Decision to Admit

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

• Your personal doctor
  
  
• An emergency department doctor in consultation with your doctor
  
  
  • Generally, it is in your interest to ask the emergency department doctor to contact your personal doctor, even if your doctor does not admit patients to the hospital you went to.
    
    
  • 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 service physician (when you don’t have a personal doctor)
  
  
• A covering doctor
  
  
  • 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 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 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 medical problem
    
    
  • Your past medical history
    
    
  • The possibility your medical concern could be serious
    
    
  • Other medical problems that may complicate or cause the current problem to get worse
    
    
  • 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 presence or absence of a private doctor
    
    
  • The availability of close follow-up, if required
    
    
  • Outpatient care fails to improve your condition
    
    
  • You need surgery
    
    
  • Family members or friends relate other details to the admitting doctor or emergency department physician
    
    
  • Insurance issues
    
    
• When you don’t want to be admitted: People who are mentally competent may refuse to be admitted for any reason.
  
  
  • Before you decide, however, get the best information available. Be aware that you may be putting yourself at significant risk of death or disability by not following the admitting doctor’s advice.
    
    
    • Ask why you need to be admitted and discuss the risks and benefits of admission versus going home.
      
      
    • Ask to speak with your doctor.
      
      
  • If you refuse to be admitted, you may be asked to sign out against medical advice (AMA).
    
    
  • If you sign out against medical advice, your insurance company may not cover the costs for that visit.
    
    
    • If you sign out against medical advice, ask for the best advice to care for your problem.
      
      
    • You can always go back to be admitted at any time.
      
      
• Types of hospital stays and admissions
  
  
  • Same-day surgery: Technically, this is not an admission.
    
    
    • With same-day surgery or ambulatory surgery, you schedule a procedure that will be performed at the hospital.
      
      
    • You are discharged home the same day as the procedure.
      
      
  • Emergency admission: This occurs through the emergency department. You may be admitted to a floor, a unit, or a holding unit.
    
    
  • Holding unit 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 23 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 23 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 didn’t spend a full day in the hospital.
      
      
  • 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 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 transfusion during surgery, ask your doctor if you can set aside or donate blood for yourself, in advance, in case you require it
      
      
  • 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)
      
      
  • In some cases, your doctor may ask you to go to the emergency department. Factors that influence this decision include the following:
    
    
    • Need for immediate workup
      
      
    • Need for further evaluation to determine the type of floor you should be admitted to
      
      
    • Bed availability
      
      
  • Transfer: You may be transferred to another hospital for several reasons, including the following:
    
    
    • You can request a transfer.
      
      
    • 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.