Hospitalization rules, terms and documents. The need for hospitalization is surrounded by a huge number of Indications for emergency hospitalization

As a result of an unexpected emergency, it is often necessary to continue treatment in hospital. The patient requires hospitalization. Hospitalization may also be required for a number of other conditions that do not require immediate medical attention but require short-term or long-term monitoring by a team of specialists.

Hospitalization may also be required for certain procedures, medical tests, or planned surgeries. But what exactly does hospitalization mean?

Hospitalization department

As a term, hospitalization refers to the process of referring, admitting, and admitting a patient to a hospital. Depending on the condition, patients are placed in the most appropriate department.

For example, children with infections are placed in a children's (pediatric) infectious diseases department, which is specifically designed to limit the spread of infectious diseases.

Depending on the etiology and type of disease, patients can be hospitalized in the cardiology department (cardiovascular diseases), gastrointestinal department (for diseases of the digestive system), nephrology (kidneys), pulmonary department (for respiratory diseases). The hematology department cares for patients with diseases affecting the blood and lymphatic system.

In the presence of injuries affecting the nervous system with an inflammatory, degenerative, idiopathic, or autoimmune nature, patients are referred to the neurological department. For planned preoperative or emergency surgical treatment, patients are admitted to the surgical department. Hospitalization is also possible in psychiatric wards and specialized clinics designed to treat symptoms and stabilize the mental and emotional state of patients.

Purpose of hospitalization

The primary goal of hospitalization is to meet the patient's needs and maintain optimal health, healing, and recovery, both physically and mentally. Depending on your specific situation and needs, you will receive the medical care you need.

In a hospital, in addition to doctors (your primary care physician and other specialists), you will also meet nurses (perhaps the first health care workers you encounter when you walk through the doors of a hospital).

They will take care at the appointed time of the appropriate dose of the medicine prescribed by your doctor (whether for oral or injection use), and will accompany you to the appropriate laboratories and premises to carry out the necessary manipulations.

In addition to nurses in a number of hospitals, you will also meet pre-med medical students, medical specialists, and others. In addition to doctors and nurses, the core team that will care for you may include physical therapists, nutritionists, psychologists, and others.

Indications for hospitalization

Indications for hospitalization are numerous and vary depending on the needs of the patient (it is necessary to diagnose a specific disease, conduct the necessary tests, provide treatment).

Forms of hospitalization

In general, depending on the patient's current situation, hospitalization may be urgent or planned:

• Emergency hospitalization: Occurs in conditions that are potentially life-threatening, require urgent surgical treatment, or when the patient's general condition is severe and requires monitoring of vital signs. Emergency hospitalization of a patient is usually ordered by the ambulance team on duty or in the emergency room. Examples of the need for emergency hospitalization include, for example, Addisonian crisis, anaphylactic shock, myocardial infarction, pulmonary collapse, eclampsia, acute appendicitis, and others.
• Planned hospitalization: allows you to specify the day of admission to the hospital. It is required to perform planned operations, chronic diseases, conduct research, periodic blood transfusions, hemodialysis. The documentation for hospitalization includes a corresponding direction, according to which the planned hospital stay is most often issued by a specialist or the corresponding chronic disease is treated. The patient has time to prepare (the necessary set of items, accessories, documentation, as well as time for purely mental and emotional preparation) and choose the appropriate day. Planned hospitalization, for example, is used for surgical treatment of glaucoma, progression of psoriasis, chronic nephritis syndrome, chronic renal failure and others.

The need for urgent or planned hospitalization is determined by the appropriate physician, with standardized regimens.

Admission to a psychiatric hospital

For example, in patients with mental illness, some of the main indications for hospitalization include:

• suicidal thoughts and experiments
• visual or auditory hallucinations
• delusions (believing things that are not true)
• problems with a certain addiction (alcohol, drugs)
• patients do not eat or sleep for more than 5 days
• patients are unable to take care of themselves (or have no one to take care of them)

Hospitalization may be voluntary or involuntary depending on the severity of the patient's symptoms.

Some of the major indications for hospitalization include life-threatening acute metabolic complications of diabetes, newly diagnosed diabetes in children and adolescents, severe chronic complications requiring intensive care, newly diagnosed or uncontrolled diabetes during pregnancy, and others.

