How does the hospital admission process work. What are the key steps involved in being admitted to a hospital. Why is clear communication between emergency and inpatient departments crucial for patient care. How can patients prepare for a potential hospital stay.

Understanding the Hospital Admission Process

The hospital admission process is a crucial step in ensuring patients receive appropriate inpatient care. It involves several key stages and decisions that can significantly impact a patient’s treatment and overall hospital experience.

One of the first questions many patients have is: How does the admission process typically unfold? In most cases, patients enter the hospital system through the emergency department (ED). ED physicians assess the patient’s condition and determine whether hospitalization is necessary. If admission is recommended, the ED team initiates communication with the appropriate inpatient department, often involving hospitalists who specialize in managing inpatient care.

Key Steps in Hospital Admission

• Initial assessment in the emergency department
• Decision to admit made by ED physician
• Communication with admitting provider (often a hospitalist)
• Determination of appropriate level of care (e.g., general floor, ICU)
• Admission orders placed by the admitting provider
• Transfer of patient to inpatient unit

While this process may seem straightforward, it often involves complex decision-making and coordination between different hospital departments.

The Role of Hospitalists in Admissions

Hospitalists play a critical role in the admission process, serving as the bridge between emergency care and inpatient treatment. These specialists in hospital medicine are responsible for assessing admission requests from the ED and determining the most appropriate course of action for each patient.

How do hospitalists handle admission requests? Dr. Ann Kellogg, assistant director of the hospitalist program at Sky Lakes Medical Center, provides insight into this process. According to Dr. Kellogg, hospitalists at her facility end up discharging about 10% of patients that emergency physicians initially recommend for admission. This highlights the importance of the hospitalist’s role in evaluating each case and ensuring that hospital resources are used appropriately.

Furthermore, Dr. Kellogg notes that “the ED mislabels between 15% and 20% of admissions, due to patient severity.” This observation underscores the need for careful assessment by hospitalists, who often must conduct additional work-ups after receiving patients from the ED to ensure they are placed in the correct unit.

Challenges in Communication Between ED and Inpatient Teams

Effective communication between emergency departments and inpatient teams is crucial for smooth hospital admissions. However, several challenges can arise during this process, potentially impacting patient care and hospital efficiency.

Common Communication Challenges

1. Premature admission requests before necessary tests are completed
2. Inadequate information transfer between departments
3. Disagreements about the need for admission or appropriate level of care
4. Pressure to meet time-based performance metrics

These challenges can lead to misunderstandings, delays in care, and potential misallocation of hospital resources. How can hospitals address these communication issues? Implementing standardized handoff protocols, fostering interdepartmental collaboration, and regularly reviewing admission processes can help improve communication and patient outcomes.

The Impact of Performance Metrics on Admission Decisions

In recent years, the use of performance metrics has become increasingly prevalent in healthcare settings. These metrics can significantly influence how different departments approach patient care and interact with one another, particularly in the context of hospital admissions.

For emergency departments, key performance indicators often include:

• Door to diagnostic evaluation time
• Admission decision time to ED departure time
• Overall length of stay in the ED

How do these metrics affect the admission process? The emphasis on rapid patient throughput in the ED can sometimes lead to pressure on hospitalists to quickly accept admission requests, potentially before all necessary information is available. This situation can create tension between departments and may occasionally result in premature or unnecessary admissions.

On the other hand, hospitalists are typically evaluated on different metrics, such as patient outcomes, readmission rates, and appropriate resource utilization. This discrepancy in performance measures can sometimes lead to conflicting priorities between ED physicians and hospitalists.

Ensuring Appropriate Patient Placement and Care

One of the critical responsibilities of hospitalists during the admission process is ensuring that patients are placed in the most appropriate care setting. This decision can have significant implications for patient outcomes and efficient use of hospital resources.

How do hospitalists determine the correct level of care for admitted patients? Several factors are considered, including:

• Severity of the patient’s condition
• Need for specialized monitoring or interventions
• Availability of hospital resources
• Potential for clinical deterioration

Dr. Kellogg’s observation that hospitalists often need to conduct additional work-ups after receiving patients from the ED highlights the importance of this assessment process. By carefully evaluating each case, hospitalists can ensure that patients receive the appropriate level of care and are not unnecessarily placed in high-acuity settings like the ICU when a general medical floor would suffice.

Patient Rights and Decision-Making in Hospital Admissions

While much of the admission process focuses on medical decision-making by healthcare professionals, it’s crucial to remember that patients play a vital role in their own care. Understanding patient rights and preferences is an essential aspect of ethical and patient-centered hospital admissions.

Key Patient Rights During Admission

• The right to be informed about their condition and treatment options
• The right to consent to or refuse treatment
• The right to have advance directives honored
• The right to privacy and confidentiality

One critical aspect of patient rights during admission is the discussion of resuscitation preferences. All patients admitted to the hospital are asked about their preferences regarding resuscitation measures, regardless of the reason for their admission or their current health status. This practice ensures that patients’ wishes are respected and that appropriate care plans are in place.

What resuscitation measures might be discussed during admission? These typically include:

• Cardiopulmonary resuscitation (CPR)
• Use of a breathing tube and mechanical ventilation
• Administration of medicines to support heart function
• Electrical shocks to restart the heart

It’s important to note that decisions about resuscitation measures are highly personal and should be made by the patient after discussing the options with their healthcare providers and family members. Patients have the right to change their decision about resuscitation measures at any time during their hospital stay.

Preparing for a Potential Hospital Admission

While hospital admissions are often unexpected, there are steps individuals can take to be better prepared for the possibility of hospitalization. Being prepared can help reduce stress and ensure that important information is readily available to healthcare providers.

Tips for Hospital Admission Preparedness

1. Keep an up-to-date list of current medications and allergies
2. Have important medical information readily accessible, including insurance details and emergency contacts
3. Consider creating advance directives and keeping a copy with you
4. Pack a small “go bag” with essential items for a hospital stay
5. Familiarize yourself with your local hospital’s admission procedures

How can advance preparation benefit patients during admission? By having crucial information readily available, patients can facilitate smoother communication with healthcare providers, potentially expediting the admission process and ensuring that important details about their health history are not overlooked.

The Future of Hospital Admissions: Trends and Innovations

As healthcare continues to evolve, so too does the hospital admission process. Several trends and innovations are shaping the future of how patients transition from emergency care to inpatient settings.

Emerging Trends in Hospital Admissions

• Increased use of telemedicine for pre-admission assessments
• Implementation of artificial intelligence to support decision-making
• Development of streamlined, electronic admission processes
• Greater emphasis on care coordination and transitional care
• Focus on reducing unnecessary admissions through improved outpatient management

How might these innovations impact patient care? By leveraging technology and improving care coordination, hospitals aim to create more efficient and patient-centered admission processes. This could lead to reduced wait times, more accurate placement decisions, and ultimately, better patient outcomes.

One area of particular interest is the potential for AI-assisted triage and admission decision support tools. These systems could help ED physicians and hospitalists quickly assess complex cases and determine the most appropriate care pathways, potentially reducing errors and improving resource allocation.

As healthcare systems continue to adapt to changing patient needs and technological advancements, the hospital admission process will likely become increasingly sophisticated and tailored to individual patient circumstances. This evolution presents both challenges and opportunities for improving the quality and efficiency of inpatient care.

In conclusion, understanding the intricacies of the hospital admission process is crucial for both healthcare providers and patients. By addressing communication challenges, aligning performance metrics across departments, and embracing innovative technologies, hospitals can work towards creating smoother, more effective admission processes that ultimately benefit patient care and outcomes.

Being Admitted to the Hospital – Special Subjects

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:

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.

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 providers as people near the end of life.

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.

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 TV shows and movies, 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 people 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.

How hospitalists handle admission requests from the emergency department

ASK HOSPITALISTS about what happens when the ED wants to admit patients, and you’ll get an earful. ED physicians, they say, regularly make end runs around them with admission requests, first calling specialists who invariably recommend that the patient be admitted to internal medicine.

