Admission to the hospital
Hospital admission involves staying at a hospital for at least one night or more.
Staying in the hospital overnight is done because the individual is too sick to stay at home, requires 24-hour nursing care, and/or is receiving medications and undergoing tests and/or surgery that can only be performed in the hospital setting.
An individual may be admitted to the hospital for a positive experience, such as having a baby, or because they are undergoing an elective surgery or procedure, or because they are being admitted through the emergency department. Being admitted through the emergency department is the most stressful of these circumstances because the event is unexpected and may be a major life crisis.
Before the person is taken to their room, admitting procedures are performed. The person's personal data is recorded and entered into the hospital's computer system. This data may include:
- home and work telephone number
- date of birth
- place of employment
- emergency contact information, or the names and telephone numbers of those individuals the hospital should contact if the person being admitted needs emergency care or their condition worsens significantly
- insurance coverage
- reason for hospitalization
- allergies to medications or foods
- religious preference, including whether or not one wishes a clergy member to visit
There may be several forms to fill out. One form may be a detailed medical and medication history. This history will include past hospitalizations and surgeries. Having this information readily available will make the process move faster, and can allow a family member or friend who is accompanying the person to help fill out the forms more easily. The hospital may ask if there are any advance directives. This refers to forms that have been filled out indicating what medical decisions one wants others to make on their behalf. One form is called a living will and clearly tells which specific resuscitation efforts the person does or does not want to have performed on them in order to save or extend their life. Another form may be a durable power to attorney. This is a form stating whom the patient wishes to make medical decisions for them if they themselves are unable to do so, such as if they are in a coma. Some hospitals have blank forms that the individual can use to make these designations, others may just ask if the forms have been filled out, and if so to add a copy of them into the person's medical record. They are considered legally binding, and an attorney can assist in filling them out. During the time spent in admitting, a plastic bracelet will be placed on the person's wrist with their name, age, date of birth, room number, and medical record number on it. A separate bracelet is added that lists allergies. Forms are completed and signed, so that the patient is giving full consent to have the hospital personnel take care of them while they are in the hospital during that particular hospital stay. Subsequent hospital stays require new consent forms.
Once all the admitting information has been completed, the next step is usually being taken to one's room. Most people stay in a semi-private room, which means that there are two people to a room. In some circumstances, a person's medical condition may require staying in a private room. If there are private rooms available, and the individual is willing to pay the extra cost (insurance companies generally only cover the cost of a semi-private room), it may be possible to have a private room. Most hospital rooms are set up so that one bed is closer to the door, and the other is next to a window. There are curtains that can be drawn completely around the bed so that some degree of privacy is possible. Once taken to a room, the nurse taking care of the patient will go over the medical and medication history, and orient the person to the room. This means that they will explain how to adjust bed height, how to use the nurse call button, show where the bathroom is located, and explain how to use the bedside telephone and television. The cost for the telephone and television are not usually covered by insurance. There is usually a calendar in the room, to help the patient keep track of the date, as it can be disorienting to be in an unfamiliar place, especially over several days or weeks. There may be limitations on using the bathroom, if the person's doctor feels that the patient's condition is such that they should not get out of bed. These kinds of decisions are made with the person's safety and medical condition in mind. If the person is not thinking clearly, perhaps because of some medication they are receiving, the side rails of the bed may be put up, to prevent falling out of bed. The nurse will review the doctor's orders, such as what tests have been scheduled, whether or not they can get out of bed for the bathroom or to walk around the unit, what medications they will be getting, and whether or not there are restrictions on what they can eat. The hospital will supply towels, sheets, and blankets, but some people like to bring something personal with them from home. Because of the risk of infections being transferred from one patient to another, one may prefer to leave things at home. If one does choose to bring in something personal, it should be washed with warm or hot water and soap to make sure that germs are not brought home from the hospital.
Sometimes when people are admitted to the hospital they need extremely close observation that can only be given in specialized care called an intensive care unit . Because of the severity of their condition, visiting hours are more restricted than in the regular rooms. It may be that only one or two people can visit at a time, and only for a few minutes at a time. Once the person's condition improves, they may then be transferred to a room with a less rigid visitation policy. If an individual has a surgical procedure performed, they will spend a few hours in a recovery area. This is to make sure that the person's condition is stable before returning to the regular room. Visiting is limited in the recovery area, and the person may spend most of the time sleeping, as the effects of the surgical anesthesia wear off.
If the person entering the hospital is a child, the parents or guardian will fill out the hospital forms. Most hospitals allow parents and guardians to stay overnight in the hospital with the child, and to be with them 24 hours a day. Many hospitals have special areas for children to play in, and even areas in which they do not have anything done to them which is painful, so they can completely relax.
If the hospitalization is prearranged, there are preparations that will make the process go more smoothly. It is helpful to have a list of all medications currently being taken, the dosages, how often they are taken, and the reason for taking them. The list should also include any allergies to food and medications, including a description of the reaction, and when the food or medication was last taken. The list should include over-the-counter (OTC) and prescription medications, vitamins, supplements, and herbal and home remedies.
If the hospital stay involves surgery in which there is the potential for significant blood loss, it may be possible to arrange to have blood drawn and stored so that in the event of a transfusion , the individual receives his or her own blood.
If the hospital stay is an extended one, a list of family and friends, with their telephone numbers, can make it easier to stay in touch with people who can come and visit, or offer support by telephone. It is not a good idea to bring anything of value to the hospital as there are many times when one could be out of the room. However, it may be helpful to have some pocket change available if one needs to make some small purchases at the hospital gift shop, such as a newspaper. If one is going to visit someone in the hospital, change or one dollar bills to use at vending machines may come in handy.
A small bag can be brought into the hospital that contains:
- night clothes (The hospital supplies their own, but some people like to wear familiar clothing; some people use the hospital outfits to decrease the chance of staining their own clothing or bringing germs home from the hospital.)
- a robe
- clothes for the return trip home
- reading material for the hospital stay
- hobby materials such as knitting or a book of crossword puzzles
- reading glasses
- personal care items such as comb, brush, and toothbrush (most hospitals supply these items, but many individuals prefer to have their own from home)
It is best not to bring in any medication from home unless it has been prearranged with the physician and hospital staff prior to hospitalization. This is to prevent an error from occurring by having the person taking one dose from their own medicine and then being given another dose from the hospital pharmacy.
Perry, Anne Griffin. Clinical Nursing Skills and Techniques. Mosby, 1998.
American Hospital Association. One North Franklin, Chicago, IL 60606. (312) 422-3000. http://www.aha.org .
Nemours Center for Children's Health Media. http://kidshealth.org .
Esther Csapo Rastegari, R.N., B.S.N., Ed.M.