Planning a Hospital Stay

Definition
Purpose
Description
Hospital registration and admission
Results

Definition

Planning a hospital stay includes determining what hospitals or facilities are covered by the patient’s insurance plan, evaluating the credentials of the health care providers and the hospital, gathering information about the hospital, including services offered, scheduling the hospital stay, completing pre-admission testing, receiving and following all of the appropriate pre-admission instructions, registering at the hospital upon arrival, and completing an informed consent form.

Purpose

Patients are admitted to the hospital for a variety of reasons, including scheduled tests, procedures, or surgeries, emergency medical treatment, administration of medication, or to stabilize or monitor an existing medical condition.

Planning a hospital stay helps the patient understand what to expect before admission to the hospital and ensures the patient is physically and psychologically ready.

Description

If the hospital stay was planned, some of the steps involved in preparing for the hospital stay will take place beginning one to two weeks before the patient is admitted to the hospital. Many of these steps will not apply if the hospital stay was unexpected or was the result of an emergency.

Determining insurance coverage

Although there are many types of hospitals available to meet the needs of different patients, the patient’s choice of hospital may be limited by his or her insurance plan. The patient should find out if the selected hospital is approved by his or her plan. If the patient receives care from a facility that is not approved by the health care plan, the patient may be responsible for paying for most or all of the medical expenses related to the hospital stay.

Managed care insurance plans often require pre-certification before any hospital stay, except for emergency hospital admissions. Usually, the patient’s doctor has to authorize the hospital stay, and some types of care provided in the hospital may require insurance clearance.

If the patient has Medicare insurance (for patients over age 65), a semiprivate room, meals, general nursing care, and other hospital services and supplies are covered services. Those services not covered by Medicare include private duty nursing, a private room (unless medically necessary), and television and telephone fees.

The patient may desire to seek a second opinion to confirm the doctor’s treatment recommendations. The patient should check with his or her insurance provider to determine if the second opinion consultation is covered.

FOR PATIENTS WITHOUT INSURANCE COVERAGE. For patients who do not have insurance coverage, other payment options and sources of financial aid can be discussed. The patient should ask to speak with the hospital’s financial counselor for more information.

Evaluating credentials

The patient should find out if the physicians who will provide care in the hospital are board certified. Even though board certification is not required for an individual physician to practice medicine, most hospitals require that a certain percentage of their staff be board certified. There are 24 certifying boards recognized by the American Board of Member Specialties (ABMS) and the American Medical Association (AMA). Most of the ABMS boards issue time-limited certificates, valid for six to 10 years. This requires physicians to become re-certified to maintain their board certification—a process that includes a credential review, continuing education in the specialty, and additional examinations.

KEY TERMS

Anesthesiologist— A specially trained physician who administers anesthesia.

Case manager— A health care professional who can provide assistance with a patient’s needs beyond the hospital.

Catheter— A small, flexible tube used to deliver fluids or medications or used to drain fluid or urine from the body.

Clinical nurse specialists— Nurses with advanced training as well as a master’s degree.

Discharge planner— A health care professional who helps patients arrange for health and home care needs after they go home from the hospital.

Electrocardiogram (ECG, EKG)— A test that records the electrical activity of the heart using small electrode patches attached to the skin on the chest.

General anesthesia— Anesthesia that makes the patient unconscious and not feel pain.

Guided imagery— A form of focused relaxation that coaches the patient to visualize calm, peaceful images.

Infectious disease team— A team of physicians who help control the hospital environment to protect patients against harmful sources of infection.

Informed consent— An educational process between health care providers and patients intended to instruct the patient about the nature and purpose of the procedure or treatment, the risks and benefits of the procedure, and alternatives, including the option of not proceeding with the test or treatment.

Inpatient surgery— Surgery that requires an overnight stay of one or more days in the hospital.

Local anesthesia— Anesthesia that numbs a localized area of the body.