Or ED doctors click their electronic decision-to-admit button, time-stamping that decision, before they even talk to an admitting provider. Or the ED requests an admission before it has any of the labs or tests back that hospitalists need to decide if the patient should go to the ICU or not.

Ann Kellogg, DO, assistant director of the hospitalist program at Sky Lakes Medical Center in Klamath Falls, Ore. , describes how admission requests play out at her hospital: Hospitalists end up discharging from the ED about 10% of the patients that emergency physicians think should be admitted. And “the ED mislabels between 15% and 20% of admissions, due to patient severity, and we routinely have to do a significant amount of work-up after the ED signs out,” Dr. Kellogg says. “We have to be very proactive to make sure patients aren’t sent to the wrong floor.”

“The ED mislabels between 15% and 20% of admissions, due to patient severity.”

~ Ann Kellogg, DO
Sky Lakes Medical Center

Such scenarios highlight a longstanding tension between the ED and hospital medicine. All too often, the ED wants to identify patients too sick to go home—and let hospitalists figure out where in the hospital those patients need to go.

But in recent years, that tension has been stoked by different metrics being used for ED physicians and hospitalists. For several years, a portion of the reimbursement of many ED physicians has been pegged to several time measures that include patients’ door to diagnostic evaluation time and admission-decision time (typically, when the ED requests an admission) to ED departure time for admitted patients.

ED departure time has a lot to do with when an admitting provider (usually a hospitalist) puts in an admission order. As a result, EDs are pressuring their colleagues on the receiving end of admissions. Hospitalists complain that some EDs even cut corners—with inadequate work-ups, for instance— to make their own times look better.

For now, most hospitalists aren’t being incentivized on how long it takes them to file admission orders on requests. But with ED clinicians watching the clock and hospital administrators pushing ED throughput, hospitalists are under growing pressure to reduce the time they spend evaluating potential admissions and filing admission orders.

How long should orders take?
Another cause of the tension with the ED is that ED doctors often identify hospitalists as the path of least resistance in terms of admissions that should instead go to other specialties. 
”I often hear that hospitalists should have ‘a culture of yes’ and that we should just take on any patient or transfer,” says Kendall Rogers, MD, division chief of hospital medicine at the University of New Mexico Hospital in Albuquerque. But besides not serving the best interests of patients who would be better cared forby another service, he says, that approach is “an incredible danger to professional satisfaction in hospital medicine.”

“I’ve pushed back with a 60-to-90 minute window.”

~ Karri Vesey, RN
Billings Clinic

Before requesting an admission, Dr. Rogers says he expects the ED to complete a work-up to determine not only that the patient should be admitted, but what the appropriate admitting service and level of care should be. In addition, for urgent conditions like sepsis, he expects the ED to start initial treatment, like antibiotics and fluids.

But “we have variable success” nationwide in having EDs make those determinations, he points out. “Too often, hospitalists have to do the primary work-up to make those decisions, and that greatly increases how much time it takes between the request for admission and the admission order.”

Because work-up delays are so common, many hospitalist groups object when EDs push to speed up admission orders. At Billings Clinic in Billings, Mont., for instance, Karri Vesey, RN, the hospitalist department program manager, says the ED wants hospitalists to place admission orders within 30 to 60 minutes. “But I’ve pushed back with a 60-to-90 minute window, and I feel that’s fair,” she says.

Ms. Vesey also tracks how long it takes between admission requests and admission orders. “I always look at how many of our providers are outliers and why,” she adds. “When we get three admission requests five minutes before an ED doctor goes off shift, the time it takes to get to admission orders shouldn’t be on us.”

Mixed results
Still, hospitalists are working hard to process potential admissions faster—sometimes with unintended consequences.

“We’re seen as the easier admission option.”

~ Brian McGillen, MD
Penn State Health Milton S. Hershey Medical Center

At Penn State Health Milton S. Hershey Medical Center in Hershey, Pa., hospitalist Brian McGillen, MD, says that his group began collaborating with its ED in 2017 to help the ED find an accepting service faster. They put in place this workflow change: If the ED calls a particular service with an admission and that service doesn’t feel it should admit that patient, that service—not the ED, whose primary job it had been previously—is now responsible for calling the department it believes is more appropriate.

The good news is that the time between admission request and admission order has fallen from a median of 90 minutes to 68.

The bad news: The hospitalists were immediately identified as “the service most likely to get patients in quickly, and the ED now calls us for admissions that may be better suited for other services,” Dr. McGillen says. That’s left the hospitalists stuck calling different services, then admitting patients themselves when other departments say no.

“Our higher census bears that out, and it hasn’t boosted our morale,” he says. “What was supposed to be a collaboration has shifted work to us because we’re seen as the easier admission option.”

A screening role
At the University of Virginia in Charlottesville, the ED likewise complained about delays in admission orders, particularly when resident teams were called to admit. The ED also had to spend time figuring out which of several general medicine admitting teams they should call.

“Some of these times are dropping just through competition.”

~ Sheryl L. Williams, MD
Baptist St. Anthony Hospital

To solve those problems, the hospitalists in 2016 created a new position: that of admissions and throughput coordinator (ATC). The ATC hospitalist takes all ED admission requests, as well as all requests for direct admissions and transfers.

“The ATC serves as a filter for obvious mistakes,” deflecting admission requests that should go to other services, explains hospitalist director George Hoke, MD. The ATC has helped the group shave significant time off its median time to admission orders.

But when the ATC refuses an admission request, who’s supposed to call the next service line to admit? Unlike at Hershey Medical Center, Dr. Hoke says, that responsibility reverts back to the ED—most of the time.

“If I know there are certain magic words that need to be said to get cardiology to accept that admission, I may make that call myself,” he says. And if the ED calls cardiology and cardiology refuses the admission?

At that point, “if a cardiologist saw the patient in the ED and is still refusing to admit, hospital medicine will take that patient,” he says. “Everyone is tired of waiting.” But if he believes a department is refusing an admission due to some misunderstanding, “I’ll call the attending and discuss. Sometimes, you have to cut out the layers and go to the top.”

Identifying obstacles
According to Dr. Hoke, only half the hospitalists in his group rotate through the ATC role.

“Sometimes, you have to cut out the layers and go to the top.”

~ George Hoke, MD
University of Virginia

“You need some institutional knowledge and that takes years to build, plus you need to know who’s sick enough for the ICU,” he says. “That can be hard for a novice doctor.” And because services get in admission stand-offs, “we’re often asked to mediate and decide where the patient would get the safest care.”

At Hershey Medical Center, Dr. McGillen says the hospitalists and the ED, as well as all the other service lines, are in “sustained discussions” to figure out how to shift more admissions away from hospital medicine and to a more appropriate service. In the meantime, he’s sat down with both the cardiology and orthopedic departments and hammered out admission guidelines for the ED to use.

“We’ve said, ‘Here are the conditions under which you should call this particular service,’ ” he notes. “That’s helped.” It’s also helped to have utilization management nurses embedded in the ED who point out when patients don’t meet admission criteria and steer those patients to observation instead.

But at Billings Clinic, the hospitalists realized they had an admission bottleneck due to legacy care management-utilization management practices. As Ms. Vesey points out, the ED used to not be able to request a bed for an admission, even after a hospitalist or specialist agreed to accept that patient.

“Care managers in the ED used to have to look over all admission orders, and it wasn’t until you got their blessing that you could request a bed,” she says. “Sometimes, that could take time.” Now, the ED can put in preliminary bed requests as long as the admitting service (usually the hospitalists) agrees the patient needs to be admitted. “That gets the ball rolling in bed board and on the floor. ”

Slam-dunk admissions
To improve median times to admission orders, groups are also green-lighting ways to place orders sooner for slam-dunk admissions, even before hospitalists evaluate patients in the ED. At the University of Virginia, for instance, “the ED can request a ‘fast-track’ evaluation” for a patient it considers a straightforward admission, says Dr. Hoke.

“When you’re past capacity, the rapid admission is not your most important throughput metric.”

