transported to a hospital that is not a trauma center.
  • You are not near a trauma center or the local ambulance service does not go to a trauma or stroke center.
  • If you are the victim of serious trauma or stroke, ask if you're being taken to a trauma or stroke center, if you are able to communicate. If you are not being taken there, ask if the hospital you're going to can handle your injuries or stroke.
  • You may always be transferred to a trauma or stroke center, once stabilized, if you require it.
  • The hospital you request to go to may be "on divert." This means the hospital is so full it is requesting not to receive anyone by ambulance and is diverting or asking ambulances to go to other hospitals.
  • You may still ask to be taken to that hospital, however.
  • Inform the ambulance personnel that you still want to go to the hospital on divert, and tell them the reason. Please understand that the EMS personnel may or may not override the diversion request.
  • Your request made to EMS may or may not be honored. If it is, be aware you could spend hours or days in the emergency department until a hospital unit bed becomes available for you.

What you should bring to the hospital is very important for your care. The following is a brief list of items you should have immediately available if you need to go to an emergency department or if an elective admission occurs:

1. Identification (driver's license, student ID) and emergency contacts (relatives and friends names and phone numbers)
2. List of all allergies to medicine with the reaction
3. List of all current medications (name, strength, frequency) and "treatments" (include over-the-counter medications such as Tylenol, vitamins, herbals, and any other items such as energy enhancers; do not lie – if a person ingests, sniffs or injects anything such as drugs or even uses aromatherapy, tell the ER doctor or staff. If you do not have a list, place all of the medication bottles in a bag and bring them to the ER.
4. List of all medical conditions (for example, diabetes, hypertension, peripheral vascular disease)
5. List all surgeries (all means all, not just the most recent including elective plastic surgery)
6. Have available the name(s) of the primary care physician and the specialists that treat the patient
7. Bring a copy of the person's advance directive that is signed; If you are a parent of a child, you are the caregiver and have medical power of attorney unless you have assigned this right to another (grandparent, friend).
8. Bring all cards that pertain to insurance coverage; in addition, you may need a checkbook and/or a credit card.

For those patients with an up-to-date web, company, flash drive or phone app with your complete medical record, the brief checklist is as follows:

1. Bring the security code for your medical records and the name of the website, company, flash drive or phone app or device that contains the health information, including the signed advance directive to the emergency department or doctor's office.
2. Bring whatever is not included in your electronic medical record in items 1 through 8 above (most good sites should include everything, including a signed advance directive)

Do not bring your valuables. Leave money and jewelry at home.

The decision to admit you to a hospital likely will be made by one of the following medical staff:

• Your personal doctor arranging an elective admission
• An emergency department doctor in consultation with your doctor
• Generally, it is in your best interest to ask the emergency department doctor to contact your primary care physician, even if he or she does not admit patients to the hospital where were taken.
• Your doctor may have important information regarding your medical history. Your doctor may have a relationship with a doctor at that hospital and may request that you be admitted to that person.
• An emergency department doctor in consultation with the hospitalist or specialist physician (when you don't have a personal doctor that has credentials at the hospital you are at)
• A covering doctor (usually an associate of your private physician who is on call to manage several doctors patients during non-office hours
  • Your doctor cannot be on call 24 hours a day, 365 days a year.
  • When your doctor is not on call, usually another doctor covers your doctor's service. This "on call" physician can admit you to the hospital.

Doctor-patient relationship: You should play an active role in your own health care, be involved in decisions about, and agree with all aspects of your medical care. Questions you should consider asking if you require admission to a hospital include the following:

• Why do I need admission?
• What is my diagnosis?
• If the doctor does not know, what are the possible things I might have?
• What are the chances I might have any of the medical problems on the list?
• How long might I need to be admitted?
• Will my insurance pay for the admission?
• What workup or treatments will I need?
• Are there any risks to my admission?
• What are the risks if I don't agree to be admitted?
• Are there any other options?
• Was my doctor contacted

The following factors should be considered in a decision to admit you to a hospital:

• Your medical problem
• The history relating to your current medical problem
• Your past medical history
• The possibility your medical problem could be serious
• Other medical problems that may complicate or cause the current problem to worsen.
• Abnormal tests, ECGs, lab work, X-rays
• Abnormal physical exam
• Unstable vital signs - temperature, heart rate, blood pressure, oxygen concentration in your blood
• Diagnosis - what you have
• Prognosis - what most likely will happen because of your conditions and in what time frame
• Whether you require care that cannot be given as an outpatient (someone treated at the hospital but not admitted as a patient)
• Whether you require diagnostic testing that cannot be performed as an outpatient
• Whether you require the immediate service of a consultant
• The availability of close follow-up, if required
• Outpatient care fails to improve your condition or your condition worsens
• You need surgery
• Family members or friends relate other details to the admitting doctor or emergency department physician that are new and affect the diagnosis
• Insurance issues (some hospitals do not take certain insurance carriers so the insurance company or hospital may request that you be transferred to another hospital).