NPO— A term that means “nothing by mouth.” NPO refers to the time after which the patient is not allowed to eat or drink prior to a procedure or treatment.

Nurse manager— The nurse responsible for managing the nursing care on the nursing unit and also supervises all of the other personnel who work on the nursing unit.

Nursing unit— The floor or section of the hospital where patient rooms are located.

Outpatient surgery— Also called same-day or ambulatory surgery.

Pharmacologist— Medication specialist who checks patients’ blood levels to monitor their response to immunosuppressive medications.

Regional anesthesia— Anesthesia that does not makes the patient unconscious; it works by blocking sensation in a region of the body.

Registered nurses— Specially trained nurses who provide care during the patient’s hospital stay. Registered nurses provide medical care, medications, and education, as well as assess the patient’s condition.

Social worker— A health care provider who can provide support to patients and families, including assistance with a patient’s psychosocial adjustment needs and referrals for community support.

A physician’s membership in professional societies is also an important consideration. Professional societies provide an independent forum for medical specialists to discuss issues of mutual interest and concern. They provide a place for doctors to discuss the latest practices and technologies, and to learn from each others’ experiences of cases that went well or poorly. Examples of professional societies include the Society of Thoracic Surgeons (STS) and the American College of Physicians-American Society of Internal Medicine (ACP-ASIM).

To find information about a physician’s qualifications, the patient can call a state or county medical association for assistance. A reference book is also available, The Official ABMS Directory of Board-Certified Medical Specialists, which lists all physicians who are certified by approved boards. This publication also contains brief information about each physician’s medical education and training. The directory can be found in many hospital and university libraries, and in some local libraries.

Evaluating the health care team

Selecting a hospital that has a multi-disciplinary team of specialists is important. The medical team should include surgeons (as applicable), physicians who specialize in the patient’s medical condition (such as cardiologists for heart disease and pulmonologists for lung disease), infectious disease specialists, pharmacologists, and advanced care registered nurses. Other medical team members may include fellows, residents, interns, clinical coordinators, physical therapists, occupational therapists, respiratory therapists, registered dietitians, social workers, and financial counselors.

Evaluating the hospital

The patient should find out if the hospital has been accredited by the Joint Commission on Accreditation of Healthcare Organizations, a professionally sponsored program that stimulates a high quality of patient care in health care facilities. Joint Commission accreditation means the hospital voluntarily sought accreditation and met national health and safety standards.

Here are some questions to consider when evaluating a hospital:

• Does the hospital offer treatment for the patient’s specific condition? How experienced is the hospital staff in treating that condition?
• What is the hospital’s success record in providing the specific medical treatment or procedure the patient needs?
• Does the hospital have experience treating other patients the same age as the potential patient?
• Does the hospital explain the patient’s rights and responsibilities?
• Does the hospital have a written description of its services and fees?
• How much does the patient’s type of treatment cost at the hospital?
• Is financial help available?
• Who will be responsible for the patient’s specific care plan while he or she is in the hospital?
• If the hospital is far from the patient’s home; will accommodations be provided for caregivers?
• What type of services are available during the patient’s hospital stay?
• Will a discharge plan be developed before the patient goes home from the hospital?
• Does the hospital provide training to help the patient care for his or her condition at home?

Hospital services

Usually, the patient receives information about the hospital from the admitting office when the hospital stay is scheduled. This information should include directions to the hospital, parking information, lodging information if the patient is from out of town, types of rooms, and services offered.

