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What To Do Before Entering A Hospital


Before entering a hospital, it is advisable to:

  • Schedule a meeting with your doctor. The visit will:
    • Give you an idea of what will happen upon your admission.
    • Provide an opportunity to discuss any remaining questions.
    • Allow you to express any preferences that you may have.
  • If it hasn't been discussed, ask your doctor (or his or her office manager) if you can be treated as an outpatient rather than entering the hospital.
    • Outpatients are patients who come to a hospital or ambulatory center, receive their treatment, and leave on the same day. Outpatients are not admitted to the hospital for even one night.
    • Outpatient procedures are usually performed in the day surgery unit of a hospital or at ambulatory surgery centers (ASC's).
    • When appropriate, treatments or tests should be performed on an outpatient basis. You will save money, time, and minimize your risk of obtaining an infection. However, even with these benefits, there are times when it is more beneficial to be an inpatient -- a patient who stays in the hospital at least one night. If you have managed care coverage, the company is likely to require outpatient treatment whenever possible, including some instances when it may be more beneficial to be an inpatient.
    • If you and your doctor believe that you should be admitted to the hospital for a treatment and the managed care company insists on an outpatient status, appeal the decision. To learn more about the appeal process see Appealing a Claim. 
  • Get pain and other symptom relief until you enter the hospital.
    • Just because you are waiting to go into a hospital is no reason not to treat pain and other symptoms now.
    • Conservative doctors may want to hold off with the stronger pain medications for fear you may become addicted -- even though studies show that is unlikely to happen.
  • Ask to see any consent forms in advance so you have time to consider the pros and cons of any treatment and to make any necessary changes. 
    • You will be required to sign consent forms before any treatments such as radiation or surgery.  Generally patients are asked to sign the consent form just before the treatment or procedure starts. That leaves little time to read the form, and no time to ask questions or insist on changes. There's also the pressure to not take the necessary time because there's an expensive facility or professional on hold for you.
    • If possible, request the form at least a week before your treatment. This will provide you with an opportunity to review the contents, and ask questions, and make changes.  
    • For example, if you are interested in having a specific doctor perform the procedure, be sure the consent form specifies that the doctor you care about is to do the actual work. If the consent form states that the procedure can be performed by your doctor or another doctor, or a member of a listed team, cross through the names of any people you do not want to perform the procedure.
    • Before signing the consent, make any necessary changes and initial them.

Prepare to maximize your stay in the hospital and avoid medical errors. Proper preparation can help minimize costs and avoid unnecessary infections. For instance, consider the following:

  • Create a List of Medications. Doctors will want to know what medications you have are taking on an ongoing basis. (We have a chart that can help).
    • Provide all of your doctors, including your surgeon, with a list of all medications that you are currently taking. 
    • With your doctor's assistance, compile a list of drugs that you are likely to require during your hospitalization.  The list should include the name, purpose, dosage instructions and preferably the color and shape of the pills.  Be certain to take this list with you to the hospital. 
    • Also discuss which medications you should discontinue or avoid during the pre-surgery period.  Aspirin and other non-steroidal anti-inflammatory medications such as ibuprofen, should be avoided for at least one week before surgery as they may increase the risk of blood loss during and immediately after surgery.  Some supplementary drugs that can contribute to blood loss during surgery include garlic, ginkgo bilboa, and Vitamin E. St. John's Wort can interfere with some prescription drugs and anesthesia. 
    • During the course of your stay it is likely that other medications will be added to your regimen.   Make note of each one as well as the dosage. Note what each drug is for.  All drugs dispensed by the hospital should be identified and explained by the nurse before being taken.   If you can't do this yourself ask your care partner to do this for you.
    • Ask your doctor to leave a standing order in your hospital chart for medications to treat insomnia, constipation and pain. Your hospital nurse is not allowed to administer any medications without a doctors' order. With advance planning, you can avoid a long and possibly uncomfortable delay.
    • Last but not least, take at least a few days supply of the drugs you normally take with you to the hospital in case it takes the hospital time to process your drug needs. 
  • Find out which doctor will be in charge of your hospital care. It may not be the person you think.
    • It is important that you have one doctor that coordinates your medical care. Generally it is the attending physician -- the doctor on record at the hospital as being in charge of your case. It may also be a hospitalist, an in hospital doctor who specializes in coordinating care.
    • On any given day in the hospital you may speak with and often be examined by your attending physician, surgeon, specialists, and an ever-changing list of interns and residents.  It is not uncommon to receive conflicting information or overlapping orders from all these people, so it's important to have one person in charge that you can turn to if necessary.
    • Ideally you should receive a daily visit from your primary care/attending physician or at least a physician assistant - a doctor who works with your doctor. If not, you should at least be able to get hold of your doctor on the telephone during daytime hours, and hopefully 24 hours a day. It helps if you have your doctor's mobile phone number.
  • Try to time when you enter the hospital to maximize the benefit of being in a hospital. For instance, if you can: 
    • Enter during the beginning rather than the end of a week.  Hospitals have limited staff on weekends.
    • Don't go in the day before a holiday.
    • Try to avoid July and August for a hospital stay.  New residents begin their residencies on July 1.  They are just out of medical school.  And many senior doctors are on holiday.  Postpone elective surgery until the fall.
  • Think about who can be your patient advocate(s) once you are in the hospital.  It is advisable to have an advocate with you as much of the time as possible.
    • To help avoid medical errors, to maximize your time in the hospital, and to help in case you need to challenge a bill, it's preferred that you have a patient advocate with you all the time you're in the hospital -- or at least during the day. More than one person can fill the job if necessary. (Perhaps a family member or friend can coordinate who will be with you at various times of the day).
    • The person should be someone who can speak up politely, but firmly. 
    • For your information, Medicare stopped paying for complications arising from certain infections and conditions that result from hospital care and are "reasonably preventable." Insurance companies are following suit.
    • Professional patient advocates are available if needed.
  • Prepare a letter that you can give to the person in charge of your floor to let him or her know that you are aware that infections can be picked up in even the best of hospitals and that you would like the team to be extra careful around you. Also include the names of the people you authorize staff to speak with about your medical condition.  (For your information, Medicare stopped paying for complications arising from certain infections and conditions that result from hospital care and are "reasonably preventable." Insurance companies are following suit).
  • Check that the hospital will enforce your Living Will and other Advance Directives if it comes to that.
    • If you have a Living Will and other Advance Directives, remind your doctor of your wishes and confirm that he or she is willing to honor those wishes. Ideally your doctor should have an original copy of your Advance Directive in your medical chart. You should also bring an original copy to the hospital.
    • Be sure the hospital policy accords with your wishes. If it doesn't, and if something happens, your representatives will either have to battle the hospital or have you moved to a different facility.
    • Admissions or a hospital social worker will often come and inquire if you have a health care proxy or living will. Often the hospital will have a proxy form that you can fill out while in the hospital. 
  • Think about what is the easiest method for you to keep family and friends up to date.
  • Write a short summary of your medical history. 
    • For example, a wallet-size list of your medical history. Maintaining a medical history list will mean you won't have to try to remember this critical information at a time when you are under the stress of checking into the hospital and not feeling well. It will also assist in expediting your admission. (You can also use it each time you see a new doctor outside the hospital.)
    • The list should include all of your current medications, allergies, chronic conditions, and current diagnosis. If you have insurance, include the name of your insurer and policy number. If your insurance is through your employer or another group, include their name.
    • Indicate if you have a Living Will or other Advance Directives. Include the contact information for your health care proxy.
    • If there is too much information for a wallet-size sheet, keep the information in your emergency room tote bag.
  • If you are entering the hospital for surgery, start thinking about how to minimize cost and maximize the chances for a positive result. For instance:
    • Discuss pre-operative tests and limit them to only those that are required.
    • Schedule surgery for a day and time most likely to maximize your care.
    • Ask that the spot which will be operated on be marked prior to surgery. 
    • If your health insurance only pays for in-network personnel: 
      • Ask that all members of the surgical team, including the anesthesiologist and other specialists, be in the insurer's network.  (Otherwise you may be billed for his or her services. This is known as "Balance Billing").
      • It is more difficult to control which medical personnel treat you once in a hospital room. Two practical methods include:
        • Ask that your request about network doctors be entered into your chart.
        • Create a sign you can tape to the wall behind your bed which says: "In Network Doctors Only Please".  If the sign doesn't stop non-network personnel from treating you: (a) it alerts them to the fact that they may only get an out-of-network payment and (b) gives you an argument to use if the insurance company only wants to an amount equal to a non-network fee.  
  • Keep an emergency room tote bag available in case you have to go to the hospital earlier than anticipated. 

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