Indications for hospitalization can also be divided into:

• medical: patient diagnosis, stage of disease, presence of concomitant diseases, general condition
• social: the patient's condition also allows for home treatment, but due to the inability to buy medicine and the lack of someone to take care of him, he needs to be hospitalized and cared for in a hospital

Regardless of the reasons for hospitalization, the upcoming hospital stay (especially for a first-time hospitalization) conceals many questions, uncertainties and causes of anxiety for patients.

What to take to the hospital when hospitalized

How to prepare for an upcoming planned hospitalization and stay in the hospital?

In the event of a planned hospitalization, the patient has time to take care of his luggage and provide everything necessary to facilitate his stay in the hospital, as well as prepare the necessary documents from an administrative point of view.

Upon admission to the hospital, you will need:

• Some documents: identity card, prescription booklet (for chronic diseases), referral for hospitalization, epicrisis and documents from previous hospitalizations, results of recent studies;
• Small amount of cash: You are not advised to bring large amounts of cash with you as some other patients may not be particularly sympathetic and card payment is not always possible. You have food in the hospital, but you may need a little money for coffee, tea, food, newspapers and magazines and much more.
• Clothes: you need to take a nightgown, changing clothes, underwear, slippers,
  reading glasses (in case you need them)
• A pen and a small notebook: If you have questions for your treating staff, you can save them and you may need a pen, and if you like crossword puzzles
• Toiletries: toothpaste and toothbrush, soap, deodorant, shampoo, comb or hair brush, and everything you need to maintain daily hygiene
• Anti-boredom: During your hospital stay you will have a lot of free time, so it is useful to find a way to avoid boredom in advance by taking your favorite books, magazines, and in some cases you can pick up knitting to fill your time
  photographs or small personal items of sentimental value: leaving your home frequently, especially over a longer period, can make you feel lonely and isolated, the list is roughly identical (items taken to recreate a familiar and cozy home, favorite toys, entertaining games).

Hospitalization of children

It is recommended that you first familiarize your child with the situation in the hospital, explaining in simple language what they will encounter and what to expect. You should not be afraid, you should not convey your fears and worries.

Some children (mostly between the ages of 3 and 6) perceive hospital stays as punishment for some of their actions. You need to explain to them that the need to stay in the hospital is not a punishment, but a need to be healthy, energetic, and full of desire to play again. Adolescents need an appropriate approach to prevent rebellion and sabotage of medical procedures.

Risks of hospitalization

Hospitalization does not hide certain risks; the dangers are associated with the nature of the manipulations, research and therapeutic strategies.

Possible complications as a result of the test (for example, when receiving blood), unwanted effects resulting from the use of a particular drug or combination of drugs, postoperative infection or bleeding after a certain surgical procedure, hospital-acquired infection, and others.

All known allergic reactions should be reported to reduce the risk of exposure to known allergens, including medications.

In most cases, the risk of side effects of administered drugs is lower than the benefit to the patient, being predominantly mild, predictable and correctable.

Risks for the patient exist if they refuse hospitalization, refuse treatment, or perform certain manipulations. In this case, patients voluntarily expose themselves to an unpredictable risk of serious deterioration in their health. By filling out a refusal application for hospitalization, patients openly declare their unwillingness to be treated, putting themselves and their loved ones at risk.

When a patient is discharged from the hospital, regardless of the length of stay in a medical institution, home therapy and medication are administered, if necessary.

The patient's discharge date is determined by the attending physician depending on the patient's condition, improvement after therapy, basic indicators and other factors. The patient may be prematurely written at his own request, in which case it is necessary to familiarize himself with the risks to which he is exposed.

If readmission is necessary within a short time (readmission) in the same or another hospital, the appropriate procedure is followed. The high number of readmissions in the country indicates poor quality of healthcare (the need for readmission only a couple of weeks after discharge suggests poor initial treatment).