Hospital services offered may include:

• Ethics consultation: Bioethics professionals are available at most hospitals to provide advice or help the patient identify, analyze, and resolve ethical issues that may arise during the patient’s care at the hospital.
• Barber or beautician: These services may incur a fee, in addition to the fees of the patient’s hospital stay.
• Complementary techniques such as guided imagery and relaxation tapes, massage therapy, or aromatherapy (to reduce a patient’s stress and anxiety).
• Home care: If home health services will be needed after the patient is discharged, they can be arranged by the social worker or nursing staff.
• Interpreter: An interpreter or other special services may be available to assist patients and family members who do not speak the language or are from out of the country.
• Nutrition therapy: Registered dietitians are available to provide comprehensive nutrition assessment, counseling, and education.
• Ombudsman: Health care personnel available to address concerns and problems about medical services that cannot be resolved by reporting these concerns to the nursing staff.
• Pastoral care: Clergy members are available at most hospitals to provide religious support and services to meet patients’ spiritual needs. Many hospitals also have a small chapel that provides a quiet retreat for patients and family members of all religious backgrounds and faiths.
• Patient education: A variety of services are available to teach patients about their medical condition or to help them prepare for their scheduled tests or procedures. Patient education may include one-on-one instruction from a health care provider, educational sessions in a group setting, or self-guided learning videos or modules. Informative and instructional handouts are usually provided to explain specific medications, tests, or procedures.
• Pediatric services: Many hospitals have dedicated services and programs available to help children, teenagers, and their parents feel better prepared to cope more effectively with hospital stays, surgery, procedures, and other health-related events.
• Social work: Social workers are available to help patients manage the changes that may occur as a result of the patient’s hospitalization. Social workers provide referrals to community resources and can help the family make arrangements for care in the home as necessary after the patient is discharged from the hospital.

Patient rights and responsibilities

All hospitals have a list of patient rights and responsibilities, established by the American Hospital Association. These rights and responsibilities are usually published and posted throughout the hospital. Bylaw, all patients have certain rights. Some patient rights include the right to:

• considerate and respectful care
• complete information about diagnosis, treatment, and expected recovery in terms the patient can understand
• knowledge of the name and function of any health care professional providing care
• informed consent
• the right to refuse treatment to the extent permitted by law and be informed of the medical consequences of refusing treatment

Each patient should obtain a list of his or her rights and responsibilities prior to a hospital admission.

Hospital environment

Most hospital rooms have a bed, bedside table, chair, telephone, television, and bathroom. Some hospitals charge a fee for use of the telephone or television; patients should be notified of these charges prior to their hospital admission. Each patient area has a call signal button so the patient can notify the nursing staff if help is needed. Most hospital rooms are doubles that are shared by two patients. In many cases a private room can be specifically requested in one is available. Some hospitals also have wards in which four or more patients stay in one room. Three nutritionally balanced meals are provided to the patient daily during a hospital stay; daily menus are usually provided for patients to select their food choices, as applicable. (Some patients have dietary restrictions so their food choices may be limited.)

Hospital caregivers

Sometimes, the patient’s personal or family physician is not the attending physician who is in charge of the patient’s overall care and treatment in the hospital. The attending physician may be a doctor on the hospital staff or a specialist. Fellows, residents, or interns may also provide care. Fellows are doctors who receive training in a special area of medicine after their residency training. Residents are doctors who have recently graduated from medical school and are training in a medical specialty. Interns are first-year residents.

Nurses work closely with doctors to supervise the care provided in the hospital. Nurses take the patient’s vital signs, administer medications, provide treatments, and teach patients how to care for themselves. The head nurse, also called the clinical nurse manager, coordinates care for each patient on the nursing unit.

Other health care providers include medical technologists, radiographers, and nuclear medicine technicians who perform diagnostic tests, therapists such as physical therapists, occupational therapists, and speech therapists who provide specialized care as needed, and dietitians who provide nutrition counseling and nutrition assessments. There are several other health care providers who may assist patients during their hospital stay; patients should ask for more information about the types of providers they may be in contact with during the time they are in the hospital.

Information for visitors and family members

It may be helpful for the patient to select a spokesperson from the family to communicate with the health care providers. This may improve communication with the health care providers as well as with other family members. The patient should also communicate his or her wishes regarding the spokesperson’s telephone communications to other family members.

Educational classes may be available for family members to learn more about the patient’s condition and what to expect during the patient’s recovery at home.