When you don't want to be admitted: People who are mentally competent may refuse to be admitted for any reason.

• Before you decide not to be admitted, however, get the best information available. Be aware that you may be putting yourself at significant risk of death, disability, or your condition may worsen by not following the admitting doctor's advice.
• Ask to speak with your doctor: Ask why you need to be admitted and discuss the risks and benefits of admission versus going home.
• If you refuse to be admitted, you usually will be asked to sign out against medical advice (AMA) if you are in an emergency department.
• If you sign out of the hospital against medical advice, your insurance company may not cover the costs for that visit.
• If you sign out against medical advice, ask the doctor treating you for the best advice to care for your problem.
• You can always go back to an emergency department to be considered for admission to a hospital at any time, but you may need to go through all of the diagnostic testing, even if you go back to the same hospital, depending on the time interval and the judgment of the admitting doctor(s).

There are two major types of admissions, 1) elective and 2) emergency admissions, but there are some variations. The following is a brief description of the major and other admission types:

Elective admission: You have a known medical condition or complaint that requires further workup, treatment, or surgery.

• The admission itself may be delayed until a time is convenient for both you and your doctor.
• In most cases of elective admission, you will come to the hospital's admitting office.
• You may be instructed to go to the hospital several days in advance for lab work, X-rays, ECGs, or other prescreening tests.
• If you require elective surgery and think you may need a blood transfusion during surgery, ask your doctor if you can set aside or donate blood for yourself, in advance, in case it is required.

Emergency admission: This occurs through the emergency department. You may be admitted to a floor, a specialized unit (for example, the medical or surgical intensive care unit), or a holding (observation) unit.

Same-day surgery: Technically, this is not an admission.

• With same-day surgery or ambulatory surgery, your doctor will schedule a procedure that will be performed at the hospital.
• You are discharged home the same day after you recover from the procedure.

Holding unit or observation admission: This admission often takes place through the emergency department.

• In this case, you are admitted for diagnostic testing.
• Unless something shows up positive, you will be discharged within 24-48 hours. You have chest pain, for example, that appears not to be related to your heart, but the emergency department or your doctor cannot be 100% sure. Or you may be admitted to a holding unit for up to 48 hours to ensure you didn't have a heart attack. If you had a heart attack, you would be upgraded to full admission. If not, you would be discharged and sent to your doctor for further testing, which might include a stress test, cardiac catheterization, or other testing. The cost to you and your insurance company will be much less because you are not admitted to the hospital.

Direct admission: You have spoken to or seen your doctor, who feels you need to be admitted.

• Your doctor may arrange an ambulance to take you to the hospital or may request that you go to the hospital yourself.
• In cases of direct admission, ask your doctor which hospital to go to.
• Your doctor may reserve a bed and want you to go directly to the floor (or admitting office).

Transfer: You may be transferred to another hospital for several reasons, including the following:

• You can request a transfer at any time but be aware it will take some time to find an accepting doctor and/or hospital bed.
• Your doctor does not practice at the hospital you initially went to.
• You are stable and your insurance will not cover further care at the hospital you were originally admitted to.
• You require specialized care not rendered by the hospital where you are currently.
• Transfers usually require an ambulance with trained personnel to transport the patient. Insurance may not cover the cost for transfer if it is not deemed medically necessary.
• In some cases, your doctor may ask you to go to the emergency department for any number of reasons. This request does not mean you will be admitted. Most doctors that send patients to the emergency department, send them for evaluation and treatment if they decide they cannot do the evaluation or treatment in their office. If they want you admitted, many will simply complete a direct admission. Factors that influence this decision for admission include the following:
  • Need for immediate workup
  • Diagnosis
  • Treatment plan
  • Need for further evaluation
  • Hospital bed availability

Level of care: You will be admitted to a certain level of care in the hospital. You may be upgraded or downgraded from a unit or a floor at any time. That is, you may be transferred to a higher or lower level of care, depending on your medical condition.