Indications for hospitalization of infectious patients:

1. Clinical indications. According to clinical indications, patients with severe forms of any infectious diseases, as well as persons under 3 and over 60 years of age with moderate forms of infectious diseases. In addition, according to clinical indications, patients with acute infectious diseases of any severity are hospitalized, provided they have concomitant chronic non-infectious diseases (CHD, COPD, diabetes mellitus, etc.), which have a high probability of exacerbation/decompensation due to the addition of acute infectious pathology and Therefore, they require inpatient monitoring.

2. Epidemiological indications. According to epidemiological indications, patients with mild or moderate infectious diseases are hospitalized if these patients pose an epidemic danger and must be isolated from the team in a hospital setting. Diseases that pose an epidemic danger include particularly dangerous infections (plague, cholera, yellow fever), hemorrhagic fevers with an unknown reservoir of infection (Lassa, Marburg, Ebola), highly contagious respiratory infections (chicken pox, measles, rubella, scarlet fever, mumps, diphtheria, etc.).

In addition, according to epidemiological indications, patients with mild or moderate infectious diseases are hospitalized, if these patients are members of closed groups(soldiers, prisoners, children from orphanages and boarding schools, patients in hospitals for psychochronic patients, nursing hospitals, nursing homes, students living in dormitories, etc.), since, without being promptly isolated, such patients can provoke an outbreak of an infectious disease limited only by the size of the closed group.

The same principle underlies the hospitalization of patients with mild or moderate infectious diseases, if they belong to the so-called. " decreed contingent" The decreed contingent includes all employees of food industry enterprises who are directly related to the preparation, packaging, transportation, storage and sale of food products. In addition, this contingent includes workers at water intakes and artesian wells who are directly related to the collection, purification and transportation/bottling of drinking water. Any of the listed workers who have a mild, asymptomatic form of intestinal infection, without being promptly isolated from the team, can contaminate food or drinking water with pathogenic microorganisms, thereby provoking a large-scale outbreak or even an epidemic of the corresponding disease. In view of this, such persons are hospitalized at the first signs of infectious diseases, specified in special regulatory documents, and receive inpatient treatment until complete recovery, confirmed by repeated negative results of bacteriological tests.

3. Social readings. For social reasons, patients with mild or moderate infectious diseases are hospitalized if these patients, while at home, are unable to independently care for themselves and carry out doctor’s orders due to old age or disability of 1-2 groups, aggravated by the phenomena of an infectious disease, in the absence of joint living children and relatives. In the future, in relation to such persons, it is necessary to resolve the issue of establishing patronage over them by social guardianship authorities.

Rules for hospitalization of infectious patients:

1. When hospitalizing patients with infectious diseases, the following requirements must be met:

– they are not allowed to be together with other hospitalized patients in the premises of the emergency department of a multidisciplinary hospital. Infectious patients must be isolated in an isolation and diagnostic box (or ward) with one bed;

– patients with symptoms of influenza and other acute respiratory infections should be provided with respiratory protection.

2. When admitting patients to an infectious diseases hospital, the following requirements must be met:

– the flow of movement of patients entering an infectious diseases hospital should be directed from the reception and examination box of the admission department to the specialized treatment departments;

– admission of patients with infectious pathology should be carried out strictly individually. Waiting for two or more patients in the same room at the same time is not permitted;

– patients in need of resuscitation measures can be hospitalized in the intensive care unit, bypassing the emergency department of the infectious diseases hospital;

– hospitalization of patients with infectious pathology and contact persons should be carried out in the boxes of specialized departments of the infectious diseases hospital in accordance with the nosological forms of infectious diseases identified in them;

– in doubtful cases, patients with infectious pathology should be sent to the boxed diagnostic department of the infectious diseases hospital until the diagnosis is clarified.

3. Boxed rooms for patients with infectious diseases must:

– be emptied of discharged patients and filled with hospitalized patients as quickly as possible;

– filled out by patients of the same profile, preferably with the same nosological form of the infectious disease;

– placing newly admitted infectious patients in the same ward together with recovering patients is prohibited;

Unfortunately, no matter how afraid a person is of hospitals and doctors, sooner or later everyone ends up in a hospital ward. If your attending physician recommends undergoing examination and treatment in a hospital hospital, you should not immediately refuse this opportunity. It is best to think everything over carefully, weigh it and make a decision in a calm environment with a clear and sober head.