~ Kendall Rogers, MD
University of New Mexico Hospital

In such cases, the ATC OKs the fast-track admission over the phone and allows the ED to put an admission order in, even before calling the resident or hospitalist admitter to go see the patient.

At Baptist St. Anthony Hospital in Amarillo, Texas, hospitalist Sheryl L. Williams, MD, the hospital’s medical director of quality, baselined the hospitalists’ data on their median time to admission order earlier this year. She found it was between 60 and 70 minutes.

“So we thought, ‘How can we make this time shorter?’ ” she says. She and many of her fellow admitters—and in Dr. Williams’ group, admitters do only admissions and don’t rotate between admitting and rounding—have started putting in single admission orders on patients they consider slam-dunks.

“We do this before we walk in the door to evaluate the patient,” she says, “and the order specifies the admitting physician, the attending and the level of care required.” That order allows for early bed assignment and preparation for transfer. It has also “cut anywhere from 15 to 45 minutes off our time clock.” A full set of orders can then be placed as patients are prepared for and transported to their destination floor.

What’s also worked is making a chart every month out of individual hospitalists’ median times to admission orders, color-coding it green, yellow and red, and posting it on the wall of the hospitalists’ office.

“It’s in a locked office so we’re the only ones who see it,” she says. “Some of these times are dropping just through competition.”

The case for full staffing
At the University of New Mexico, Dr. Rogers says that several initiatives now being discussed or implemented should help speed up admissions.

For one, the hospitalists plan to start staffing a 24-hour ED triage role. They are also about to implement having all admission requests be communicated between ED and hospitalist attendings, not residents.

And a new position at his medical center with 80% protected time begins this month: an executive director of patient flow. Dr. Rogers says that physician, a family medicine hospitalist who’s worked at the center for years, will “help further develop admission guidelines, evaluate different chokepoints in the admission process and intervene when admitting services disagree.”

Dr. Rogers also points to other factors that he believes are lost in the rush to beat the clock.

“When you’re past capacity, the rapid admission is not your most important throughput metric,” he says, adding that his center is almost always over 100% capacity. “Anytime you have ED boarders, your most important metrics are being able to dispo patients out of the hospital and prevent unnecessary admissions.” To that end, his hospital medicine division just got the approval it needed to hire significantly more FTEs. Many will be devoted to day coverage.

“You can’t put all your resources upfront and not be clearing beds,” he points out. “To facilitate throughput, we need full staffing upstairs first.”

Ramping up observation
Dr. Rogers says he’d also like to see standardization nationally of ED observation.

“In some institutions, ED observation is used for only a small, defined number of conditions,” he says. Some hospitals, however, are placing patients in ED observation as soon as ED physicians can’t make a definite admission decision about patients after initial studies come back or when they need to wait hours for test results. “That use of ED obs status can have a big impact on reported metrics.”

We also need, Dr. Rogers adds, agreement on when the time stamp for “decision to admit” occurs. “Once you have a complete work-up that determines the need for admission and the appropriate service and level of care, that’s the time you can make a decision to admit.” Further, “that time should be mutually agreed upon by both ED and hospitalist attendings.”

And despite hospitalists’ frustration with the ED, Dr. Williams counsels taking a collegial—and interdisciplinary—approach.

“We have a whole bunch of buckets: the door-to-doc bucket, the doc-to-admit bucket, the decision-to-admit-to-admission-order bucket,” she points out. “All the doctors involved know how to game their own buckets—and then we all dump on the nurses who are charged with actually getting the patients out of the ED.”

Instead, “we should all be looking at the entire length of stay in the ED,” says Dr. Williams, “not trying to offload time on one another.”

Phyllis Maguire is Executive Editor of Today’s Hospitalist.

Admission orders and quality incentives

HOW CLOSELY ARE hospitalists being tracked on how long they take to put in admission orders after the ED requests an admission? And should hospitalists be incentivized for that time as part of a group—or even individual—quality bonus?

At Penn State Health’s Milton S. Hershey Medical Center in Hershey, Pa., hospitalist Brian McGillen, MD, notes that his group’s times are measured and reported every week.

Interested in more about hospitalist incentive plans? See What’s in your incentive plan

But “it’s a service-line only measurement,” he notes, adding that the data are shared among only the inpatient service leadership. “The data go down to the physician level, but we tend to not pull out names.” And while his institution hasn’t suggested making the metric part of hospitalists’ quality bonus, he says he “would have pushed back hard” against any such effort.

“There are too many factors at play that an individual hospitalist doesn’t control,” says Dr. McGillen, adding that he worries that the “right” admission is being sacrificed for the “fast.”

But at Sky Lakes Medical Center in Klamath Falls, Ore., the hospitalists several years ago did include a 90-minute window between admission request and order as one of several metrics that made up their quality bonus. The group got rid of that metric last year, says Ann Kellogg, DO, assistant director of the hospitalist service, because “we were all largely meeting it.”

“We have a residency program separate from our hospitalist service and we work with residents at night,” Dr. Kellogg says. “They routinely aren’t able to get that time under 90 minutes, but the hospitalists had no problem.”

And at Baptist St. Anthony Hospital in Amarillo, Texas, Sheryl L. Williams, MD, the medical director of quality for the hospital, says that she and the hospitalist medical director are considering making the metric part of the hospitalists’ quality bonus, beginning next year. They haven’t yet decided whether to make it a group or individual metric.

But before such an incentive could be put in place, everyone would need to agree on certain ground rules. Chief among them: What constitutes a true outlier?

“Say the ED first tries to get the surgeons to admit, but the surgeons refuse and then the ED asks another service and then another,” Dr. Williams says. “Finally, the hospitalists—because we are at the bottom of the hill—admit the patient.” That all adds up to a three-hour delay that hospital medicine shouldn’t be dinged for. “There needs to be a legitimate way to scrub out the outliers.”

Published in the August 2019 issue of Today’s Hospitalist

How to Get Admitted to the Hospital

Getting admitted to a hospital involves a serious medical condition or specific diagnosis that warrants immediate and overnight care. In a non-emergency situation, bringing complete personal information and an advocate to speak on behalf of the patient can result in a faster admission. In an emergency situation, the attending physicians will make a decision on admission during the triage stage when a patient arrives for initial evaluation.

How to Get Admitted to the Hospital

Expect a doctor to make the decision on admittance if you go to the hospital emergency room.

Chest Pain From Cycling Class

Get a referral from a personal physician and approval from the insurance company to increase the likelihood of a swift admission to the hospital. Take these documents to the hospital.

Bring to the hospital your identification, insurance card, Social Security number, home address, telephone numbers and contact information for a relative or friend. In a non-emergency, bringing all personal information should speed up the admissions process.

What Are Personal Attributes?

Consider getting a second opinion from another doctor if an initial visit for a medical complaint fails to result in a hospital admission. A second opinion will be less expensive than a trip to the local emergency room.

Know that a complaint of chest pains often leads to hospital admission, monitoring and observation. Hospital admissions for chest pain and angina climbed 110 percent since 2000, according to Bio-Medicine.com, a website that tracks medical statistics. Complaining of chest pains may result in admission, but after running a series of diagnostic tests, the physicians may send a patient home if the results show nothing or are inconclusive. Such an effort could result in nothing more than a large medical bill.

Warnings

While legal procedures vary by state, a suicide threat virtually guarantees a 72-hour admission to a medical facility: specifically a psychiatric ward for secure observation. Automatic admission for suicide threats is a policy intended to protect the patient from self-harm while protecting the public as well. Such policies also protect medical providers from potential legal liability. For example, Florida law states that “when a patient goes beyond verbalizing thoughts of suicide to verbalizing an actual plan for suicide, caregivers have an immediate legal responsibility to seek admission of the patient for inpatient psychiatric care. ” Using a threat of suicide to gain admission to a hospital for other medical reasons is unlikely to be effective, since the patient will probably be sent to a mental-health institution for evaluation, observation and either treatment or discharge if doctors determine the suicide threat is an attempt to manipulate a hospital admission.

