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This week we are discussing hospital admissions. How do doctors decide if you have to ne admitted? Do they just throw the dice and hope for the best? #hospitaladmission #navigatinghealthcaresystem #caregivers

Photo: Canva

Go here to see other posts in this series.

How do you know if your loved one will be admitted to the hospital? Are there criteria? What are the routes through which you can get there? These are some of the questions I plan to answer here.

Routes through which your loved one can be admitted to the hospital?

Actually, I should start here first. Unless you live in a very small town with a very small hospital, it is unlikely you will be admitted from your doctor’s office anymore. But if I leave that option out, someone will tell me their doctor still does it! It used to be more commonly done when you went to see your doctor and turned up sick enough to be admitted. He would write up your orders and you would head to the hospital. That is a rare thing nowadays with hospitalists treating you while you are in the hospital and your personal doctor treating you in the office. It makes for easier scheduling in the office and the ability to get in to your appointment on time…usually.

More commonly, if your loved one is ill or injured, you are sent to the ER rather than seen at the doctor’s office at all. They do all the tests in the ER, start an IV if needed and decide from there if you are sick enough to be admitted. Sometimes, you are even treated there for a few hours and released, if possible. This is especially true if it is during Covid or flu season and the hospital beds are all full. But that is beside the point. We’re talking about if you are admitted. The ER is a very common route. Your loved one gets there via ambulance or is taken there by you or another family member.

Another way you will be admitted to the hospital is for elective surgery. All that means is that it has been planned ahead instead of being an emergency. You go into the admitting office. Often they have your orders there. Usually, you have had bloodwork done a few days before and you go in the morning of your surgery, having prepared ahead of time according to the directions given you by the surgeon’s office.

No matter which way you are admitted, you need to have this information with you for the person being admitted:

  1. Photo ID (usually a driver’s license)
  2. Insurance/Medicare/Medicaid information
  3. List (either on your phone or on paper) of all medications including vitamins, doses and dose frequency.
  4. List of all allergies including drug allergies and other allergies such as latex, tape, etc. and drugs you don’t tolerate and what that looks like such as vomiting, elevated liver enzymes, etc.

The reason I recommend keeping the list on your phone is because it seems that everyone has a phone and your phone is with you all the time.. I keep mine on the reminders or list app and label it with my husband’s name or my name. It is one less thing I have to remember when I’m running out the door in an emergency. I always grab his wallet. Those 2 things keep it very simple.

When I head for the ER, if I have 5 minutes or if he is going there in an ambulance, I take a few extra minutes to grab a few things so I have a bag in the car in case he is admitted. That way, I don’t have to head home to get all his stuff.  See here for a post on this info. The post has more details on what to take to the ER.

Are there criteria for hospital admissions?

Yes, there very definitely are specific criteria for admissions for the doctor. For example, you can’t decide you are tired and manufacture a reason to put your loved one in the hospital so you can have a rest. There are specific criteria for admissions and there must be a specific diagnosis. Certain diagnoses are only allowed a certain number of days in the hospital unless accompanied by other diagnoses. It is a very complex system. There are constant changes coming all the time. Extra people are hired by both office practices and hospitals to keep up with all the changes that take place in the coding. They make sure the doctors code what they do for the optimum pay when Medicare pays so little for their what they do. By simply leaving off one number, a doctor can miss being paid at all. As I said, it is a complex system.

But back to my point, you need to know that there are specific criteria for a patient being admitted to the hospital. That is why it can take quite awhile for the doctor to know if your loved one will be admitted. If he has a clearcut diagnosis, you are home free. If it is unclear, you have a problem. Then, it is up to the doctor you have.

They may go with their gut a bit. Some doctors need to have all facts and aren’t good at going with their gut. They will send your loved one home. Often, you are tuned in to what is happening with your loved one and when things are starting to go downhill before the facts all aligns you can see what is coming. However, the diagnosis probably isn’t there yet.

If you are working with this kind of doctor, the worst thing you can do is start screaming at him/her. They will just shut down. They don’t deal in emotions. When emotions come at them like that, they will shut down and discharge your loved one. It’s as if you are speaking Russian and they speak English! If you want to communicate with them and get your last bits of facts in, you will have to stay calm. You will have to communicate in facts, symptoms you have observed, changes you have seen in the past 24-48 hours. You may have to describe a time in the past when this same set of problems combined and what happened.

You will have to calm your brain down, write yourself a couple of notes if needed, and state your facts for that doctor if you feel he/she is not hearing you. You will have to start speaking the language of Facts, not Emotion, or you will not get through to a doctor like this. Even with doctors who understand Emotion, you need to speak some of the language of Facts because that is the language they have to use in writing their notes and in speaking to other doctors and in discussing your loved one’s situation. See this post for more help with that language.

Do they agree something is going on with your loved one but don’t have a specific diagnosis? They may admit him for a 24 hour admission to watch and see under some set of criteria. They may give him IV’s overnight and redraw lab in the morning. Maybe they will redo a CT scan in the morning. Some other test or exam will be redone and on the basis of that, they will decide on either a full admission or a discharge. But even for the 24 hour admission, there has to be a specific reason that can be documented…that is allowed. Otherwise, your loved one will be sent home…or back to her nursing home or other residence. In the end, it really won’t make any difference how much you don’t like it.

Can I predict whether my loved one will be admitted to the hospital?

Obviously, it is difficult to predict with 100% certainty because most of the time you will need the results from a specific blood test, physical exam by the doctor, or radiological exam. For example, you may suspect that your loved one is having a heart attack, but until they are checked out at the hospital to see if either their blood tests confirm it or their EKG confirms it or some other exam confirms it, you won’t know for sure. The same goes for a stroke. That can only be confirmed by either a CT scan or an MRI. The same goes for a multitude of other diagnoses.

I have told you most of what I know about admissions now. There is plenty more to know, but this is the layman’s version. If you are reading this and note that I am horribly misinformed, please notify me at grittymartha at gmail dot com. Thanks.

For I, the Lord your God,
    hold your right hand;
it is I who say to you, “Fear not,
    I am the one who helps you.”

Isaiah 41:13 ESV