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Hospital Admissions (cont.)

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 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 your 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 patient's doctors may request that you 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 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).

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