The 5 T's to Ensuring You Have a Successful Hospital Stay
Have you or one of your loved ones ever ended up in the hospital? I would imagine for the majority of us the answer would be a resounding yes. What was the stay like? Did you feel like you had a clue about why you were there, and what they were doing? For a lot of people the response to that question may be just the opposite with a resounding no. The difference in those experiences can truly be altered to some degree by your own actions when you or a loved one has been hospitalized. As someone who has been a patient, sat at the bedside next to my loved one, and been the nurse delivering the care I believe there are 5 T's that can make the difference in your stay.
When you come to the hospital whether it is in the back of a speeding ambulance or walking through the double doors on your own, you'll initially be evaluated in the emergency room to be assigned an admitting diagnosis. Understanding your admission status is crucial to knowing the time frame that you may be in the hospital, the type of interventions they may do to make you better, and the possible costs you may incur. Typically there are three statuses that are used when you stay at the hospital:
- Ambulatory - This status is most often used when having a same day surgery or short stay surgical procedure that is performed in the hospital versus an outpatient center. If you have Medicare they will generally switch this status quickly to observation or inpatient, but with a commercial(non-Medicare/Medicaid) patient you may stay in this status. It's important to understand your own plan, so you'll have an idea of the costs you may have to pay. Typically this should be an overnight stay unless there are complications, and then the status of the admission would change. If you are a Medicare beneficiary this stay will not qualify you to get paid rehabilitation as an inpatient in the community. In that way it is like observation status.
Type of Problem - Admitting Diagnosis
- Observation - This is a status that is utilized to provide providers and the hospital a short window of time to evaluate someone's condition (usually 48 hours), and measure their needs against the criteria necessary to switch the person to an inpatient. Some of the conditions, illnesses, or trauma that may fall into this category are often chest pain or orthopedic injuries that don't require a surgical intervention. Where this status creates a problem is with the Medicare population because an observation status patient doesn't qualify to have Medicare pay 100% for a rehab stay under Part A. Part B beneficiaries also billed 20% of their hospital stay. You might avoid these costs if you have a supplement or long-term care insurance that will pick up the co pays and cover the cost of the rehab stay. When you're admitted in this status as a Medicare beneficiary the hospital must inform you of your status, and have you acknowledge you've been provided the information.
- Inpatient - This status pertains to all other admissions where the individual meets the medical necessity to stay in the hospital. Commercial patients will need to look at their policies or call the toll free number on your card to hear about the specific coverage. Medicare beneficiaries must meet the medical necessity of this status for three qualifying midnight's to go to a Rehab facility where Medicare pays 100% for the initial two weeks prior to co-pays taking effect. As a Medicare beneficiary in an inpatient status you have the right to appeal your discharge if you don't feel safe going home. After the appeal is initiated a third party will review the admission, and make a determination if it's a safe discharge. If it's considered safe, the hospital can bill you for any services not covered by your insurance.
There is a reason you went to the hospital. It could have been a persistent pain you had been experiencing, bleeding that you noticed from different areas of your body, or you felt like you couldn't breath. No matter what symptoms you presented with at the time you came to the hospital you will eventually require an admitting diagnosis. This diagnosis will determine how the hospital gets paid and what type of care and services you may expect to receive during your stay. Typically the course of coming to that conclusion involves taking a medical history, hearing about present symptoms, evaluating medications, and diagnostic testing. Depending on the severity of your situation it may also require other providers outside of the Internal Medicine Hospitalist to be consulted. These days hospitals are frequently struggling with the challenge of getting people access to services. Therefore, there is a push to proactively start planning a patient's discharge on the day they're admitted. Understanding your admitting diagnosis and asking the providers involved in care questions will give you the answers needed to have an idea about the duration of your hospital stay. It will also alert you about the medications and services that may be required to support your health.
Type of Results - Diagnostic Findings
While you're admitted in the hospital you're not going to get any sleep generally. This is because you're going to be inundated with numerous people coming into your room performing their jobs to gather the information necessary to support your treatment. You should expect that you may be subjected to imaging(CTs or MRIs), lab tests, and surgical interventions to collect what the lab needs. Do you struggle with a fear of needles or have claustrophobia? Completing these tests is imperative to getting the right treatment, so make the provider and staff aware of your concerns to ensure they can find alternatives to support your comfort in completing the testing.
