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Medical Author:

Charles Patrick Davis, MD, PhD

Charles Patrick Davis, MD, PhD

Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

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Medical Editor:

William C. Shiel Jr., MD, FACP, FACR

William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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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.

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