Being Admitted to the Hospital
Hospitals provide extensive resources and expertise that enable doctors to rapidly diagnose and treat a wide range of diseases.
However, a hospital can be a frightening and confusing place. Often, care occurs quickly and without explanation. Knowing what to expect can help people cope and actively participate in their care during their stay. Understanding more about what hospitals do and why they do it can help people feel less intimidated by their hospital experience, more in control, and more confident about their health when they are discharged home.
People are admitted to a hospital when they have a serious or life-threatening problem (such as a heart attack). They also may be admitted for less serious disorders that cannot be adequately treated in another place (such as at home or in an outpatient surgery center). A doctor—the primary care doctor, a specialist, or an emergency department doctor—determines whether people have a medical problem serious enough to warrant admission to the hospital.
The main goal of hospitalization is
Thus, hospital stays are intended to be relatively short and to enable people to be safely discharged to home or to another health care setting where treatment can be completed.
For many people, hospital admission begins with a visit to the emergency department. Knowing when and how to go to an emergency department is important. When people do go to the emergency department, they should bring their medical information.
Children may require a parent or other caregiver to stay at the hospital most of the time.
The first step in admission is registration. Sometimes registration can be done before arriving at the hospital. Registration involves filling out forms that provide the following:
People are given an identification bracelet to be worn on the wrist. They should check to make sure the information on it is correct and should wear it at all times. That way, when tests or procedures are done, staff members can make sure that they have the right person.
Whether people are admitted to the hospital through the emergency department or by their doctor, they should bring their medical information.
The most important things people should bring are
If people do not have this information or they are too ill to communicate, family members or friends should provide it if possible, and they should bring all bottles of drugs they can find at home.
People should also bring a copy of their most recent medical summary and records of recent hospital stays. However, many people do not have these records. In such cases, the hospital staff typically obtains the information from the primary care doctor, the hospital records department, or both.
Hospitals recommend that people also bring advance directives and any legal forms that indicate who can make medical decisions for them in case they cannot make decisions for themselves (durable power of attorney for health care).
People should give all of this information to the nurse responsible for getting them settled into a hospital room.
People should also bring the following:
Toiletries, including a razor if used at home
Eyeglasses, hearing aids, and dentures (if they are used at home)
A CPAP (continuous positive airway pressure) machine to help with breathing (if they use one at home)
A few personal items, such as photographs of loved ones, to make them feel more comfortable
Cell phone and cell phone charger
If a child is being hospitalized, parents should bring a comforting object, such as a favorite blanket or stuffed toy.
Because items often get lost in the hospital (especially when changing rooms), all personal items should be marked or labeled. Valuables (such as a wedding ring or other jewelry, credit cards, and large sums of money) should be left at home.
Many people bring their own drugs to the hospital so that they can use their own supply. However, because hospital staff members must document all the drugs people are taking, people are instead given the same or similar drugs from the hospital's supply.
Thus, in general, prescription drugs should be left at home. Exceptions are expensive, unusual, or hard-to-obtain drugs that are taken at home. These drugs should be brought because the hospital may not be able to provide equivalent drugs immediately. Such drugs include rare chemotherapy drugs and experimental drugs. In these cases, the drug is given to the hospital pharmacist who inspects and verifies it before it is given. During the person's hospital stay, the drug is kept in a drug storage area, and the nurse gives the drug to the person.
After admission, people may be taken for blood tests or x-rays or go immediately to a hospital room.
Hospital rooms may be private (one bed) or shared (more than one bed). Even in a private room, privacy is limited and the bathroom is often shared. Staff members frequently go in and out of the room, and although they usually knock, they may enter before people can respond.
Various tests, such as blood or urine tests, may be done to check for problems. Staff members may ask questions to determine whether people are likely to develop problems in the hospital or to need extra help after discharge from the hospital. People may be asked about eating habits, mood, vaccinations, and drugs taken. They may be asked a standard series of questions to evaluate mental function (called mental status testing).
An IV line is placed in almost every person who is admitted the hospital. An IV line is a flexible tube (catheter) inserted into a vein, usually a vein in the crook of the arm. IV lines can be used to give people fluids, drugs, and, if needed, nutrients.
If people stay in the hospital for more than a few days, the IV line may have to be moved to a different place in the arm to avoid irritating the vein.
All people admitted to the hospital are asked what their preferences for resuscitation are, even when they are in the hospital for minor problems and are otherwise healthy. Therefore, people should not assume that this question means they are seriously ill.
Resuscitation measures include the following:
The decision about resuscitation measures is very personal and depends on many factors, including the person's health, life expectancy, goals, values, and religious and philosophical beliefs and on family members' thoughts. Ideally, people should decide on their own after discussing the issues with their family members, doctors, and others. They should not allow others to make this decision for them.
People may decide against resuscitation if they are older and feel they have lived a full life or if they have a serious disorder with a short life expectancy or a disorder that makes their quality of life poor. Doctors may suggest that people decide against resuscitation measures if they have a terminal disorder or a disorder that makes returning to an acceptable quality of life unlikely after resuscitation. If people decide against resuscitation, doctors write do-not-resuscitate (DNR) or do-not-attempt-resuscitation (DNAR) orders on their chart.
The decision against resuscitation measures does not mean no treatment. For example, people who have a DNR or DNAR order are still treated for all disorders they have until their heart stops or until they stop breathing.
If people indicate that they do not know how to answer, doctors assume that they want all resuscitation measures.
People can change their decision about resuscitation measures at any time by telling their doctor. They do not have to explain why.
Ideally, resuscitation measures would restore the body's normal functions, and assistance with breathing and other support would no longer be needed. However, in contrast to what is typically portrayed in TV shows and movies, these efforts have varying degrees of success, depending on the person's age and overall condition. These efforts tend to be more successful in younger, healthier people and are much less successful in older people and in people with a serious disorder. However, there is no sure way to predict who will have a successful outcome after resuscitation and who will not.
In addition, resuscitation can cause problems. For example, rib fractures can result from chest compressions, and if the brain does not get enough oxygen for a while before people are resuscitated, they may have brain damage.
If people indicate that they do not want to be resuscitated (a DNR or DNAR order), a plastic bracelet is applied to their wrist and kept in place during the hospital stay to indicate their preference. Also, a doctor fills out a form called Physician Orders for Life-Sustaining Treatment (POLST) to indicate that they do not want to be resuscitated. People are given this form for their records. Then, those who have a serious illness can post this form prominently at home (for example, on the refrigerator) in case they are found at home unconscious by medics. Formal POLST and similar programs do not exist in every state or community, but their development is spreading rapidly.