• Intensive care unit (ICU): Generally reserved for the sickest people, those who require close nursing supervision, or those who require a ventilator to help them breathe.
• Cardiac care unit (CCU): Like the ICU, but reserved for people with heart problems
• Surgical intensive care unit: For people who have had surgery
• Pediatric intensive care unit (PICU): For children
• Neonatal intensive care unit (NICU): For newborns
• Telemetry or step-down unit: For people who need close nursing support or cardiac monitoring but not intensive care
• Surgery floor: A general floor for people who need surgery
• Medical floor: A general floor for medical care
• Other specialized units or floors, including the following:
  • People who have suffered a stroke (Neurological or Neurosurgical unit)
  • People with cancer (Oncology unit)
  • People who require dialysis or have other kidney problems
• Emergency department holding unit: You are admitted to a floor or unit, but that area is full. You will wait until a bed becomes available.
  • You are then boarded in the emergency department until a bed becomes available.
  • Generally, emergency department nurses continue to care for you.
  • Your personal doctor or the service (hospitalist) doctor is responsible for your care while you are boarded once he or she accepts and admits the patient. In some busy hospitals, this transfer of care may take some time to occur; meanwhile, the emergency doctor manages your care.
  • The emergency doctor will provide care in the case of a life-threatening event but does not provide ongoing care.

Factors determining who is admitted to the hospital are used continually to assess who should be upgraded or downgraded to another level of care.

• In the majority of cases, your private doctor or a hospitalist will write orders for your care.
  • The doctor may dictate them to the emergency department or unit nurse.
  • The doctor may come in personally to write them.
  • Rarely, an emergency department physician will write your admitting orders.
• Although you should not delay care and should go to the closest appropriate emergency department, you should notify your insurance company or health maintenance organization (HMO) of your admission as soon as safely possible. You also should be aware of any of the following issues. Failure to address issues in nonemergency cases may mean you will pay for your care yourself. The issues are as follows:
  • Restrictions your insurance company or HMO has regarding emergency or urgent care
  • What constitutes emergency or urgent care (described previously)
  • When you are required to contact the company or your personal doctor
  • Which hospitals your insurance covers
• If you are ill and you already have gone to a hospital, contact your insurance company or HMO as soon as possible.

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Your rights as a patron of a hospital include:

• Your rights are listed in the hospital's Patient's Bill of Rights.
• If these rights are not given to you or posted, ask for them.
• You must be given a medical screening exam and be evaluated for care whenever you go to a hospital. The severity of your problem will determine your level of treatment after this exam.
• You have the right to considerate and respectful care.
• You have the right to complete information regarding your diagnosis, treatment, and expected recovery in terms that you can understand.
• You have a right to know the name of the doctors and all health care personnel who provide care for you.
• You should be provided with sufficient information about the benefits, risks, and other alternative treatments or procedures to be able to give informed consent for any procedure performed on you.
• You have the right to refuse treatment and to be informed of the possible medical consequences of doing so.
• You have the right to privacy - your doctors or health care providers cannot talk to anyone about your medical care without your permission.
• If you need to be transferred to another facility, the information on why you require transfer must be given to you.
• The hospital you are being transferred to must have accepted you prior to transfer.
• You have a right to know if the hospital has any relationship to other health care or educational institutions and if this relationship affects your care.
• You have the right to know if any experimentation will be performed on you, if it will affect your care, and that you have the right to refuse participation, at any time, for any reason.
• You have the right to reasonable continuing care once discharged.
• You should be informed of appointment times, the location for follow-up, and who will provide follow-up care.
• You have the right to be informed about your continuing health care requirements after you are discharged.
• You have the right to examine and receive an explanation of your bill.
• You have a right to know what hospital rules and regulations apply to your conduct.
• Go to the following section for more on patient's rights and responsibilities for additional general information.

Do not resuscitate (DNR) and health care proxy (medical power of attorney): At some time, you or a loved one may become severely ill, with little or no chance of recovery, or your quality of life will be severely affected if you do survive. Although you have rights (listed above), you are responsible for having an advance directive. Without any directive, your family members or others will have to make decisions about your care if you are unable to communicate your wishes. You should be aware of three types of directives that may help you and your family in this situation if you plan ahead. They are as follows:

Living will: This is a statement, in document form, made by you, that dictates your will regarding your medical care if you become incapacitated with a life-threatening illness. The living will or advance directive clearly explains your wishes and whether you want the doctor to withhold certain types of care if your condition worsens.

