Admission Process

• Level of care: You will be admitted to a certain level of care in the hospital. You may be upgraded or downgraded from a unit or a floor at any time. That is, you may be transferred to a higher or lower level of care, depending on your needs.
  
  
  • Intensive care unit (ICU) - Generally reserved for the sickest people, those who require close nursing supervision, or those who require a ventilator to help them breathe
    
    
  • Cardiac care unit (CCU) - Like the ICU, but reserved for people with heart problems
    
    
  • Surgical intensive care unit - For people who have had surgery
    
    
  • Pediatric intensive care unit (PICU)- For children
    
    
  • Neonatal intensive care unit (NICU)- For newborns
    
    
  • Telemetry or step-down unit - For people who need close nursing support or cardiac monitoring but not intensive care
    
    
  • Surgery floor - A general floor for people who need surgery
    
    
  • Medical floor - A general floor for medical care
    
    
  • Other specialized units or floors, including the following:
    
    
    • People who have suffered a stroke
      
      
    • People with cancer
      
      
    • People who require dialysis or have other kidney problems
      
      
  • Emergency department holding unit - You are admitted to a floor or unit, but that area is full. You will wait until a bed opens for you.
    
    
    • You are then boarded in the emergency department until a bed becomes available.
      
      
    • Generally, emergency department nurses continue to care for you.
      
      
    • Your personal doctor or the service doctor is responsible for your care while you are boarded.
      
      
    • The emergency doctor will provide care in the case of a life-threatening event but does not provide ongoing care.
• 
  
• Factors determining who is admitted to the hospital are used continually to assess who should be upgraded or downgraded to another level of care.
  
  
• In the majority of cases, your private doctor will write orders for your care.
  
  
  • The doctor may dictate them to the emergency department or unit nurse.
    
    
  • The doctor may come in personally to write them.
    
    
  • Rarely, an emergency department physician will write your admitting orders.
• 
  
• You should notify your insurance company or health maintenance organization (HMO) of your admission as soon as safely possible. You also should be aware of any of the following issues. Failure to follow these rules in nonemergency cases may mean you will pay for your care yourself.
  
  
  • Restrictions your insurance company or HMO has regarding emergency or urgent care
    
    
  • What constitutes emergency or urgent care
    
    
  • When you are required to contact the company or your personal doctor
    
    
  • Which hospitals your insurance covers
• 
  
• Do not delay your care if you have an emergency, however. Go to the closest, most appropriate hospital immediately.
  
  
• If you are ill and you already have gone to a hospital, contact your insurance company or HMO as soon as possible.
  
  
• Your rights as a patron of a hospital
  
  
  • Your rights are listed in the hospital’s Patient’s Bill of Rights.
    
    
  • If these rights are not given to you or posted, ask for them.
    
    
    • You have the right to considerate and respectful care.
      
      
    • You have the right to complete information regarding your diagnosis, treatment, and expected recovery in terms that you can understand.
      
      
    • You have a right to know the name of the doctors and all health care personnel who provide care for you.
      
      
    • You should be provided with sufficient information about the benefits, risks, and other alternative treatments or procedures to be able to give informed consent for any procedure performed on you.
      
      
    • You have the right to refuse treatment and to be informed of the possible medical consequences of doing so.
      
      
    • You have the right to privacy—your doctors or health care providers cannot talk to anyone about your medical care without your permission.
      
      
    • You must be given a medical screening exam and be evaluated for care whenever you go to a hospital. The severity of your problem will determine your level of treatment after this exam.
      
      
    • If you need to be transferred to another facility, the information on why you require transfer must be given to you.
      
      
    • The hospital you are being transferred to must have accepted you prior to transfer.
      
      
    • You have a right to know if the hospital has any relationship to other health care or educational institutions and if this relationship affects your care.
      
      
    • You have the right to know if any experimentation will be performed on you, if it will affect your care, and that you have the right to refuse participation, at any time, for any reason.
      
      
    • You have the right to reasonable continuing care once discharged.
      
      
    • You should be informed of appointment times, the location for follow-up, and who will provide follow-up care.
      
      
    • You have the right to be informed about your continuing health care requirements after you are discharged.
      
      
    • You have the right to examine and receive an explanation of your bill.
      
      
    • You have a right to know what hospital rules and regulations apply to your conduct.
      
      
    • Go to this section for more on patient’s rights in general.
• 
  
• Do not resuscitate (DNR) and health care proxy (medical power of attorney): At some time, you or a loved one may become severely ill, with little or no chance of recovery, or your quality of life will be severely affected if you do survive. You should be aware of 3 types of directives that may help you in this situation.
  
  • Living will: This is a statement, in document form, made by you, that dictates your will regarding your medical care if you become incapacitated with a life-threatening illness. The living will or advance directive clearly explains your wishes and whether you want the doctor to withhold certain types of care if your condition worsens.
    
    
    • You or a family member should always have this document close by.
      
      
    • You will need to bring it to the hospital whenever you require immediate care or admission.
  • 
    
  • Medical power of attorney (health care proxy): With this document you appoint someone to make decisions regarding your medical care if you become unable to make decisions yourself. Make sure the person understands your wishes when you give them this power.
    
    
  • Do not resuscitate (DNR): The DNR order dictates which procedures you do not want to have carried out on you should you become gravely ill. The basic DNR deals with the following:
    
    
    • Cardiac compressions (pressing on your chest to circulate your blood) if your heart stops
      
      
    • Being placed on a ventilator (having a tube placed in your lungs so a machine can breathe for you) if you stop breathing
      
      
    • Electricity being applied to your chest to start your heart if it stops
      
      
    • Generally, if you do not want these efforts performed in the event your heart stops or you stop breathing, it refers to all the measures. Because all 3 measures are interrelated, it makes little sense to allow 1 or 2 to occur, but not all 3.
  • 
    
  • Some people may benefit from being placed on a ventilator—those with severe isolated lung problems, for example.
    
    
  • Being placed on a ventilator can and should be separated from the rest of the DNR order in appropriate cases.
    
    
  • Speak with your doctor about what you mean when you request DNR for yourself or for a loved one.
    
    
  • Other considerations also apply to the DNR order.
    
    
    • For instance, you may want a DNR order in the event your heart stops or you stop breathing, but you may still want antibiotics, blood products, and any other care—including admission to the ICU or CCU—in the hope that these treatments will cure you.
    • 
      
    • In other situations, you or your family might prefer that only comfort measures be taken after you are admitted. The DNR order might extend to withholding antibiotics, blood products, IV solutions, and other agreed-on treatments.
  
  
• In other words, DNR does not mean "do not treat," unless otherwise specified. It has complex meaning and can be tailored to the needs of either you or your loved ones. Again, make sure you know exactly what the order means when you request it.
  
  
• Many hospitals give a copy of advance directives to you when you are admitted, along with a copy of the patient bill of rights. Ask for both if you don’t receive them. Federal law guarantees these rights.