Monday, August 15, 2011

Whether or not to Admit a Patient

Hospitals all over the world have a tough time deciding which patients should be admitted to a hospital floor from the emergency room. This is because risks, insurances, patient comfort, room availability, and doctor recommendation are all involved.
Hospitals frequently are overcapacity.
1. Risks are associated with this decision because if a patient becomes worse after being admitted then the hospital is liable for this (i.e. hospital acquired infection, pressure ulcer). The hospital then will treat the patient with no reimbursement and a red mark from the government on patient safety.
2. Insurances are very tricky on whether they want you to be admitted. Admitting costs a lot of money, but an insurance company can't deny a doctor's recommendation to have you admitted. Unfortunately they have a work around, which is where they will arrange to send you to a cheaper hospital via ambulance. Also they may arrange to have doctor's from their cheaper network to provide care for you and the follow up treatment. These less expensive networks aren't always less effective, indeed many hospitals over charge insurance companies to cover their other costs. This is especially true with the rising number of for-profit hospitals as opposed to faith-based and/or non-profit hospitals.
3. Patient Comfort: Some patients want every test imaginable. I had a patient not long ago complain his lip briefly hurt. He demanded to have it checked out by an MRI and the doctor gave it to him because he didn't want to deal with the patient. This means the patient had to be checked into the intensive care unit overflow and monitored 24/7. Patient ended up eventually being discharged for simple vertigo after a couple days.
4.  Room Availability: This is a key factor because if there are no rooms available, ambulances and people are going to be directed to other hospitals. This is when people who really don't need a room are going to get scooted out the door pretty quickly. This is also when non-urgent people are going to see wait times skyrocket. Basically if you are still conscious, you are still going to be alive in the next 10 minutes. Some people won't be. Even if you've been there 2 hours with a broken leg, if someone walks in through the door complaining about chest pain they will get treated first.  If it is slow however, you may find more non-urgent people admitted for both patient safety, and to make some money.
5. Doctor Recommendation is the trickiest of them all because doctor's all have very different admitting practices. Some (usually older) doctors never admit and some younger ones always do (safest option). This is also how patients can be admitted against their will. More and more young doctors are choosing to admit older/intoxicated patients against their will. This has to do with changing times, laws, and liabilities over the past 20 years. For example, I was treating an elderly woman with dementia who had picked a good chunk of her skin off. The woman was getting ready to go home (she was very alert, just would forget things occasionally) but the social worker had actually allowed the daughter to get power of attorney and the doctor had decided she wasn't alert enough to make medical choices. She was admitted against her will for a week and then transferred to an elderly care facility.
Does it come down to money?
In my area several respected hospitals have been accused by the government of milking government insurance programs. They have defended themselves by saying this enables them to cover less fortunate people and to maintain hospitals in low-income areas. Others have said they are doing this for profit and not philanthropy. I'd say its a bit of both.


  1. Interesting article. Hospitals must have a hell of a time trying to deal with all the hypochondriacs there seem to be nowadays.

  2. It sucks that people would get admitted based on insurance, i feel lucky to live in the u.k where you dont have to worry about that.

  3. Wow this is a really nice article. I always wondered why it took them so long to admit people sometimes.

  4. Would you admit a pirate? Like if one came in with a peg leg, eye patch and a parrot on his shoulder? Dont discriminate now. ~_^

  5. Complex stuff going on there, but I understand it.

  6. It's unfortunate but it's true. how else are doctors supposed to obtain their six figure salaries and how else is the hospital supposed to run? the government sure as hell won't fund it. The more people realize that medicine is a business the quicker they can get this idea out of their heads that they owe US something

  7. i always check on more than one doctor, to anything i have! i think this should be something everyone would do, the docs are not always right :P

  8. My dad is a doctor. Sometimes the administration does seem to get in the way with doctor quality and money. My dad got fired for pointing this out.

  9. The healthcare system is certainly corrupted. (Especially here in America!
    With that being said, Michael Moore's "Sicko" documentary opened my mind to a lot of ideas discussed in the blog post.