• You or a family member should always have this document close by.
• You will need to bring it to the hospital whenever you require immediate care or admission.

Medical power of attorney (health care proxy): With this document, you appoint someone to make decisions regarding your medical care if you become unable to make decisions yourself. Make sure the person understands your wishes when you give them this power.

Do not resuscitate (DNR): The DNR order dictates which procedures you do not want to have carried out on you should you become gravely ill. The basic DNR deals with the following:

• Cardiac compressions (pressing on your chest to circulate your blood) if your heart stops
• Being placed on a ventilator (having a tube placed in your lungs so a machine can breathe for you) if you stop breathing
• Electricity being applied to your chest to start your heart if it stops
• Generally, if you do not want these efforts performed in the event your heart stops or you stop breathing, it refers to all the measures. Because all three measures are interrelated, it makes little sense to allow one or two to occur, but not all three.

• Some people may benefit from being placed on a ventilator - those with severe, isolated, reversible lung problems, for example.
• Being placed on a ventilator can and should be separated from the rest of the DNR order in appropriate cases.
• Speak with your doctor about what you mean when you request DNR for yourself or for a loved one.

• Other considerations also apply to the DNR order.
  • For instance, you may want a DNR order in the event your heart stops or you stop breathing, but you may still want antibiotics, blood products, and any other care - including admission to the ICU or CCU - in the hope that these treatments will cure you.
  • In other situations, you or your family might prefer that only comfort measures be taken after you are admitted. The DNR order might extend to withholding antibiotics, blood products, IV solutions, and other agreed-on treatments.
  • In other words, DNR does not mean "do not treat," unless otherwise specified. It has complex meaning and can be tailored to the needs of either you or your loved ones. Again, make sure you know exactly what the order means when you request it.

Many hospitals give a copy of advance directives to you when you are admitted, along with a copy of the patient bill of rights. Ask for both if you don't receive them. Federal law guarantees these rights.

Many services are available at hospitals, but some may be limited by your doctor and your medical condition.

• Feeding and meals: Generally, you will be given choices and menus for meals.
  • Some people are placed on restricted diets. For example, kidney failure patients are given low sodium, low potassium, and low protein diets; diabetic patients are given special low sugar diets.
  • At any time you may be restricted from eating at all, for instance before a test, surgery, or treatment.
  • At times, family or friends may want to bring you food from the outside. Check with your doctor or nurse for permission.
• Visiting hours are usually posted.
  • There may be restrictions on children, so check prior to bringing them.
  • Other restrictions may be placed to protect visitors or patients. These could include the use of gowns or face masks while visiting.
  • People in the hospital are susceptible to contracting infections. Care should be taken not to visit someone in the hospital whenever you are sick with a communicable disease, such as the flu.
• Family boarding: Hospitals may allow family members to stay overnight in a person's room.
  • This is usually allowed for parents of admitted children.
  • If you wish to board with a child or adult family member, check with the hospital to see if it is allowed.

Other hospital services

Medications: Although the nurse gives you your medications, your doctor writes the orders for them, including the following:

• Route (oral, IV, intra-muscular, rectally)
• Frequency
• Times of day they are to be given
• Your admitting doctor may allow you to use your own prescription and other home medications, ask your doctor about their use because using the hospital pharmacy for all medications can be costly

Television: Some hospitals provide television for free, but many charge for this service. Make sure you understand if you are being charged, as your insurance usually does not cover this charge.

Telephone: You may or may not be charged for local calls. Check before you call. Long-distance charges will, of course, be added to your bill.

Internet: Some hospitals provide free wireless internet services; most require an ID and password that can be obtained from the nurses.

Billing: Before you leave the hospital, you can check with the hospital administration about your bill. Some hospitals offer payment plans and some you can negotiate the final amount owed. If you are a self-pay (no insurance) patient, negotiation of the bill amount is something you should attempt.

When the doctor will see you once you are admitted is determined by his or her schedule. The nursing staff or other doctors cannot make them arrive at your bedside at any specific time.