If a family member needs to contact the patient or the patient’s other family members, the family member should call the hospital and ask for the nursing unit where the patient is staying. The nursing unit staff can connect the caller to the patient’s room, take a message, or connect the caller to the patient’s family members who are present. Since every hospital has patient confidentiality rules, some information may not be able to be disclosed over the telephone.

Most hospitals prohibit the use of cellular phones in patient care areas, as they interfere with the operation of medical equipment.

Most hospitals are smoke-free environments. There are usually designated outside areas where visitors can smoke.

Most hospitals have designated visiting hours that should be adhered to by family members and friends.

Most hospitals have on-site pharmacies where family members can fill the patient’s prescriptions, gift shops, and a cafeteria. Usually a list of on-site and off-site dining options can be obtained from the hospital’s information desk or social work department.

Preadmission testing

Preadmission testing includes a review of the patient’s medical history, a complete physical examination, a variety of tests, patient education, and meetings with the health care team. The review of the patient’s medical history includes an evaluation of the patient’s previous and current medical conditions, surgeries and procedures, medications, and any other health conditions such as allergies that may impact the patient’s hospital stay. Preadmission testing is generally scheduled for a few days before the hospital admission.

The patient may find it helpful to bring along a family member or friend to the preadmission testing appointments. This caregiver can help the patient remember important details to prepare for the hospital stay.

Preadmission instructions

Preadmission instructions include information about reserving blood products if necessary, taking or discontinuing medications, eating and drinking, smoking cessation, limiting activities, and preparing items to bring to the hospital.

Blood transfusions and blood donation

Blood transfusions may be necessary during surgery. A blood transfusion is the delivery of whole blood or blood components to replace blood lost through trauma, surgery, or disease. About one in three hospitalized patients will require a blood transfusion. The surgeon can provide an estimate of how much blood the patient’s procedure may require.

To decrease the risk of infection and immunologic complications, some hospitals offer a blood donation program if surgery is scheduled or if it is known that blood products will be needed by the patient during his or her hospital stay. Autologous blood (from the patient) is the safest blood available for transfusion, since there is no risk of disease transmission. Methods of autologous donation or collection include:

• Intraoperative blood collection: The blood lost during surgery is processed, and the red blood cells are re-infused during or immediately after surgery.
• Preoperative donation: The patient donates blood once a week for about one to three weeks before surgery. The blood is separated and the blood components needed are re-infused during surgery.
• Immediate preoperative hemodilution: The patient donates blood immediately before surgery to decrease the loss of red blood cells during surgery. Immediately after donating, the patient receives fluids to compensate for the amount of blood removed. Since the blood is diluted, fewer red blood cells are lost from bleeding during surgery.
• Postoperative blood collection: Blood lost from the surgical site right after surgery is collected and re-infused after the surgical site has been closed.

The physician determines what type of blood collection process, if any, is appropriate.

Medication guidelines

Depending on the reason for the hospital stay, certain medications may be prescribed or restricted. The health care team will provide specific guidelines. If certain medications need to be restricted before the hospital stay, the patient will receive a complete list of the medications (including prescription, over-the-counter, and herbal medications) to avoid taking. The patient should not bring any medications to the hospital unless specifically instructed to by the hospital staff. In the majority of cases all necessary medications, as ordered by the doctor, will be provided in the hospital.

Eating and drinking guidelines

Before most procedures, the patient is advised not to eat or drink anything after midnight the evening before the surgery. This includes no smoking and no gum chewing. The patient should not drink any alcoholic beverages for at least 24 hours before being hospitalized, unless instructed otherwise.

Smoking cessation

Patients are encouraged to quit smoking and stop using tobacco products prior to their hospital admission and to make a commitment to be a nonsmoker. Quitting smoking will help the patient recover more quickly. There are usually several community-based smoking cessation programs available. Members of the hospital staff are more than happy to recommend a program to fit the patient’s needs.