• Expect a doctor to make the decision on admittance if you go to the hospital emergency room.
• Get a referral from a personal physician and approval from the insurance company to increase the likelihood of a swift admission to the hospital.

You won’t necessarily be admitted to the hospital. Here’s why.

When we take our sick or injured loved ones to the hospital, we often hope that they will be admitted. In many instances, this is a very reasonable request. When heart or lung disease are at work, when severe infections, dehydration, fractures or strokes occur, admission may well be the only option. However, sometimes our desire to admit our family members is a throwback to a simpler time in medicine; particularly where the elderly are concerned. I don’t know how many times I have heard this, or some variation: “Doc, I know you say she’s fine, and all the tests are normal, but if you could just put mama in for a few days so she could get some rest, I think it would work wonders!”

When I was a younger doctor, without reading glasses and a gray-streaked beard, we called them “social admissions,” but we all knew that they were often necessary for pain control, or simply because the patient’s home life was so horrific. In the days when people were generally admitted by their own physicians, it was simple stuff.

“Hey Billy, Mr. Mason is feeling very weak. We can’t find anything wrong, but he just doesn’t walk well.”

“Wow, Ed, that’s odd. He’s never like that! Let’s just watch him overnight.”

And it was a done deal!

Alas, it’s not that way anymore, and for a number of reasons. First, insurance companies, along with Medicare, are imposing much stricter controls on what they will pay for, both in and out of the hospital. Honestly, many things we used to do as inpatients can be done much more cheaply as outpatients (and without risk).

Second, health care costs are rising. As we live longer, as we learn to treat more severe illnesses and injuries and simultaneously extend health insurance coverage for more people, look for a lot fewer admissions to the hospital as insurers cut costs wherever they can.

Third, admissions are increasingly done by hospitalists, who do only inpatient care. They do excellent work, but they are under enormous pressure to admit only what is necessary and to discharge patients as quickly as possible. Otherwise they (and their hospitals) have to answer to chart reviews and face denial of payment by insurance companies.

Finally, (and perhaps most important) we have fewer admissions because most of us in medicine have figured out that being in the hospital isn’t inherently safer. You see, in hospitals, mistakes are sometimes made. Medication mistakes, transfusion mistakes, surgical mistakes. Falls and other accidents happen. The modern hospital is a chaotic environment, and for all the heroic efforts of the staff, they are entirely human and their patients are remarkably complex, both adding to the risk of error. In addition, even the best hospitals harbor terrible viruses and bacteria which patients can contract from one another. One is well advised to avoid them whenever possible.

It would be nice if we could keep everyone who wanted to stay. Wait, no it wouldn’t. It would be terrible and crowded and unsafe! So the next time you or a loved one has a condition that might lead to admission, take a step back and ask, ‘is there any way to do this as an outpatient?’ The results might be just as good. Or even better.

Edwin Leap is an emergency physician who blogs at edwinleap.com and is the author of the Practice Test and Life in Emergistan.  This article originally appeared in the Baptist Courier.

Reasons for Being Admitted to the Hospital through the Emergency Department, 2003 – Healthcare Cost and Utilization Project (HCUP) Statistical Briefs

Statistical Brief #2

Anne Elixhauser, PhD and Pamela Owens, PhD.

Published: February 2006.

Introduction

In 2003, over 16 million patients entered the hospital through the emergency department—roughly 44 percent of all hospital stays or 55 percent of hospital stays excluding pregnancy and childbirth. Policymakers and health care professionals are concerned about potential overuse and inappropriate use of emergency rooms (EDs). There is also concern that emergency departments care for patients with chronic conditions who may not be receiving adequate outpatient follow-up to control their conditions.

This Statistical Brief presents data from the Healthcare Cost and Utilization Project (HCUP) on the most common reasons in 2003 for all hospitalizations that began in the ED.

Findings

Highlights

• Circulatory disorders (diseases of the heart and blood vessels) were the most frequent reason for admission to the hospital through the ED, accounting for 26.3 percent of all such admissions; injuries accounted for 11.4 percent.

• The top 20 specific conditions accounted for more than half of all hospital admissions through the ED, with pneumonia as the single most common specific condition at nearly one million (5.7 percent) of all such admissions.

• Complications of procedures, devices, implants, and grafts ranked as the ninth most common reason for admission through the ED and included postoperative infections, malfunction of orthopedic devices, and infection of arteriovenous fistulas used for dialysis.

• The top 20 specific conditions admitted through the ED included several chronic conditions: chronic obstructive lung disease, asthma, diabetes, and mood disorders. Also included were fluid and electrolyte disorders; urinary, skin, and blood infections; gall bladder disease, gastrointestinal bleeding, and appendicitis; and hip fracture.

• While up to 82 percent of the most frequent acute conditions were admitted through the ED, a large percentage of chronic conditions were also admitted through the ED; for example, 72 percent of cases with congestive heart failure, chronic obstructive lung disease, and asthma were such admissions.

Major reasons for admission to the hospital through the ED

shows the reasons for admission to the hospital through the emergency department, organized by body system, excluding pregnancy and childbirth. Circulatory disorders were the most frequent reason for admission to the hospital through the ED, accounting for 26.3 percent of all admissions through the ED. Respiratory and digestive disorders were the next most common category of conditions, respectively comprising 15.1 percent and 14.1 percent of all admissions through the ED. Injuries constituted 11.4 percent of all hospital admissions through the ED. Three other body systems each accounted for 5–6 percent of all admissions through the ED: mental health and substance abuse disorders (MHSA), endocrine disorders, and genitourinary disorders.

Figure 1

Reasons for hospitalizations admitted through the emergency department, 2003. Note: All other conditions include nervous system disorders, infections, neoplasms, musculoskeletal disorders, skin disorders, and blood disorders. Admissions for pregnancy, (more…)

Most frequent specific conditions

contains the top 20 specific conditions admitted to the hospital through the ED. These 20 conditions accounted for over half of all admissions through the ED. Pneumonia was the single most common condition admitted to the hospital through the emergency department, with nearly one million hospital admissions or 5.7 percent of all admissions through the ED. This was followed by four conditions related to the heart—congestive heart failure, chest pain, hardening of the arteries, and heart attack—together accounting for over 15 percent of all admissions through the ED.

Table 1

Most frequent specific conditions admitted to the hospital through the emergency department, 2003.

Chronic obstructive lung disease ranked sixth, with nearly half a million hospital admissions. This was followed closely by stroke and irregular heartbeat, each with over 400,000 admissions through the ED. Complications of procedures, devices, implants, and grafts ranked as the ninth most common reason for admission through the ED, with over 400,000 cases and included postoperative infections, malfunction of orthopedic devices (e.g., hip replacements that had worn out), and infection of arteriovenous fistulas used for dialysis. Mood disorders were number 10, with nearly 390,000 cases admitted through the ED.

Among the remaining top 20 conditions were asthma and diabetes (both chronic conditions), three infections (urinary, skin, and blood), three gastrointestinal disorders (gallbladder disease, gastrointestinal bleeding, and appendicitis), one injury (hip fracture), and fluid and electrolyte disorders.

Most frequent acute and chronic conditions admitted through the ED

Chronic conditions are illnesses that generally last longer than one year, have some impact on behavior or lifestyle, and for which a patient is under medical care. The top five most frequent chronic and acute conditions admitted through the ED are shown in . While 65–82 percent of cases with the five most frequent acute conditions were admitted through the ED, a large percentage of chronic conditions were admitted through the ED as well. Most notably, 72 percent of cases with congestive heart failure, chronic obstructive lung disease, and asthma—all chronic conditions that should be controlled on an outpatient basis with good primary care—were admitted through the ED. Almost half of mood disorders (depression and bipolar affective disorders) were admitted through the ED.

Table 2

Top five acute and chronic reasons for hospitalizations with at least 20 percent of admissions through the emergency department, 2003.

Data Source

The estimates in this Statistical Brief are based on data from the HCUP 2003 Nationwide Inpatient Sample (NIS).

