Hospitals provide extensive resources and expertise that enable doctors to rapidly diagnose and treat a wide range of diseases.
However, a hospital can be a frightening and confusing place. Often, care occurs quickly and without explanation. Knowing what to expect can help people cope and actively participate in their care during their stay. Understanding more about what hospitals do and why they do it can help people feel less intimidated by their hospital experience, more in control, and more confident about their health when they are discharged.
People are admitted to a hospital when they have a serious or life-threatening problem (such as a heart attack). They also may be admitted for less serious disorders that cannot be adequately treated in another place (such as at home or in an outpatient surgery center). A doctor—the primary care doctor, a specialist, or an emergency department doctor—determines whether people have a medical problem serious enough to warrant admission to the hospital.
The main goal of hospitalization is
To restore or improve health so that people can be safely discharged
Thus, hospital stays are intended to be relatively short and to enable people to be safely discharged to home or to another health care setting where treatment can be completed.
For many people, hospital admission begins with a visit to the emergency department. Knowing when and how to go to an emergency department is important. When people do go to the emergency department, they should bring their medical information.
Children may require a parent or other caregiver to stay at the hospital most of the time.
Registration for Hospital Admission
The first step in admission is registration. Sometimes registration can be done before arriving at the hospital. Registration involves filling out forms that provide the following:
Basic information (such as name and address)
Health insurance information
Telephone numbers of family members or friends to contact in case of an emergency
Consent to be treated
Consent to release information to insurance companies
Agreement to pay the charges
People are given an identification bracelet to be worn on the wrist. They should check to make sure the information on it is correct and should wear it at all times. That way, when tests or procedures are done, staff members can make sure that they have the right person. In many hospitals, the identification bracelet has a unique, personal barcode that health care providers scan prior to giving medications or other treatments or doing tests to ensure the proper care is given to the right person at the right time.
In the United States, a federal law called the Health Insurance Portability and Accountability Act (HIPAA) applies to most health care institutions and clinicians. The act sets detailed rules regarding privacy, access to information, and disclosure of individually identifiable health information, referred to as protected health information.
What to Bring to the Hospital
Whether people are admitted to the hospital through the emergency department or by their doctor, they should bring their medical information.
The most important things people should bring are
A list of all medications they are taking and the doses of the medications (the list should include over-the-counter medications, prescription medications, and dietary supplements, such as vitamins, minerals, and medicinal herbs)
A list of any medication allergies
Any written instructions from their doctor
If people do not have this information or they are too ill to communicate, family members or friends should provide it if possible, and they should bring all bottles of medications they can find at home so that the hospital staff can make a list of those medications for the medical record.
People should also bring a copy of their most recent medical summary and records of recent hospital stays. However, many people do not have these records. In such cases, the hospital staff typically obtains the information from the primary care doctor, the hospital records department, or both.
Hospitals recommend that people also bring advance directives and any legal forms that indicate who can make medical decisions for them in case they cannot make decisions for themselves (durable power of attorney for health care).
People should give all of this information to the nurse responsible for getting them settled into a hospital room.
Personal items
People should also bring the following:
Toiletries, including a razor if used at home
A robe
Sleepwear
Slippers
Eyeglasses, hearing aids, and dentures (if they are used at home)
A CPAP (continuous positive airway pressure) machine to help with breathing (if they use one)
A few personal items, such as photographs of loved ones, to make them feel more comfortable, and, if they wish, something to read
Cell phone and cell phone charger
If a child is being hospitalized, parents should bring a comforting object, such as a favorite blanket or stuffed toy.
Because items often get lost in the hospital (especially when changing rooms), all personal items should be marked or labeled. Valuables (such as a wedding ring or other jewelry, credit cards, and large sums of money) should not be brought to the hospital.
Current prescription medications
Many people bring their own medications to the hospital so that they can use their own supply. However, to ensure patients are receiving the correct type and dose of medication, people are instead given the same or similar medications from the hospital's supply. If people bring medications to the hospital for the doctor or staff to review, the medications are usually returned home by a family member or friend after the medications are recorded in the medical record.