Indications for hospitalization

The doctor may recommend hospitalization in cases where the medical and diagnostic procedures necessary for the patient cannot be performed at home or in a clinic at the place of residence. Such procedures include the need for constant medical supervision and medical manipulation.

In the case where the patient lives alone and is not able to independently follow all the doctor’s recommendations and ensure his safety, hospitalization in a medical institution is also carried out. Providing emergency medical care is an indication for emergency hospitalization, since otherwise irreparable damage may be caused to the patient's health.

Carrying out surgical interventions and providing cardiac care are also indication for hospitalization sick. The presence of a viral or bacterial infection, which can negatively affect the health of people around the patient, may cause the patient to be hospitalized in a special department of a medical institution.

Planned hospitalization is carried out when it is necessary to conduct a thorough examination of the patient and determine further treatment tactics.

Indications for psychiatric hospitalization

Serious disturbances in a person’s psychological state are indication for hospitalization sick. It is worth noting that hospitalization of a person is permissible only with the consent of the patient. Unfortunately, serious deviations in a person’s mental health do not give him the opportunity to adequately assess the current situation and make the right decision.

For patients with psychiatric disorders, a procedure is provided for registration of hospitalization by a legal representative or by court decision, for which the patient’s relatives or government authorities must apply to the court.

Hospitalization in a day hospital

If the patient’s health condition allows, medical care can be provided in a day hospital at a medical institution or a commercial medical clinic. In a day hospital, all necessary diagnostic examinations and therapeutic procedures, rehabilitation and a range of health treatments can be carried out.

It is unacceptable for patients before and after surgery, cardiac patients and patients with psychological pathologies to be in the day hospital. Pregnant women with suspected natural abortion, identified pathologies, as well as in case of exacerbation of chronic diseases are hospitalized in the obstetrics and gynecology department of a medical institution or in a maternity hospital.

Hospitalization procedure

As part of a planned hospitalization, the patient can independently reach a medical facility or use the ambulance service. When registering at a public medical institution, it is recommended to have a passport, medical insurance policy, a doctor’s referral and the results of previous examinations.

In case of emergency hospitalization, the patient is registered without presenting documents. Upon admission to a medical facility, blood and urine are collected from the patient for clinical examinations, and an X-ray examination, ultrasound examination and ECG are performed. In the future, the doctor can refer the patient for additional studies that will allow a more clear and correct diagnosis of the disease and effective treatment. The length of stay in a medical facility depends on the severity of the disease and the effectiveness of the treatment used.

You can get more detailed information about the reasons for hospitalization, medical institutions in the city, undergo an examination and get advice from specialists at our medical center. The use of high-tech diagnostic equipment and many years of experience of our doctors will allow us to conduct a full examination and select the necessary treatment.

Related materials:

You need to define:
- whether it was fainting or convulsions;
- probable cause of syncope, based on assessment of clinical data and ECG;
- whether the patient requires hospitalization.

Was it fainting or convulsions?
To differentiate between vasovagal syncope, cardiac syncope (Morgagni-Adams-Stokes attack), and seizures, a thorough history must be obtained from the patient and any witnesses to the events. Remember that involuntary movements (including tonic-clonic seizures 30 seconds after cardiac arrest) are common with syncope and do not necessarily indicate epilepsy.

What should you pay attention to when taking anamnesis?

Background states:
Any history of a similar attack.
History of severe traumatic brain injury (eg, skull fracture or loss of consciousness).
Birth trauma, febrile seizures in childhood, meningitis or encephalitis.
Epilepsy in close relatives.
Heart disease (? history of myocardial infarction, hypertrophic or dilated cardiomyopathy, prolonged QT interval [risk of developing ventricular tachycardia]).
Taking medications.
Alcohol abuse or drug addiction.
Insomnia.

Before the attack:
- Prodromal symptoms: were there any cardiovascular symptoms (eg, dizziness, palpitations, chest pain) or focal neurological symptoms (aura)?
- Conditions for the occurrence of an attack, for example, physical activity, standing, sitting or lying down, during sleep.
- Last action before loss of consciousness (for example, coughing, urinating or turning the head).

