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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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There are two major types of admissions, 1) elective and 2) emergency admissions, but there are some variations. The following is a brief description of the major and other admission types:

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 blood transfusion during surgery, ask your doctor if you can set aside or donate blood for yourself, in advance, in case it is required.

Emergency admission: This occurs through the emergency department. You may be admitted to a floor, a specialized unit (for example, the medical or surgical intensive care unit), or a holding ( observation) unit.

Same-day surgery: Technically, this is not an admission.

• With same-day surgery or ambulatory surgery, your doctor will schedule a procedure that will be performed at the hospital.
• You are discharged home the same day after you recover from the procedure.

Holding unit or observation 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 do not spend a full day in the hospital.

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).

Transfer: You may be transferred to another hospital for several reasons, including the following:

• You can request a transfer at any time but be aware it will take some time to find an accepting doctor and/or hospital bed.
• 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 currently.
• Transfers usually require an ambulance with trained personnel to transport the patient. Insurance may not cover the cost for transfer.
• In some cases, your doctor may ask you to go to the emergency department for any number of reasons. This request does not mean you will be admitted. Most doctors that send patients to the emergency department, send them for evaluation and treatment if they decide they cannot do the evaluation or treatment in their office. If they want you admitted, many will simply complete a direct admission. Factors that influence this decision for admission include the following:
  • Need for immediate workup
  • Diagnosis
  • Treatment plan
  • Need for further evaluation
  • Hospital bed availability

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