Activity

The patient should eat healthy foods, rest, and exercise as normal before a hospitalization, unless given other instructions. The patient should try to get enough sleep, although this can often be difficult if the patient is nervous or anxious about the upcoming hospital stay.

The patient should make arrangements ahead of time for someone to care for children and take care of any other necessary activities at home such as getting the mail or newspapers. The patient should inform family members about the scheduled hospital stay, so they can provide help and support.

Items to bring to the hospital

The patient should bring a list of current medications, allergies, and appropriate medical records upon admission to the hospital. The patient should also bring a prepared list of questions to ask.

The patient should not bring valuables such as jewelry, credit cards, checkbooks, or other such items. A small amount of cash (no more than $20) may be packed to purchase items such as newspapers or magazines. If necessary, patients can secure their personal belongings in the hospital cashier’s office, safe, or vault for safekeeping until discharge. Most hospitals state in their policies that they are not responsible for lost or stolen personal items.

The patient should only pack what is needed. Some essential items include a toothbrush, toothpaste, comb or brush, deodorant, razor (not electric), slippers, robe, pajamas, and one change of comfortable clothes to wear when going home. The patient should also pack eyeglasses, hearing aids, and dentures, including their carrying cases, if applicable. These items should be labeled with the patient’s name when not in use, should be stored in their carrying cases, and put in the bedside stand so they are not lost. They should never be placed on food trays because they may be forgotten and thrown out with the food garbage.

The patient should bring a list of family members’ names and phone numbers to contact in an emergency. The patient may also want to pack a book or other personal item such as a family picture.

Personal electronic devices such as hair dryers, curling irons, electric razors, personal televisions, computers, and other electronic devices are not permitted in the hospital, since these devices may interfere with the hospital’s medical equipment.

Transportation

The patient should arrange for transportation home, since the effects of certain medications given in the hospital make it unsafe to drive.

Hospital registration and admission

Upon arriving at the hospital, the patient first reports to the hospital registration or admitting area. The patient will be required to complete paperwork and show an insurance identification card, if insured. Often, a pre-registration process performed prior to the date of hospital admission helps make the registration process run smoothly. An identification bracelet that includes the patient’s name and doctor’s name will be placed on the patient’s wrist.

If the patient is not feeling well upon arrival to the hospital, a family member or caregiver can help the patient complete the admitting process. Sometimes, a patient’s illness may require that the hospital stay be rescheduled.

Informed consent

The health care provider will review the informed consent form and ask the patient to sign it. Informed consent is an educational process between health care providers and patients. Before any procedure is performed or any form of medical care is provided, the patient is asked to sign a consent form. Before signing the form, the patient should understand the nature and purpose of the procedure or treatment, the risks and benefits of the procedure, and alternatives, including the option of not proceeding with the procedure. Signing the informed consent form indicates that the patient understands and permits the surgery or procedure to be performed. During the discussion about the procedure, health care providers are available to answer the patient’s questions about the consent form or procedure.

Advance directives

As part of the admissions process, the patient will be asked about advance directives. Advance directives are legal documents that increase a patient’s control over medical decisions. A patient may decide medical treatment in advance, in the event that he or she becomes physically or mentally unable to communicate his or her wishes. Advance directives either state what kind of treatment the patient wants to receive (living will ), or authorize another person to make medical decisions for the patient when he or she is unable to do so (durable power of attorney ).

Advance directives are not required and may be changed or canceled at any time. Any change should be written, signed, and dated in accordance with state law, and copies should be given to the physician and to others who received original copies. Advance directives can be revoked either in writing or by destroying the document.

Advance directives are not do-not-resuscitate (DNR) orders. A DNR order indicates that a person—usually with a terminal illness or other serious medical condition—has decided not to have cardiopulmonary resuscitation (CPR) performed in the event that his or her heart or breathing stops.

Admission tests

Some routine tests will be performed, including blood pressure, temperature, pulse, and weight checks, blood tests, urinalysis; chest x ray, and electrocardiogram (ECG). A brief physical exam will be performed.

