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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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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 medical condition.

• 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 (Neurological or Neurosurgical unit)
  • People with cancer (Oncology unit)
  • 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 becomes available.
  • 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 (hospitalist) doctor is responsible for your care while you are boarded once he or she accepts and admits the patient. In some busy hospitals, this transfer of care may take some time to occur; meanwhile, the emergency doctor manages your care.
  • 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 or a hospitalist 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.
• Although you should not delay care and should go to the closest appropriate emergency department, 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 address issues in nonemergency cases may mean you will pay for your care yourself. The issues are as follows:
  • Restrictions your insurance company or HMO has regarding emergency or urgent care
  • What constitutes emergency or urgent care (described previously)
  • When you are required to contact the company or your personal doctor
  • Which hospitals your insurance covers
• If you are ill and you already have gone to a hospital, contact your insurance company or HMO as soon as possible.

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