Definitions

Types of hospitals included in HCUP

HCUP is based on data from community hospitals, defined as short-term, non-Federal, general, and other hospitals, excluding hospital units of other institutions (e.g., prisons). HCUP data include OB-GYN, ENT, orthopedic, cancer, pediatric, public, and academic medical hospitals. They exclude long-term care, rehabilitation, psychiatric, and alcoholism and chemical dependency hospitals, but these types of discharges are included if they are from community hospitals.

Principal diagnosis and Clinical Classifications Software (CCS)

The principal diagnosis is that condition established after study to be chiefly responsible for occasioning the admission of the patient to the hospital for care. CCS categorizes patient diagnoses into 260 clinically meaningful categories. This “clinical grouper” makes it easier to quickly understand patterns of diagnoses and procedures. For the purposes of this Statistical Brief, the CCS was used in conjunction with the CCS for Mental Health and Substance Abuse Conditions (CCS-MHSA).

Unit of analysis

The unit of analysis for HCUP data is the hospital discharge (i.e., the hospital stay), not a person or patient. This means that a person who is admitted to the hospital multiple times in one year will be counted each time as a separate “discharge” from the hospital.

References

For a detailed description of HCUP and more information on the design of the NIS and methods to calculate estimates, see the following publications:

Steiner, C., Elixhauser, A. and Schnaier, J. The Healthcare Cost and Utilization Project: an Overview. Effective Clinical Practice 5(3):143–51, 2002

Design of the HCUP Nationwide Inpatient Sample, 2003. Online. June 14, 2005. U.S. Agency for Healthcare Research and Quality. http://www.hcup-us.ahrq.gov/db/nation/nis/reports/NIS_2003_Design_Report.jsp

Houchens, R. and Elixhauser, A. Final Report on Calculating Nationwide Inpatient Sample (NIS) Variances, 2001. HCUP Methods Series Report #2003-2. Online. June 2005 (revised June 6, 2005). U.S. Agency for Healthcare Research and Quality. http://www.hcup-us.ahrq.gov/reports/CalculatingNISVariances200106092005.pdf

About the NIS: The HCUP Nationwide Inpatient Sample is a nationwide database of hospital inpatient stays. The NIS is nationally representative of all short-term, non-Federal hospitals. It is sampled from hospitals that comprise 90 percent of all discharges in the United States and includes all patients, regardless of payer. The vast size of the NIS allows the study of topics at both the national and regional levels for specific subgroups of patients. In addition, NIS data are standardized across years to facilitate ease of use.

Preparing for Admission | Johns Hopkins Medicine

When you are getting admitted to a hospital for a scheduled treatment, there is a lot to consider. Having a checklist of what to bring, as well as a list of special instructions from your doctor, can help you stay organized.

What to Bring

Important Documents

Please bring the following items with you when you are being admitted to one of the Johns Hopkins hospitals:

• Your hospital ID card, if you received one on a prior visit. (Some Johns Hopkins facilities issue a card with each visit.)
• Your health insurance cards for all of your insurance plans, including Medicare and Medicaid.
• Personal identification, such as a driver’s license
• Referral and/or authorization forms, if required by your insurance provider
• Your medical records, x-rays, or previous test results (if your doctor has requested them)
• A copy of your advance directive/living will and medical orders for life sustaining treatment (MOLST) if you have these documents
• Money for parking and payment for services such as deductibles and co-payments that may be collected at the time of admission (send unused cash and credit cards home with a family member after you are admitted)

A List of Medications

Please do not bring your medications to the hospital. Instead, please bring a list of all medications, including information about dosage, administration times and any allergies. You will likely be asked about your medications several times by different personnel the day of your procedure. Keeping an accurate, up-to-date list handy can be helpful.

If you have brought your medications, please send them home with a family member or ask our staff to have them sent to the Security Department.

Your Personal Items

Please bring only essential items to the hospital and leave jewelry, keys, watches, extra cash and other valuables at home. Though the hospitals are not responsible for lost or stolen items, we will do our best to work with you to safeguard your belongings while you are here. Some hospital rooms have a safe; ask your nurse if one is available.

If you choose, nursing staff may be able to itemize any valuable that you cannot send home and store them with Security. When you are preparing to leave the hospital, our staff will contact Security to return your valuables.

Here are some more tips on what to bring:

• Toiletries and personal hygiene items
• Comfortable, loose fitting clothes, including sleepwear
• Vision, hearing, dental or breathing aids, such as glasses, contact lenses, dentures or a C-PAP machine, along with their storage cases. Check with your doctor if any of them should not be worn during your procedure.
• Personal electronics, such as laptops, tablets, phones and media players with headphones.

Radios, hair dryers, fans, heaters or electrical appliances are not permitted for safety reasons. It may also be best to remove all jewelry including body piercings and wedding rings, wigs and hair accessories, and leave these items at home.

When You Are Having Surgery

When you are preparing for a planned surgery, you might have some extra steps you may need to complete before your admission.

Your surgeon will require a complete history and physical exam from your primary care doctor. Other tests such as an EKG, chest X-ray and blood test may be required, also.

Some hospitals have a pre-surgery screening center that coordinates all of your required testing. At other hospitals, you may be responsible for contacting your primary care doctor, lab or imaging center, and following your surgeon’s directions for sending the results within the requested time period. View these instructions (PDF) if you are scheduled for an outpatient surgery at Suburban Hospital.

Before Your Procedure

• Inform your surgeon of any medications you are currently taking.
• Contact your surgeon if there is any change in your health.
• Prefill any new prescriptions your surgeon has prescribed.
• Shower the evening before your procedure using an anti-bacterial soap and complete any other cleansing or preparation instructions your surgeon has requested.
• Follow your surgeon’s instructions about eating and drinking before your surgery. You can brush your teeth, but avoid swallowing water or toothpaste.
• Do not apply make-up, cologne, body lotions or powders.

Arriving at the Hospital

On the day of your admission, please be mindful of your appointment time and give yourself plenty of time to get to the hospital or treatment center, park, locate the correct medical building and register at the front desk.

For clinic and outpatient visits, please try to arrive 15 to 30 minutes before your scheduled appointment to allow for registration. For inpatient procedures, please arrive by the specific time requested by our admitting staff or your physician’s office.

Going into hospital

What is it like?

What is hospital like?

When you go into hospital, one of the nurses should ask you for your details. The hospital staff may be dressed in their own clothes or in a uniform. They should wear name badges.

If you have questions about your treatment or your rights, ask a nurse or your key worker on the ward.

Hospital routine

There will be a routine on the ward. There will be regular mealtimes for breakfast, lunch and dinner. There may be a water machine or a kitchen to make hot drinks.

Smoking

You cannot smoke on the ward. The government have made all hospitals smoke free zones. The hospital staff may offer you nicotine replacement therapy (NRT), varenicline or e-cigarettes.

Layout and rooms

In some hospitals you will have a room of your own. Other hospitals may have wards with a few beds in the same room. This is the same as other hospital wards you may have been on. They should not have men and women in the same room. There should always be separate toilets and bathrooms for men and women.

In some cases, you might have to go into a room with people who are not the same sex as you. If this happens the hospital will keep you separated from everyone else to give you privacy. The hospital should put you in a room with the same sex as you. This should be done as soon as possible.

Arrangements for the patient’s accommodation should also consider the patient’s history and personal circumstances, including;

• history and personal circumstances where known, including history of sexual or physical abuse and risks of trauma, and
• the particular needs of transgender patients.

There should be an area where you can spend time away from your room during the day. This is called the common room or day room. These rooms may be for men and women. In some hospitals, there are separate day rooms for men and women.

There should be a chaplaincy or spiritual care service that you can use. These services can be used by anybody of any faith, and by people who are not religious.

Observation on the ward

If staff are worried about you, they may put you on observation. This means that staff will watch over you to make sure that you are safe. For example, staff might check on you every hour. Or stay with you all the time.

Problems with other patients

If you have any problems with any of the other patients on the ward you should tell a member of staff straight away.