QUESTIONS TO ASK THE DOCTOR

• How can I prepare myself for the hospital stay?
• Who are the members of the health care team at this hospital?
• What types of questions should I ask my insurance provider to determine if the medical expenses of my hospital stay will be covered?
• What type of tests or procedures will be performed?
• What types of precautions must I follow before and after my hospital stay?
• Will I have to have blood transfusions during my hospital stay?
• Can I take my medications the day I am admitted to the hospital?
• Should I change my diet or eating habits before my hospital stay?
• How long will I have to stay in the hospital?
• What kind of pain or discomfort will I experience and what can I take to relieve it?
• What types of resources are available to me during my hospital stay, and during my recovery at home?
• After I go home from the hospital, how long will it take me to recover?
• What are the signs of infection, and what types of symptoms should I report to my doctor?
• What types of medications will I have to take? How long will I have to take them?
• When will I be able I resume my normal activities? When will I be able to drive? When will I be able to return to work?
• What lifestyle changes (including diet, weight management, exercise, and activity changes) are recommended to improve my condition?
• How often do I need to see my doctor for follow-up visits?

The health care team will ask several questions to evaluate the patient’s condition. The patient should inform the health care team if he or she drinks alcohol on a daily basis so precautions can be taken to avoid complications.

Results

Patients who receive proper preparation for their hospital experience, including physical and psychological preparation, are less anxious and are more likely to make a quicker recovery at home, with fewer complications.

Resources

BOOKS

Buck, Jari Holland. Hospital Stay Handbook: a Guide to Becoming a Patient Advocate for Your Loved Ones. Woodbury, MN: Llewellyn Publications, 2007.

Wachter, Robert M., Lee Goldman, and Harry Hollander. Hospital Medicine, 2nd Ed. Philadelphia, PA: Lippincott Williams & Wilkins, 2005.

Williams, Mark V. et al, eds. Comprehensive Hospital Medicine: an Evidence Based Approach. Philadelphia: Saunders Elsevier, 2007.

PERIODICALS

Hume, Susan. “Six Tips for Hospital Survival.” The Exceptional Parent 37.8 (August 2007): 35–37.

Rentsch, Denis, Christophe Luthy, Thomas V. Perneger and Anne-Francoise Allaz. “Hospitalisation Process Seen by Patients and Health Care Professionals.” Social Science and Medicine 57.3 (August 2003): p.571–577.

ORGANIZATIONS

Agency for Health Care Policy and Research (AHCPR), Publications Clearinghouse. P.O. Box 8547, Silver Spring, MD, 20907. (800) 358-9295. <http://www/ahcpr.gov>.

American Association of Nurse Anesthetists (AANA). 222 South Prospect Avenue, Park Ridge, IL 60068-4001. (847) 692-7050. http://www.aana.com/.

American College of Surgeons. 633 N. Saint Clair Street, Chicago, IL 60611-3211. (312) 202-5000. http://www.facs.org/.

American Hospital Association. One North Franklin, Chicago, IL 60606. (312) 422-3000. http://www.hospitalconnect.com.

American Society of Anesthesiologists (ASA). 520 North Northwest Highway, Park Ridge, IL 60068-2573. (847) 825-5586. http://www.asahq.org/.

Joint Commission on Accreditation of Healthcare Organizations (JCAHO). One Renaissance Boulevard, Oakbrook Terrace, IL 60181. (630) 792-5800. http://www.jcaho.org.

National Heart, Lung and Blood Institute. Information Center. P.O. Box 30105, Bethesda, MD 20824-0105. (301) 251-2222. http://www.nhlbi.nih.gov.

National Institutes of Health. U.S. Department of Health and Human Services. 9000 Rockville Pike, Bethesda, MD 20892. (301) 496-4000. http://www.nih.gov.

Angela M. Costello

Robert Bockstiegel