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Hospital Admissions (cont.)

Going to the Hospital

  • 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 especially 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.

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