Searches on the ward

Staff may look through your belongings when you first go into hospital or when you return from leave. Staff might search you if they think you have something that is not allowed on the ward. They should ask for your permission before they search you.

The hospital should have a written policy on searches. If you are not happy with the way they are searching you, you can ask to see this policy.

If you are in hospital under the Mental Health Act 1983, staff can search your things without your consent. But if they do, they should still:

• ask you first,
• ask your doctor to see if there is any reason why you can’t be searched, and
• give you a good reason why they need to do the search.

If you are detained under the Mental Health Act, and there are good reasons, the staff can search you at anytime. Some of these good reasons maybe you have:

• brought things onto the ward you shouldn’t have,
• had drugs on the ward before,
• self-harmed on the ward with something you hid in your bag, or
• don’t take your medication and hide it in your bag.

If the staff take any of your items they have to:

• tell you why they took it,
• tell you where they will keep it,
• tell you when they will give it back, and
• give you a receipt for them.

The rules for searches are reviewed regularly. The hospital managers are then informed of any changes they need to make.

The hospital staff might want to search the people who visit you. This is more common in higher security hospitals and forensic unit wards. If your visitor does not want this to happen then they cannot force them. But they might not be able to see you, or the visit may be supervised. This depends on the hospital’s security policies.

What sort of ward will I be on?

There are different types of wards in mental health hospitals.

Acute ward

The first time you go into hospital you may go on an acute ward. The staff will assess you and give you treatment. There will be a mix of patients who are in hospital voluntarily and under the Mental Health Act 1983.

Psychiatric Intensive Care Unit (PICU)

This is a ward for people who are very unwell. PICU sounds like “P-Q”. You may be put on this ward if there is a concern you might be at risk of harming yourself or others.

Staff may move you to PICU from an acute ward, or you might go straight to PICU. There are more staff on this ward, so they can give more support.

It is likely that the PICU ward will be locked, and most patients will be in hospital under the Mental Health Act 1983.

Rehabilitation wards

If you are in hospital, you may go to a rehabilitation ward to help you become more independent. It aims to prepare you for living in the community.

Staff may offer you might be offered talking treatments and occupational therapy to help with developing daily living skills. You will be offered more activity and less supervision here.

Specialist wards

You may be admitted to a specialist ward. These may include:

• personality disorder units,
• eating disorder units,
• forensic units for offenders with mental illnesses,
• mother and baby units, and
• young person units.

Children and young people should be in a ward that is suitable for people of their age. This would usually mean a unit with specially trained staff.

The availability of specialist wards varies from area to area. You may need specialist care that local NHS services cannot give you. Your NHS may offer to transfer you to a hospital in another area.

How to get to the hospital: sovenok101 – LiveJournal

From the previous discussion with , an amazing thing became clear. People don’t know how to get emergency medical care without going through an ambulance. Not knowing how the medical service is arranged and at the same time constantly scolding it, this is so in our way. Well, let’s get busy with health education.

Let’s agree on terms first. Under emergency medical care, our Federal Law of 21.11.2011 N 323-FZ (as amended on 05.12.2017) “On the basics of protecting the health of citizens in the Russian Federation” means medical care, which is provided if there is a threat to the patient’s life.This can be with an exacerbation of any chronic diseases or with sudden acute conditions. That is, diabetes mellitus decompensation – yes, but uncomplicated acute otitis media – no.

Let’s say you think that you personally or your loved one are in urgent need of medical assistance. OK. You have several ways:
1) call an ambulance. As we saw from the example from the previous post, this is not always the fastest way
2) come to the hospital yourself. Just come to the emergency room and say: “Hello! I am sick / brought sick. “

And then a piece of paper called
“Conditions and procedure for providing free medical care to citizens of the Russian Federation on the territory … (we substitute the required region)” comes into force.

in the direction of a doctor of a medical organization;

ambulance teams;

in case of self-referral of the patient for emergency indications.

Hospitalization can be emergency or planned. Refusals of emergency hospitalization are prohibited.

So, if you came by gravity, you must be examined, examined, and if the doctor sees the indications for hospitalization, hospitalized. If not, you will be given a certificate of treatment and examination with a diagnosis and recommendations.

For example, in case of the same otitis media, you will be examined by an ENT (if there is one in this hospital), take a blood test and give recommendations on treatment.Well, he recommends the observation of an ENT in the clinic. It is useless to be indignant whether or not there are indications for hospitalization, the doctor of the admission department decides.

Well, in case of diabetes decompensation, you will be hospitalized even if there are no places at all. For this is a life-threatening condition.
Further, if you need emergency medical care, which this hospital cannot provide, for example, you have arrived with acute pyelonephritis, but there is no urological department, then they will either call a urologist on duty from another hospital or arrange for a transfer there by the same ambulance.

Separately, about the time you will spend in the admission department. Theoretically, it is limited depending on the disease, but practically depends on the number of patients and the doctor’s employment. If all the surgeons on duty are in the operating room, then you will wait for the end of the operation with abdominal pain. No pain relief. Alas and ah.

Yes, about the medical policy. It would be nice to have it with you, but no one has the right to demand it from you in case of emergency hospitalization (Law on CHI) Relatives can bring it later.But there is a nuance: without a policy, assistance is provided only until the state is stabilized, and with a policy – in full, provided for by the compulsory medical insurance program. Without a policy, they just won’t let you die, but with a policy they will cure (at least that’s how it is considered).
A passport is also a necessary thing: without it, a person is considered unidentified, no matter how he calls himself. This is especially unpleasant for relatives if the patient died – without a passport, the body is sent to the court morgue.
So in terms of documents, you are not required to do anything, but it is better to have them with you.Ideal copies that you can simply give away at checkout.

In general, the doctors of the admission department do not care how you got there. Except for one nuance: all hospitalizations are signed by the head of the department or the administrator on duty. This is such an anti-corruption component, life is complicated for ordinary doctors. But this is not your seal, remember the documents mentioned above.

In general, that’s all. Of course, it is more convenient for the doctors of the waiting room to see the patient in the ambulance: there is a preliminary diagnosis, it is already clear what to do with the patient, and there are fewer pieces of paper.But this is again the problem of the doctor’s reception. They have no right to refuse you help.

So do not be afraid of independent actions. You look, you will get help faster and earn a plus in karma from the ambulance, which you did NOT tear away from a completely helpless patient.

Hospitalization procedure (for compulsory medical insurance, voluntary medical insurance, on a commercial basis)

Hospitalization procedure (for compulsory medical insurance, voluntary medical insurance, on a commercial basis)

The procedure for hospitalization for patients under the compulsory medical insurance

Emergency hospitalization

When a patient is admitted to the hospital by ambulance, he must have a passport, a compulsory medical insurance policy, preferably an extract from the medical history or a medical card.If they are absent, ask relatives to bring documents.

Planned hospitalization

1. Obtain a referral for hospitalization at the Vvedensky hospital at the clinic at the place of registration.

2. Contact the head of the department of the hospital according to the profile of the disease in order to clarify the terms and procedure of hospitalization.

3. Sign the period of hospitalization with the deputy chief physician for the medical department.

4. On the appointed day, arrive for hospitalization from 09:00 to 13:00 at the admission department of the hospital, with you have a passport, compulsory medical insurance policy, referral, the results of the necessary tests and fluorographic examination, change shoes, a dressing gown (tracksuit).

The procedure for hospitalization for patients under the VHI

1. When you receive a referral for hospitalization, call the insurance company to clarify which medical services are covered by your health insurance program.

2. Contact the head of the department in order to clarify the terms of hospitalization, as well as the services that you can get under your insurance. Or the company’s specialist himself negotiates the procedure for your hospitalization and services.

Depending on the level of insurance, patients with a VHI policy are provided with one, two and three-bed superior rooms.

Hospitalization procedure for patients on a commercial basis

Hospitalization on a commercial basis is carried out for patients without policies, according to the price list. Patients with compulsory medical insurance policies, if desired, can be accommodated in superior rooms for a fee.