Therefore, in general, prescription medications should be left at home. Exceptions are expensive, unusual, or hard-to-obtain medications. These medications should be brought because the hospital may not be able to provide equivalent medications immediately. Such medications include rare chemotherapy drugs and experimental medications. In these cases, the medication is given to the hospital pharmacist who inspects and verifies it before it is given. During the person's hospital stay, the medication is kept in a storage area, and the nurse gives each dose of the medication to the person.
After Admission
After admission, people may be taken for blood tests or x-rays or go immediately to a hospital room. Before performing any invasive test or providing medical treatment, doctors must obtain permission from the patient or an authorized surrogate decision maker by explaining the potential harms and benefits of the tests and/or treatments. The process is known as informed consent.
Hospital rooms may be private (one bed) or semi-private (more than one bed). Even in a private room, privacy is limited as staff members frequently go in and out of the room, and although they usually knock, they may enter before people can respond.
Various tests, such as blood or urine tests, may be done to check for problems. Staff members may ask questions to determine whether people are likely to develop problems in the hospital or to need extra help after discharge from the hospital. People may be asked about eating habits, mood, vaccinations, and drugs taken. They may be asked a standard series of questions to evaluate mental function (see table Mental Status Testing).
Intravenous (IV) lines
An IV line is placed in almost every person who is admitted the hospital. An IV line is a flexible tube (catheter) inserted into a vein, usually a vein in the crook of the arm. IV lines can be used to give people fluids, medications, and, if needed, nutrients.
If people stay in the hospital for more than a few days, the IV line may have to be moved to a different place in the arm to avoid irritating the vein.
Preferences for resuscitation
All people admitted to the hospital are asked if they have a living will that documents their preferences for resuscitation and what their preferences for resuscitation are, even when they are in the hospital for minor problems and are otherwise healthy. Therefore, people should not assume that this question means they are seriously ill.
Resuscitation measures include the following:
Electric shocks to the heart
Use of certain medications
Insertion of a breathing tube in the throat (intubation) and use of a machine to help with breathing (mechanical ventilation)
Insertion of a feeding tube into the stomach to give nutrition
The decision about resuscitation measures is very personal and depends on many factors, including the person's health, life expectancy, goals, values, and religious and philosophical beliefs and on family members' thoughts. Ideally, people should decide on their own after discussing the issues with their family members, doctors, and others. They should not allow others to make this decision for them.
People may decide against resuscitation if they are older and feel they have lived a full life or if they have a serious disorder with a short life expectancy or a disorder that makes their quality of life poor. Doctors may suggest that people consider deciding against resuscitation measures if they have a terminal disorder or a disorder that makes returning to an acceptable quality of life unlikely after resuscitation. If people decide against resuscitation, doctors write do-not-resuscitate (DNR) or do-not-attempt-resuscitation (DNAR) orders on their chart.
The decision against resuscitation measures does not mean no treatment. For example, people who have a DNR or DNAR order are still treated for all disorders they have until their heart stops or until they stop breathing. Comfort care and treatment for pain are always provided and become a primary focus for health care professionals as people near the end of life.
Did You Know...
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If people indicate that they do not know how to answer, doctors assume that they want all resuscitation measures.
People can change their decision about resuscitation measures at any time by telling their doctor. They do not have to explain why they changed their mind.
Ideally, resuscitation measures would restore the body's normal functions, and assistance with breathing and other support would no longer be needed. However, in contrast to what is typically portrayed in the media, these efforts have varying degrees of success, depending on the person's age and overall condition. These efforts tend to be more successful in younger, healthier people and are much less successful in older adults and in people with a serious disorder. However, there is no sure way to predict who will have a successful outcome after resuscitation and who will not.
In addition, resuscitation can cause problems. For example, rib fractures can result from chest compressions, and if the brain does not get enough oxygen for a while before people are resuscitated, they may have brain damage.
If people indicate that they do not want to be resuscitated (a DNR or DNAR order), a plastic bracelet is applied to their wrist and kept in place during the hospital stay to indicate their preference. Also, a doctor fills out a form called a portable medical order or Provider Orders for Life-Sustaining Treatment (POLST) to indicate that they do not want to be resuscitated. People are given this form for their records. Then, after discharge, those who have a serious illness can post this form prominently at home (for example, on the refrigerator) in case they are found at home unconscious by medics. Formal POLST and similar programs do not exist in every state or community, but their development is spreading rapidly.
