Wednesday, March 4, 2009

Survive when admitted to hospital from clinic or home

Initially I prepared a pretty long post that described how to handle various types of hospital admissions. It's my understanding that long posts are ignored. This is important stuff.

Now I will break it down:

What do I do if my loved one is admitted to the hospital directly from a treating physician?

In this scenario, your loved one is advised by his or her treating physician that a hospitalization is necessary. The treating physician may base the admission decision on an acute need for medical intervention (e.g. my dad's treating oncologist sent dad to the hospital in order to receive IV antibiotics for three days) or on a chronic issue (e.g. infection or side effects from medication or chemotherapy).

The patient's treating physician may make the medical determination when you are in his clinic examining room or when you are at home.

In the former case, the treating physician is likely to put you in a wheelchair or arrange EMS service to transport you directly to the hospital. In the latter situation, you will be asked to transport your loved one to the hospital or contact an ambulance service (911) for transport.

Before you load up the toothpaste or begin calling concerned relatives, slow down and think.

Get the following information from the doctor before you "agree" to the hospital admission:

(1) What medical procedures is the treating physician recommending? Will there be any tests, blood work or x-rays?

(2) Will the admitting/treating physician be primarily responsible for the daily medical needs of the patient? If not, why not?

(3) If the patient will not be treated inpatient by the admitting/treating physician, then who specifically will be treating the patient? Get the name and check whether the physician is board certified.

(4) Will the admitting/treating physician be communicating with and coordinating the patient's care with the hospital physician? If not, why not? If not, does the treating physician have hospital privileges at a facility that would allow him or her to directly follow the patient?

(5) Will the admitting/treating physician be making decisions about discharge? If not, why not?

The bottom line is that it is your responsibility as a caregiver and patient advocate to ensure continuity of care for the patient.

If the treating physician is not involved in the hospital admission then there is more likely to be confusion between medical professionals post discharge. For example, at discharge, the patient will likely be instructed to follow-up with his or her primary care physician. If the physician at the first post discharge appointment has no idea what happened in the hospital then you will be uncomfortable. Moreover, the lack of continuity of care jeopardizes patient safety.

(6) Will a hospital room be ready for the patient by the time he or she arrives at the hospital?

This question is important because (more than once) my dad has been very ill and sent to the hospital. He has shivered in the Duke University Hospital atrium waiting area for hours while a room was being readied. If a room is not ready then the patient should be in an ED room. Period.

Do not let the physician's office push you out of clinic and into a cold admissions office.

Next post: Your responsibilities as a care-giver and patient advocate during the hospital admission. (Hint - it is about much more than sitting quietly, taking notes and stealing the patient's hospital food.)

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