90,000 How to get to our clinic

Required documents

Patients-Muscovites (when applying for compulsory medical insurance) must have:

• referral from the city polyclinic at the place of residence with the signatures and seals of the institution;
• extract from the outpatient card;
• passport of a citizen of the Russian Federation;
• compulsory health insurance policy

Nonresident patients (when applying for compulsory medical insurance) must have:

• referral from the Moscow city polyclinic at the place of actual residence with the signatures and seals of the institution, and it is necessary to have an attachment to this polyclinic with the signatures and seals of the institution;
• extract from the outpatient card;
• passport of a citizen of the Russian Federation;
• compulsory health insurance policy

In our hospital, within the framework of the compulsory medical insurance program, residents of all regions of the Russian Federation receive planned medical care.To obtain free planned hospitalization, please contact the hotline “Capital of Health” at +7 (495) 587 70 88 . Information line working hours: round the clock .

For hospitalization

• Emergency hospitalization (delivery by ambulance teams; referral from polyclinics with ambulance orders; transfer from other medical institutions; self-referral)
• Planned hospitalization (in the direction of the Moscow Department of Health; according to a coupon for the provision of high-tech medical care; in the direction of polyclinics, trauma centers, antenatal clinics; by order of the chief physician for the provision of paid medical services)

Required documents for an appointment for a consultation on planned hospitalization

Patients-Muscovites (when applying for compulsory medical insurance) must have:

• referral from the city polyclinic at the place of residence with the signatures and seals of the institution;
• extract from the outpatient card;
• passport of a citizen of the Russian Federation;
• compulsory health insurance policy

Nonresident patients (when applying for compulsory medical insurance) must have:

• referral from the Moscow city polyclinic at the place of actual residence with the signatures and seals of the institution, and it is necessary to have an attachment to this polyclinic with the signatures and seals of the institution;
• extract from the outpatient card;
• passport of a citizen of the Russian Federation;
• compulsory health insurance policy

In our hospital, within the framework of the compulsory medical insurance program, residents of all regions of the Russian Federation receive planned medical care.To obtain free planned hospitalization, please contact the hotline “Capital of Health” at +7 (495) 587 70 88 . Information line working hours: round the clock .

Duration of hospitalization

Inpatient medical care in case of emergency is provided without delay *.

The waiting period for specialized medical care (except for high-tech) in stationary conditions in a planned form (planned hospitalization) is no more than 20 calendar days from the date the attending physician issues a referral for hospitalization of the patient.Routine hospitalization is provided if there is a referral for hospitalization of the patient. *

* paragraph 2.9. “Territorial program of state guarantees for free provision of medical care to citizens in Moscow for 2018 and for the period 2019-2020”

List of insurance companies for compulsory medical insurance

• JSC Insurance Group Spasskie Vorota-M
• JSC “INSURANCE GROUP” URALSIB “
• JSC “INSURANCE COMPANY” SOGAZ-MED “
• Medical Joint Stock Insurance Company MAKS-M JSC
• OJSC “Rosno-Ms”
• MSK Medstrakh OOO
• SK Ingosstrakh-M LLC
• LLC “RGS-Medicine”
• IC “Vtb Insurance” LLC
• LLC SMK “RESO-MED”

Register of medical insurance organizations operating in the field of compulsory health insurance in the city of Moscow

90,000 How to get an appointment | Regional Clinical Hospital

Recording technologyHow to get an appointment?

“A referral for consultation or hospitalization in the regional hospital is issued only by the attending physician at the place of residence”

If you need to clarify the diagnosis, recommendations for treatment from our specialists or surgical treatment that cannot be carried out in the Central District Hospital, the following actions are necessary: ​​

Attention!

If there is a referral, consultations and diagnostic tests in the KKB are carried out free of charge

Step 1. Direction

The doctor of the polyclinic at the place of residence coordinates the referral to the regional hospital with the medical commission

Step 2: Doctor’s appointment

The attending physician examines you in accordance with the order of the Ministry of Health of the Krasnoyarsk Territory No. 725 org from 23.11. 2015

Step 3. Document approval

The attending physician fills out the referral, makes an extract from your medical record and sends documents to the website of electronic applications of the regional clinical hospital, indicating the specialists whose consultations you need

Step 4 Reservation

In the case of a justified and correct referral, the specialists of the KKB book an appointment for you at the consultative and diagnostic polyclinic indicating the date, time, office to which you should apply, and transfer the information to your medical institution by e-mail

Step 5. Invitation to an appointment

The patient is given a printed invitation for an appointment at the KKB or the text of the invitation is transmitted orally by phone. You just have to arrive at the consultative and diagnostic clinic of the KKB at the appointed time and go to the designated office. The medical card is already in the office, you do not need to contact the reception, just wait for the call

Step 6.Survey

The doctor at the reception may prescribe additional examinations. At the reception, you can agree on a convenient time to visit diagnostic rooms and specialists

We are waiting for you at the Consultative and Diagnostic Clinic of the KKB.
We remind you: if there is a referral, medical assistance in the regional clinical hospital is provided free of charge.

90,000 how to get to the hospital from Murino Homeland on the Neva

An elderly resident of Murino had to wait for hospitalization for almost a week, although relatives suspected he had a coronavirus infection from the first days due to the high temperature, which could not be brought down in any way.Now a man with confirmed viral pneumonia is in a hospital in Kirishi, there are no places closer to hospitals. One cannot count on St. Petersburg with its medical resources – it is another region.

Residents of Murino complain about the absence of a hospital in the city of many thousands.

As the daughter of the sick man told Motherland on the Neva, his father had a high temperature of 39 degrees on 11 June. It was not possible to shoot her down, and relatives called an ambulance by 112. After finding out the patient’s age and finding out that he did not have cough and shortness of breath, the ambulance was informed that there was no reason to leave.Recommendations from doctors on how to bring down the temperature did not help, and on June 13, the pensioner’s wife tried to call a doctor at home through the call center, but could not get through.

A man with a fever had to go to the clinic in person. At the reception, according to his daughter, he was not offered to take a snapshot of the lungs or undergo a test for coronavirus infection, he was prescribed antibiotics and sent home for treatment. On June 16, when a severe cough began, the wife again attempted to call a doctor through the call center, this time quickly and successfully.The arriving doctor suspected bilateral pneumonia and called an ambulance for hospitalization.

They have such a shortage of ambulances that they pick up all the sick like a taxi on the road?

The interlocutor of the publication said that on the way to the hospital, the ambulance, which was carrying her father, took another woman with a fever and cough. “Do they have such a shortage of ambulances that they pick up all the sick like a taxi on the way?” – the daughter of the hospitalized person is perplexed. She is equally worried about what the doctors are guided by when they refuse to immediately hospitalize a person with a temperature of 39 degrees.

Now the man, whose specialists from the Toksovo interdistrict hospital diagnosed bilateral infectious pneumonia, is in the hospital in Kirishi. In Toksovo and Vsevolozhsk, where residents of Murino are attached to hospitals, there are no free beds for patients with covid. Shlisselburg was an alternative option for the pensioner.

Interested in the question, what regulations are doctors guided by when deciding whether to go to a call on suspicion of covid or not?

“Motherland on the Neva” called the hotline for the coronavirus of the Toksovskaya interdistrict hospital.One of the numbers could not be reached. But relatively quickly – only six minutes of waiting – they answered the hotline of the Leningrad Region Health Committee. I was interested in the question of what regulations the doctors are guided by when deciding whether to go to a call on suspicion of covid or not, as well as the equipment of the Toksovskaya interdistrict hospital with ambulances – a huge Murino depends on this medical institution. For both questions, it was proposed to send a written official request to the name of the head physician.It will be directed.

The situation was commented on by deputy of the Murinskoye Urban Settlement municipal district Margarita Cojocaru . She recalled that officially the 60-thousandth, but in fact the 100-thousandth Murino, does not have its own hospital and even a normal polyclinic. All there is is an outpatient clinic, the resources of which are insufficient for all residents of the city. “There should be a hospital in Murino. We compared it with other cities, where the population is even less than ours, they have a hospital, clinics, everything you need, ”says the deputy.

