Types of Admissions

A person may be admitted to the hospital in a variety of ways. Types of admissions are discussed in the following sections.

Scheduled or planned admissions are admissions that are called into the admitting department in advance. Elective scheduled admissions occur when the patient and the doctor decide when to schedule a nonemergency or elective surgery or procedure. The scheduled admission patient enters the hospital through the admitting department and is usually admitted to the service of his or her primary doctor. A list of scheduled admissions may be available to print from the computer or may be sent to each nursing unit from the admitting department early in the day, allowing the nursing unit to plan for the admissions.

Direct admissions occur when a doctor sees a patient in the office, decides that the person should be admitted to the hospital, and places a call to the hospital to arrange the admission. An urgent admission occurs when a patient is determined to be in need of immediate care while at a doctor’s office or another facility. An example of an urgent admission is a pregnant woman who goes to the hospital and, after evaluation by a doctor, is immediately admitted to labor and delivery. Admission of a patient who has been transported by ambulance or helicopter from another health care facility such as an extended care facility also would be called an urgent admission.

An emergency admission is unplanned and is the result of an accident, sudden illness, or other medical crisis. Patients enter the hospital through the emergency department (ED), are processed through the ED, and are referred to as emergency admissions. ED personnel prepare an ED record (Fig. 19-1). If the patient does not have an electronic medical record (EMR) available, his or her old records from prior admissions are often requested from the health information management services (HIMS) department. Should the patient’s condition warrant admission to the hospital, the patient will be assigned to a nursing unit. The ED record is entered into the patient’s EMR, or the paper form is sent to the nursing unit with the patient for placement into the patient’s paper chart. The patient’s old records also should be sent to the nursing unit with the patient and stored on the unit (if paper charts are used) until the patient is discharged or transferred. The HUC reviews the electronic or handwritten ED record to see whether all requested tests have been completed. For example, the ED doctor may have ordered a urinalysis that was not obtained in the ED. The HUC processes all tests that need to be completed.

Some life-or-death emergency patients are brought directly to an intensive care unit (ICU) and require immediate treatment. Patients brought directly to an ICU are not preregistered by the admitting department and may be unconscious and without ID. An example is a near-drowning victim transported by ambulance from a public swimming pool or lake. The HUC would call admitting to request the patient be given an alias name and assigned a health record number. After the patient has been entered into the computer with an alias name, labels may be printed, tests ordered, and lab specimens sent to the laboratory. Family members will be sent to the admitting department on arrival so the patient can be admitted under the correct name. The patient’s correct name will be entered into the computer, but the alias name will remain in the computerized record as well, for ID purposes. If an invasive procedure or surgery is immediately required to save the life of a patient who is unable to sign an informed consent, and no family member is present, two medical doctors would sign the consent.

Types of Patients

Patient type may be assigned according to the purpose and length of hospitalization. The three patient types consist of inpatient, observation patient, and outpatient.

An inpatient is a patient who has a doctor’s electronic or handwritten order for admission to the hospital and is assigned to a bed on the nursing unit. The HUC will prepare a chart and process orders for the patient (see Chapter 8).

An observation patient is a patient who is assigned to a bed on a nursing unit to receive care for a period until deemed stable. An observation patient also may be referred to as a continuing care, medical short-stay, or ambulatory patient. Some hospitals may have a specific unit such as a medical short-stay unit (MSSU) or ambulatory care unit that provides short-term care. Some emergency rooms have an area furnished with recliner chairs and televisions designated for observation patients. The HUC may prepare a chart and process orders for the observation patient.

An outpatient is a patient who receives care in a hospital, clinic, or surgicenter. An outpatient usually is scheduled to receive surgery, treatments, therapies, or tests. The department that provides care for the outpatient processes the outpatient orders. Usually the assembly of a chart is not required, although patients on a routine basis may receive outpatient services that do require a chart.

The patient may be classified as receiving teaching service or nonteaching service, indicating whether residents and/or other health care students will be involved in the patient’s care. Patients may also be classified according to the type of insurance coverage they have (e.g., Medicare, preferred provider organization [PPO], health maintenance organization [HMO]).

Admission Arrangement

In all types of admissions, a doctor with admitting privileges to the hospital must authorize the patient’s admission. One of the following is responsible to arrange for the admission of a patient: the attending or primary doctor; the emergency room doctor; the primary or attending doctor’s office staff; or the HMO staff acting on instructions of the doctor. The doctor provides the admitting diagnosis or medical reason for admission. Many hospitals employ a hospitalist who may oversee the patient’s care during the hospital stay. The hospitalist communicates with the patient’s attending or primary doctor.

Bed Assignment

Most hospitals are open for admissions 24 hours a day. The admitting department or registration staff performs many tasks in relation to the admission of the patient to the hospital. Usually, the hospital census is computerized and provides an accurate, up-to-date list of occupied and unoccupied hospital beds. Nursing unit assignments for scheduled admissions usually are determined in advance, and a specialized unit may be requested by the admitting doctor. A list of scheduled patient admissions may be made available on the computer or may be printed and sent to each nursing unit that receives patients. Nursing assignments generally are determined for scheduled admissions in the morning. Direct admissions or emergency admissions are assigned beds when the patient arrives at the hospital and is ready for a room. The admitting diagnosis and/or patient age usually determine the type of nursing unit that is suitable, and the nursing staff usually decides on the specific bed. In many hospitals, staff members on the nursing unit decide bed assignment. Nursing personnel are familiar with staffing and roommate issues and can best decide which bed is appropriate for the new patient. After receiving patient information such as name, diagnosis, age, and sex, the HUC or nurse may assign the bed number.

HIGH PRIORITY

It is important to notify the admitting department of pending discharges in a timely manner, especially when the hospital is low on open beds. Delaying notification could cause a delay in another patient’s admission and treatment.

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