Once the test results are available it will be important to understand what's being done to help you, and the progress you're making required to be discharged. Often this is where having someone in your family at the bedside is important to advocate and understand the hospital course of treatment. If you don't have a Power of Attorney or Living Will, the hospital can provide forms. If you're incapacitated in any way having this complete will let someone else support your goals for your care, and speak on your behalf.
Type of Action - Treatment Plan
When you're laying in that bed it's not only the physician who is impacting your stay, but a team of clinicians who are supporting your care. It's important to engage with these individuals and understand their role in helping you to achieve a safe discharge. One group that you will encounter more often than any other group will be the nursing staff. They will be the eyes and ears for the physician, support you in understanding about your stay with patient education, and provide the compassionate interaction you deserve to promote healing. There will also be many other important members of the team that include the technologists, the therapists, and the numerous support staff who will deliver your nutrition and personal care. Even though you can rely on these individuals to provide your care, patients need to be motivated to care for themselves and return home..
As a hospitalized patient it's important to take some preventative measures to promote your safety and reduce complications. Two of the biggest things is movement and breathing. When you're laying in the bed your muscles can become weak, and your circulation can stagnate putting you at risk for blood clots. You also can spend more time in bed laying in positions that compromise your ability to circulate air adequately through your lungs which increases the risks of upper respiratory infections. An easy way to prevent these complications in addition to the medications you'll be receiving is to get moving. You need to advocate for yourself or your loved one to have the staff help you get moving unless directed otherwise by the physician. Getting up and walking will help circulate the air and blood, and support your recovery.
Type of Transition - Discharge Plan
Finally, you made it through your stay. Now its time to go, but where are you going? Hopefully it will be home, but often people require different environments and services to support their care following a hospitalization. It's extremely important to ensure that you or your loved one leave the hospital with the resources to support your care, and prevent a readmission. Here are some of the typical services that can support this effort:
- Skilled Nursing Facility or Rehabilitation Center - Most often used for post surgical or patients that have experienced a decline in their function that prevents them from safely returning home. It may be that they are recovering from a hip, or have a wound, or just need to increase their strength. It's important to know your options, and understand what facilities are available in the local area. Have your loved one visit the potential facilities prior to discharge, so everyone will feel comfortable with the upcoming stay.
- Medications - Going home on new medications or having required changes in dosing of current medications is often also part of the hospital stay. With new drugs coming to market all the time, sometimes they're either not covered by your payer or extremely expensive. It's imperative to fill the prescriptions, so have a family member or hospital case manager call your payer to get information about prices and any co-pays. If it's too expensive most pharmaceutical companies have programs where they provide the medication at a lower cost. Walmart also has a formulary where you can get certain prescriptions for as low a $4 for a 30 day supply. The key to staying out of the hospital is following a certain set of preventative measures which includes taking your prescribed medications when directed.
- Medical Equipment - After the hospital stay you may have equipment needs. Most often these may include oxygen, nebulizer, or a variety of other Durable Medical Equipment needs like wheelchairs and walkers. There are a number of companies that provide this service, and you will have the ability to choose who you want as your provider. To support this decision check to see if your insurance is contracted with the provider to avoid paying privately. You may also want to ask other family and friends about any good experiences they've have with vendors. Ensure that these needs are set up and in place when you discharge, so you'll have the support you need to avoid returning to the hospital.
- Community Services - If the plan is to go home, there are agencies that specialize in supporting your care in the community. At the hospital they'll arrange for these companies to contact you. Often it is either Home health and Hospice, but it may include a Dialysis Center, Outpatient Wound Clinic , Outpatient Infusion Center, or a referral to an agency in the community that will support your personal non-medical needs in the community. To ensure that you experience a smooth transition back home you'll need to get a copy of the discharge instructions with these services list, and their contact information. If you don't hear from them within 48 hours of discharge call them up immediately. These services will support your needs to stay at home, and prevent a round trip back to the hospital.
- Follow up Appointments - It will be important for anyone returning home to get follow up appointments following their hospitalization. Ensure that you either have the information or that they were scheduled for you. You'll need to see these providers to update them on the stay in the hospital, changes in medications, and avert another admission.
My hope is this little bit of information helps to make your stay or that of your loved one successful, and gives you the confidence to be your own advocate in getting your needs met. Take care.