Attack:
- Were there any focal neurological symptoms at the onset of the attack: prolonged turning of the head, or deviation of the eyeballs, or unilateral twitching of the limbs?
- Was there a scream? May be observed in the tonic phase of seizures.
- duration of loss of consciousness.
- tongue bite, involuntary urination or injury accompanying the attack.
- change in complexion (pallor is often observed during fainting, rarely during convulsions).
- Pathological pulse (can be assessed by reliable testimony of witnesses).

After the attack:
- How quickly did the patient regain consciousness or did confusion or headache persist for some time?
- Evaluation of clinical data and ECG allows us to determine the most likely cause of syncope in approximately 50% of patients.
- Assess complete blood count, creatinine, electrolytes (including magnesium in patients taking diuretic and antiarrhythmic drugs) and blood glucose.
- If an examination of the cardiovascular system or an ECG reveals pathology, perform a chest x-ray.

What you need to pay attention to attention during examination:
- Level of consciousness (whether the patient is fully oriented).
- Pulse, blood pressure, body temperature, respiratory rate, saturation.
- Systolic blood pressure while sitting, lying down and 2 minutes after standing up (a decrease in blood pressure by more than 20 mm Hg is a pathology; the presence of concomitant symptoms).
- Pulse on the arteries (assess the presence of murmurs on the main arteries and the symmetry of the pulse).

Swelling of the jugular veins (if elevated jugular venous pressure is present, rule out pulmonary embolism, pulmonary hypertension, and cardiac tamponade).
- Heart murmurs (aortic stenosis and hypertrophic cardiomyopathy can cause syncope during exercise; atrial myxoma can occur under the mask of mitral stenosis).
- Neck mobility (do neck movements cause fainting? Are there stiff neck muscles?).
- Focal neurological findings: At a minimum, assess visual fields, limb strength, tendon and plantar reflexes.
- Fundus of the eye (presence of hemorrhages or papilledema).

Indications for hospitalization for fainting

Patients with vasovagal or situational syncope do not require hospitalization. Most other patients with syncope should be hospitalized for observation for at least 12 to 24 hours.

Indications for mandatory hospitalization are fainting and:
History of myocardial infarction or cardiomyopathy (? ventricular tachycardia).
Chest pain (acute myocardial infarction or aortic dissection).
Sudden headache (? subarachnoid hemorrhage).
Swelling of the neck veins (? PE, pulmonary hypertension or cardiac tamponade).
Signs of severe damage to the valvular apparatus of the heart (aortic stenosis, atrial myxoma).
Signs of congestive heart failure (? ventricular tachycardia).
Pathological ECG.

Hospitalization often indicated for:
Sudden loss of consciousness with injury or palpitations; or loss of consciousness due to physical exertion.
Taking medications that affect the duration of the QT interval (quinidine, disopyramide, procainamide, amiodarone, sotalol).
Severe orthostatic arterial hypotension (decrease in systolic blood pressure by more than 20 mm Hg in a standing position).
The patient is over 70 years old.

Indications for hospitalization to the cardiology department and ECG monitoring:
Patients with ECG signs of conduction disturbances, but without absolute indications for temporary pacing: sinus bradycardia< 50 в 1 мин, не связанная с приемом р-блокаторов; остановка синусового узла на 2-3 с; двухпучковая или трехпучковая блокада.
Patients at risk of ventricular tachycardia: history of myocardial infarction, cardiomyopathy, prolonged QT interval.

Indications for temporary pacing:
AV block II or III (complete) degree.
Sinus node arrest > 3 sec.
Sinus bradycardia< 40 в 1 мин, не купируемая введением атропина.
Dysfunction of the constant pacemaker.

Organic cause of syncope suspected:
Arrange for appropriate testing to confirm or refute your preliminary diagnosis (eg, echocardiography [aortic stenosis], ventilation-perfusion scan [PE]).
If test results are equivocal or negative, further management is the same as for unexplained syncope.

Syncope unknown reason:
In patients over 60 years of age with an unknown cause of syncope, carotid sinus hypersensitivity must be excluded.
Patients with unexplained syncope should be advised not to drive until the cause of syncope is determined and corrected.