When entering a hospital on an elective basis, consider the following:

• Ask if you will be on "observation status"
• Think about what to take with you to the hospital 
• Confirm the identity of your in-hospital "point person."
• Bring an advocate.
• Set up an easy means of communicating with the people who want to know how you're doing.
• Set up a means of keeping track of services provided.
• Keep in mind that you do not have to accept an assigned roommate.
• Avoid weekend or holiday admissions. It adds costly days to your stay at a time when you are likely to receive only minimal care.
• Check your wristband:  Confirm that the information is correct.  The wristband should include your name and all known allergies.  Make certain that all caregivers check your wristband before providing any tests, treatments or other procedures. 
• You do not have to accept an assigned roommate.

Written With: 
Herbert Spiers, Ph.D., New York, NY

Sometimes a patient is admitted to a hospital on an "observation status."  While on "observation status" you stay in the hospital, and receive hospital services. However,  you are not considered to be a patient.

"Observation status" is meaningful when it comes to your bill. Medicare and some private insurance charge patients a 20 percent co-payment. There is also no coverage for the cost of post-hospital nursing care or rehabiltation which require a minimum stay as a patient in a hospital before coverage takes effect.

In theory, observation status should not last more than a day or two. However, hospitals are sometimes using it for longer stays to avoid Medicare penalties in case there is a readmission soon after discharge.

If you are admitted on observation status, it is advisable to insist that you be changed to "patient" status as soon as possible.

On any given day you may speak with specialists, a surgeon, anesthesiologist, and a changing casts of interns and residents.  There should be one doctor who coordinates your care to:

• Help to prevent overlapping orders.
• Conflicting information.
• Things falling through the cracks.
• Provide one person who has an overview of what is happening for you and your advocate to speak with should you have questions or concerns.

Typically your admitting / attending physician is on record at the hospital as being in charge of your care.  Depending on your condition, your admitting doctor may be your surgeon, oncologist, cardiologist, infectious disease specialist, etc. The person may also be a hospitalist - a doctor who specializes in in-hospital care.

After you have been assigned a room, confirm with your nurse the name, and contact information of your "point person." It's preferable if you can contact the doctor directly if necessary. Even if you have to leave a message with the doctor's service, you'll feel more in control than asking a nurse to contact the doctor for you and waiting for the result.

Residents and interns can be helpful in your care.  They are in the hospital to gain practical experience and expertise.  They can assist physicians in providing patient care when the attending physician is not present.  However, if you feel that any intern or resident is not up to proper standards, you have a right to ask that they be removed from your case.  If an intern or a resident is to perform a procedure ask how many times they have done it.  If it seems too few ask for someone with more experience. (You may learn that the number which seemed small, is actually a lot of experience for a particular situation. You won't know until you ask.) 

It is highly recommended that you have a friend or family member stay with you during your hospitalization.  They may act as your health advocate.  Your advocate can supply emotional support in addition to looking after your interests at a time when you may be too sick or unable to do so for yourself. The advocate can take notes, ask questions and clarify exactly what is to be done, and why. The advocate can also remind staff when something needs to be done - or command the attention of doctors and nurses when necessary. 

Being an advocate is a big responsibility, so, if possible, call upon more than one person for help.  If possible, when deciding upon an advocate, choose someone who can be assertive, think objectively, and has the capacity to listen and accurately remember details.

It will be to your advantage to have someone with you round-the-clock.  This is permissible even though posted visiting hours are usually much more limited. Posted hospital visiting hours are guidelines specifically intended for visitors, not health advocates.

Health advocates may not be allowed to stay in an intensive care unit. Space is generally at a premium and you could interfere with the treatment of other patients. 

You may think that the presence of an advocate would upset the hospital staff. However, nurses often appreciate the presence of a health advocate.  Your advocate can take care of simple needs that can be done without a nurse, but would require a nurse if you were alone, such as bringing you a drink of water, helping you to the bathroom, and assisting with other personal needs. 

If there is a group of people you would like to keep to date about your progress, consider setting up a phone tree, or ask someone to send group e-mails, or set up a blog.

E mail: Every e mail system allows for group e mails. Once the list is put together, you can copy it each time an e-mail is to be sent to the group. You can create the e mail on your phone or with another mobile electronic device. Alternatively, you can ask a family member or friend to write it for you.  NOTE: Once in writing on the internet, information can be forwarded to people you may not want to have it. Be careful what you say, and the identity of people to whom you send e mails. Consider typing "Personal and Confidential" in the subject line. 

Blog: If the hospital has high-speed internet access you can set up your own blog. With a blog, people can log in and find out your condition as you post it. Two free blog sites are:    www.thestatus.com and www.carepages.com .  

Phone Tree: With a phone tree, a group of people have a pre-assigned person or people to call once they receive a call.

• No one person will have the major burden of making calls, everyone can stay current on your status, and you can get your necessary rest.
• A phone tree will create a support group for your friends and distant relatives.   Your hospitalization will not be easy for them either.
• A phone tree will help to mobilize your loved ones, should you need them.

As you'll see, when you leave the hospital, especially if you pay all or part of the bill, your hospital bill should be checked for errors.

It would be most useful if you could write down each time a doctor visited you, or you received a diagnostic test, or medication -- or even a box of tissues. However, the reality is you probably won't be feeling up to this task while you're in hospital.

Alternatives to consider:

• Your advocate can keep track for you.
• You can leave a clip board by your bed and ask each doctor who visits to sign in each time he or she visits. It may be easier to ask each doctor to leave a calling card on each visit. The nurses and staff can also note drugs, and other services or goods provided. You may be more likely to get your doctor and nurses to agree to a system like this, if you explain that you're going to have to pay all or part of the bill and you're not a Rockefeller. (Some food or other goodies for the doctor and staff can't hurt either.) 

You will probably be assigned to a semi-private room which means that you will have a roommate, one not of your choosing. Your roommate might be of help if you are in distress and unable to call your nurse. You don't have to be a lifetime buddy with your roommate, but be civil and polite. Remember he or she is also in hospital because of an health condition.

If you have problems with a roommate speak with the hospital staff or consult a hospital social worker or patient advocate to help resolve the difficulty. If the situation causes you stress, ask to be transferred to a different room. If no other beds are available, ask to be put on a list for the first bed available in another room.