• You will see your nurse or nurse's aides several times a day.
• Many private or service (hospitalists) doctors will see you in the emergency department if you are admitted there. They may not see you, however, until you reach the floor or until the following day.
  • Do not be alarmed if your doctor does not see you the day you are admitted. Doctors usually make daily visitation rounds, usually at about the same time of day, and you probably will see the doctor by the second day.
  • Ask your nurse when your doctor normally makes visitation rounds.
  • If you haven't seen a doctor by the second day, ask when your doctor will see you.
• Make sure family members know when the doctor likely will be doing daily visitation rounds because it may be the only time they can ask your doctors questions.

The following are some other people you may encounter while you're admitted:

• Hospitalist, Service, or House doctor: A physician who is employed by the hospital to help manage patients who are admitted (the majority are internists).
• Residents, house-staff: If you are admitted to a teaching hospital, you may come into contact with medical students, nursing students, interns, or residents. Residents or house-staff usually follow admitted patients in teaching hospitals.
  • Your doctor may request that a resident cares for you (under his or her guidance) while you are admitted.
  • Residents, house staff, and medical students do not have the experience of your private or service MD but they do work under their guidance.
  • Ask any physician involved in your care his or her name and level of training. If you have any questions regarding the care provided, ask that physician if your private or attending doctor is aware of actions taken.
  • You can request that medical students or residents not take care of you when you are admitted.
  • In general, residents and house-staff elevate the level of care you receive because they are often in-house 24 hours a day and work in teaching hospitals.
• Nurses: While your floor or unit nurse does not write orders, she or he performs countless duties, including the following:
  • Administering your medications
  • Preparing you for surgery or procedures
  • Monitoring your vital signs
  • Starting IV fluids
  • Calling residents, house-staff, or attending physicians when problems arise or your status changes
  • You should ask any nursing personnel caring for you if he or she is a registered nurse (RN - highest level of nursing care), a licensed practical nurse (LPN), or if not a nurse and exactly what level of training she or he has.
• Physician Assistants (PAs) and Nurse Practitioners (NPs): These individuals have specialized training beyond nursing. They make rounds and help your doctor deliver care by ordering tests and treatments. Depending on state requirements, these individuals may diagnose, treat and prescribe medications for patients while under the supervision of approved doctors.
• Consultants: Your admitting physician calls these people in for various reasons. They help diagnose and treat difficult or unusual cases and provide care your admitting physician normally does not give. Consultants are doctors trained in a specific medical specialty such as infectious diseases, plastic surgery, or cardiac electrophysiology and many others.
• Social services: They help with any social problems and will arrange for discharge treatments and follow-up care.
• Aides and orderlies: These people help in the day-to-day functions of your care and hospital admission.

The following are some of the more common tests that could be performed on you during your hospital admission:

• Blood work: Most often is taken from a vein or, occasionally, taken from an artery in your wrist or thigh
• Intravenous: Placing a catheter in a vein (usually in your arm) to start fluid replacement or administer drugs or blood products
• X-rays: Provides a 2-dimensional picture of a body part; limited detail but good for fractures, certain types of abdominal processes, and for lung infections or fluid in the lungs
• CT scan: A doughnut-like machine that takes a 360-degree continuous images of a body segment, such as your head, chest, or abdomen (It provides greater detail than regular X-rays.)
• MRI: A process using magnetism to provide a detailed image of the internal portion of a body segment
  • The MRI uses strong electromagnets to change the hydrogen atoms in your body.
  • When the electromagnet turns off, the hydrogen atoms revert to their original status and give off a unique signal, depending on what other atoms they are next to.
  • A very powerful computer reconstructs this signal.
• ECG: Used to measure the electrical activity of your heart as a sign of damaged heart muscle
• Ultrasound: Bounces sound waves off internal body parts for a dynamic representation of that structure
• Biopsy: Also called surgical or needle biopsy, a means to take a sample of an organ to determine disease status or diagnosis
• Catheterization: Insertion of a tube or catheter into a vein or artery to do one of the following:
  • Obtain a biopsy
  • Inject contrast material into a blood vessel for imaging purposes (for instance, to enhance a CT scan or MRI)
  • Perform a procedure, such as a cardiac catheterization to repair blocked arteries

You may require any combination of these tests plus others so your doctor can make a diagnosis.

