Things to Know about Hospital Admissions
In the midst of an emergency, it’s hard to think through one’s choices. The first priority is stabilizing your loved one and making sure s/he gets critical care. Nonetheless, it is worthwhile to think through things and have a discussion when there is no emergency so that the family makes choices that are not regretted later.
A life-threatening emergency needs to be handled at the nearest emergency room. That is the protocol of EMT professionals and volunteer ambulance services. And that is what you want.
Transfers to another hospital of your choice after admission through an emergency room are unlikely. Even if the preferred hospital is part of the same system as the first hospital, it is hard to effect a transfer later and get acceptance unless there are very compelling reasons. The patient’s doctor from a participating hospital in the large system may advise and consult but transfer is unlikely.
However, if your patient has a specialty doctor at another hospital and the issue being treated is related to that doctor’s specialty, there is a chance that the patient can be transferred to that hospital. It will involve the doctor’s active participation and involvement of the second hospital’s transfer center. It may involve an emergency room to emergency room transfer if there are no beds available. But you can get to the doctor’s hospital where he has privileges, and he will be involved in your loved one’s care as soon as he gets there. Arrangements will be made for transfer by ambulance service by the accepting hospital whether it is to a regular bed or to the emergency room if there are no beds.
A transfer center at a hospital has many protocols. A doctor is your best advocate for acceptance (nonemergency), but he is not the only cog in the complex system. Often there are several steps to the process that involve detailed doctor-to-doctor conversations. The accepting doctor’s specialty matters: usually the patient will be admitted to the unit (cardiology, med-surg, for example) that is related to the issue or accepting doctor.
It is for this reason that you want to have a conversation with the doctor and his office team when there is no emergency. At a regular visit, raise this question. What do we do when there seems to be a difficult situation? Get some protocols from the medical professionals who care for your patient. All doctor’s offices have a phone recording that says go to the emergency room if there is an emergency, but you want guidance as to when, how, and where. If you are lucky enough for the situation to develop during the day hours when there is someone at the doctor’s office, let them know you are coming to the hospital through the emergency room as per their prior guidance.
Being in a hospital where your patient’s doctor is on staff or there is a formal connection with his practice provides many levels of comfort and care. First, the patient’s records and history are often available from the first minute, especially if the doctor is on staff at the hospital. That is a big thing because even if hospitals are part of the same hospital system, the records are not necessarily accessible and integrated into one system.
Second, the patient’s doctor and his associates will see the patient and be part of the care team. You may have to state this to the team in no uncertain words such as “this patient needs his doctor to be part of the team”, otherwise his effectiveness and role will be mitigated. It is obviously reassuring to the patient and family to know that a familiar trusted professional will participate in the teamwork that is hospital medicine.
There will be many unfamiliar faces, however. A care team consists of several doctors. There may be an attending doctor who leads as well as specialists called in to consult on the case. Keep in mind that the attending doctors and their team members change every few weeks in general departments. Nonetheless, in major teaching hospitals there are higher level doctors available who guide and advise.
A hospitalist system is different, however. Many hospitals today deliver care using the hospitalist model. This means that specially trained doctors who work only in hospitals (usually internists) take care of patients while in the hospital and then hand off care to the primary care physician upon discharge. This means that the primary care doctor of the patient has no role in the hospital care and does not see the patient there.
Get educated in advance. Be prepared and be advised by your medical professionals in advance so you reach the best suited hospital when you need one. You are the patient’s advocate.
Disclaimer: Be advised that this information is merely general and should not be construed as medical advice. Systems and protocols vary, and actions should be guided by appropriate medical professionals.
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