Residents of Murino step over the curb, getting from the Leningrad region to St. Petersburg, call an ambulance and from there go to St. Petersburg hospitals.

As for the linking of Murintsy to the Toksovskaya hospital and the hospital in Vsevolozhsk, the lack of places is not news. Margarita herself, having recently got into an accident, was sent from Murino to a hospital in Lomonosov. Her husband had previously been hospitalized in Otradnoye with a sore throat. “It takes an incredible amount of time to get to both hospitals by public transport.If you get to the hospital, your relatives don’t really visit, you won’t drop by after work, ”comments Margarita.

Meanwhile, Murino is so close to St. Petersburg that in the literal sense it is enough to take a step. Some residents of Murino, in search of medical assistance, go for a trick: “Residential complex“ New Murino ”, for example, is located right on the border – along the curb – with St. Petersburg. Residents of Murino go beyond the curb, call an ambulance and from there go to St. Petersburg hospitals. “

The situation is absurd, but vital. People, most of whom work in St. Petersburg, can use the medical resources of the metropolis only by resorting to tricks. The second option is to patiently wait for guaranteed medical care in your region. But sometimes for this you need to first wait for the aggravation of the condition.

Yulia Medvedeva

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Hospitalization rules

Hospitalization rules

Hospitalization of a patient can be planned and emergency, urgent.

The waiting time for planned medical care in inpatient conditions in accordance with the program of state guarantees does not exceed 30 days from the day the attending physician issues a referral for hospitalization. Emergency hospitalization is carried out immediately at the time of treatment. Emergency hospitalization is carried out according to indications after examination of the patient by the doctor of the admission department.

The procedure for admission and the waiting time for the patient to be examined by a doctor in the admission department of the hospital.

The admission department of the hospital hospital works around the clock, seven days a week and holidays. Around the clock duty in the admission department is provided by doctors: pediatrician (infectious disease specialist), surgeon, neonatologist, orthopedic traumatologist, resuscitation anesthesiologist.

The primary triage of patients in the admission department is carried out by the nurse on duty, who establishes the profile of the medical specialty of the doctor on duty for the initial examination of the patient and the sequence of examination.

The order of the initial examination in the admission department can be changed by the nurse on duty or the doctor on duty, depending on the deterioration of the patient’s condition while waiting for the examination.

When examining a patient, the doctor on duty determines the criteria that are signs of a threat to the patient’s life, provides emergency medical care if necessary and decides on the indications (absolute or relative) for hospitalization.

First of all (1st group) , immediately, patients on duty who need emergency medical care are examined by the doctor on duty, regardless of the channels of admission (via the emergency medical service, self-referral).Emergency medical care is assistance provided in case of sudden acute diseases, conditions, exacerbation of chronic diseases that pose a threat to the patient’s life and require urgent medical intervention.

The next group (2nd stage) are patients delivered by ambulance.

Third group (3rd stage) . These are patients who have already been hospitalized and are in medical departments, but due to the deterioration of their condition, they need to be examined by a doctor on duty in the evening, at night, on weekends and holidays.The doctor examines patients of the 3rd stage directly in the medical departments.

Fourth group (4th stage) , patients who applied to the emergency department with a written medical referral for hospitalization.

Last of all (5th group) the doctor on duty examines patients who applied independently, without referrals. In this group of patients, the waiting period for an examination by a doctor on duty (in the absence of signs of a clear threat to life) is, depending on the number of patients in the 1st, 2nd, 3rd and 4th groups.

When applying to the admission department of patients on their own, without a referral from a medical institution (territorial polyclinic, SSMP), the doctor on duty when examining a patient determines the criteria that are signs of a threat to the patient’s life, performs emergency medical care if necessary and decides on the indications (absolute or relative) to hospitalization in a hospital.

Providing emergency medical care in the admission department.

Emergency care is assistance provided in case of sudden acute diseases, conditions, exacerbation of chronic diseases that do not pose a threat to the patient’s life, and do not require urgent immediate medical intervention.Emergency medical care is carried out in the territorial polyclinic at the place of residence during its opening hours. At the rest of the time – by the ambulance medical personnel.

In the admission department, patients in the presence of indications of the 2nd-5th waiting groups can be provided with emergency medical care. The waiting time depends on the number of patients in the admission department of the 1st, 2nd, 3rd and 4th groups.

After the initial examination of the patient, providing him with emergency or urgent care, if necessary, the doctor on duty decides on the indications for hospitalization in the department according to the profile of the disease (injury) or on the absence of indications for hospitalization.

Indications for hospitalization.

ABSOLUTE INDICATIONS FOR HOSPITALIZATION

• Threat to the patient’s life in acute (emergency) surgical pathology.

90,090 conditions of the patient, requiring urgent medical and diagnostic measures and (or) round-the-clock observation.

CRITERIA FOR SELECTING PATIENTS FOR 24-HOUR HOSPITALIZATION

• impossibility of carrying out therapeutic measures in outpatient settings.
• impossibility of carrying out diagnostic measures in an outpatient setting.

90,090 conditions of the patient requiring round-the-clock monitoring due to the possibility of complications of the underlying disease that threaten the patient’s life.

• the need for constant medical supervision at least 3 times a day.
• The need to perform medical procedures around the clock at least 3 times a day.
• isolation for epidemiological indications.
• a threat to the health and life of others.
• territorial remoteness of the patient from the 24-hour hospital (taking into account the potential deterioration).
• ineffectiveness of outpatient treatment in patients with frequent and long-term illnesses.

90,000 BBC Russian – Country Russia

When my son first went with his father and grandmother to Moscow, everything ended in quarantine in the children’s hospital, where he was taken by ambulance. I was shocked.I don’t know what kind of disease you need to catch in order to be sent to a hospital in the UK, and even under quarantine, but obviously not tonsillitis (acute tonsillitis) – it was with this diagnosis that my son was hospitalized in Moscow.

When I came to visit my son and found out that other children in his ward were with the same diagnosis, my surprise knew no bounds. But I was even more amazed that my son was injected twice a day, drops were instilled into his ears, and before discharge he took blood and urine tests and checked his heart by connecting it to a special apparatus.And the pills were handed out to the house.

Don’t get me wrong. I’m not complaining. My son liked being in a spacious hospital ward with his peers much more than being locked up at home with the same diagnosis. In addition, in the hospital we were fed, that is, we did not have to cook ourselves while on vacation, which is always good. But to say that I am not used to such a reaction of doctors to acute angina is to say nothing.

The fact is that the British public health system (NHS), in order to save money, taught our parents not to go to doctors for nothing.An exception can be made if your child develops a rash, and it does not disappear, even when you roll a glass over the skin (this is a sign of meningitis – almost the only childhood illness that is considered serious). All other diseases, according to the British doctors, should be treated at home with improvised means – “Calpol”, watching TV, and that’s about it.

Being admitted to the hospital is a nightmare for NHS accountants, although it is not directly discussed. When my daughter was only two weeks old, she contracted a runny nose, and our doctor decided that she needed to be hospitalized, since babies can still neither clear their airways on their own, nor take pills.But even in that case, they nevertheless sent us home – however, they strictly punished that if the daughter’s condition worsened, an urgent need to return to the doctor’s appointment. Nothing bad happened. And yet, can you imagine what kind of responsibility doctors are shifting from their shoulders to their parents.

Such an easy attitude of doctors to diseases fosters a kind of dispassion in all British parents, which cannot be said about Russian parents, at least not about my Russian mother-in-law.

British children are also calm about colds, wipe each other’s snotty noses, and pass bacteria on to each other with the same enthusiasm. And we, parents, proudly tell each other how a series of colds strengthens the immunity of our children.

My mother-in-law has a completely different approach. Every time my son’s temperature rises above 39C, she throws a tantrum, locks him in a room with tightly closed windows and tries to insist that I urgently call an ambulance.