• Test results: You should ask your doctor the results of all test performed while you are admitted, especially these:
  • Abnormal results and what they mean
  • How the results affect your diagnosis (what disease or condition you may have)
  • What they mean for your outcome, both short- and long-term

You should be involved in any decisions that may affect your care. Discuss with your doctor any planned treatments, including the following:

• Medications
• Invasive procedures
• Surgeries
  • Ask how effective the treatment usually is, that is, how significant an effect you can expect. (For example, will the treatment cure cancer or just slow the disease? How much pressure reduction will a certain blood pressure medication provide?)
  • Ask what side effects there will be and how severe they will be.
• Cost of the treatment
• Alternative treatments, if available
• You can request a second opinion if you have concerns (you may not be covered by insurance and the second doctor may feel tests need repeating, so you should be aware a second opinion may involve a complete "second" work-up. There is no guarantee that a second opinion will be different from the first.
• How long your treatment will need to be extended once discharged, and how that will be accomplished

Informed consent documents should give you the information you need to determine if you want certain practices or procedures to be performed on you. By signing these documents, you state that you understand what is being done to you, including the risks, benefits, and alternative procedures or treatments. Whenever you are asked to sign an informed consent, be sure you do the following:

• Read the informed consent documents carefully.
• Ask that anything you don't understand be explained fully.
• Make sure it lists these details:
  • If you are being enrolled in research
  • The name of the physician(s) who will perform the procedure or administer the treatment
  • The risks and benefits
  • Alternative treatments, if available
  • What will be done with any bodily tissue fluids
  • What will be done with any photos or video, if taken

Length of your stay: There was a time when your doctor, and your doctor alone, determined how long you would stay in the hospital. Variation in doctors' workups, the high cost of medical care, and other factors have led to a number of initiatives designed to improve and standardize health care, including the admission and discharge process.

Central to these standards is the case manager, usually a nurse.

• The case manager becomes involved early in your admission process and helps track your workup and treatment.
• The case manager most likely uses the Diagnostic Related Group (DRG) listing to help determine whether the workup, treatment, and charges are proceeding along appropriate guidelines.

Diagnostic Related Group (DRG): Modern medicine groups related diagnoses of diseases together. This group, or DRG, provides hospitals, case managers, and insurance providers guidelines about the following:

• A range of expected length of stay
• A standard of workup (what tests should be included to give a proper diagnosis)
• A standard for treatment for any given disease
• If you stay in the hospital past DRG guidelines, your insurance provider may refuse to pay for the additional days.

Discharge planning: Your case manager works with your physician, nurse, and you to determine how long you will stay in the hospital, often following the DRG guidelines. When you are to be discharged, make sure the case manager addresses the following issues:

• Home care: Will you need home nursing care or other arrangements? (For example, will you need to build wheelchair ramps?)
• Medications: What new medication will you need to take, and for how long?
  • Does your insurance cover it and if not (or if you don't have insurance) what will the cost be?
  • Are there alternative medications if the cost is beyond your capacity to pay?
  • Do the medications have side effects?
  • Will they interact with any medications you currently are on?
• Back to work: When can you return to work?
  • Are there limitations to what you can do at work or at home?
  • Your doctor should provide a note for your employer regarding any restrictions.

Other instructions from your doctor or the hospital physician

• Follow-up: Whom should you follow up with and when?
  • On what date is your follow-up visit scheduled?
  • If you are to schedule your own follow-up, whom do you call?
  • What are the phone numbers?
  • Where do you go for follow-up?
• Your bill: Make sure you ask questions regarding your bill before you are discharged. Specifically, the following issues should be covered:
  • Who is responsible to pay for your care?
  • Be sure to check if the hospital has charity care or a sliding-scale fee if you don't have insurance.
  • For itemized bills, make sure no mistakes were made.
  • If there are discrepancies in your bill and the care you receive, bring it to the attention of both the hospital and your insurance company.
• Patient satisfaction: Many hospitals send patient satisfaction surveys to people once they are discharged. This survey is an opportunity for you to voice any problems you had with your care and/or to recognize staff members who offered you service you were particularly pleased with.
  • Most hospitals and their administrators pay close attention to these surveys.
  • If you don't receive a survey and still want to recognize or illustrate problems or satisfaction with your care, you can write a letter to the hospital administrator or appropriate department director.

This article is designed to give the reader a reasonably detailed introduction to hospitals, hospital admissions and hospital practices that affect a person's hospital stay. It is not designed to answer every question about hospitals. However, it is designed to give you some working knowledge of hospitals and may serve as a guide to lead people to the various sources in a hospital that may be able to answer more specific questions. The references provide more details about hospitals and emergency departments.