Sometimes there are situations when the patient needs to be hospitalized. What is hospitalization, and in what cases is it applicable. Hospitalization is the placement of a patient in a hospital of a medical organization of private or state ownership. Depending on the method of delivery of the patient to the hospital and his condition, there are two main types of hospitalization of patients:

emergency hospitalization- a person is in an acute condition, which carries a serious threat to his health or life.
planned hospitalization- the term of admission to the hospital is agreed in advance with the doctor.

Ways of hospitalization of a citizen in a hospital institution:

ambulance: in case of accidents, injuries, acute diseases and exacerbation of chronic diseases.
in the direction of an outpatient clinic for planned hospitalization. Also, the direction can be issued by a medical and rehabilitation expert commission or a military registration and enlistment office.
hospitalization "by gravity" - with the patient's independent treatment in the emergency department of the hospital in case of deterioration of his health.
Transfer to another medical institution in case of need for specialized care or temporary closure of the medical organization where the patient was before.

Indications for hospitalization and terms

Emergency hospitalization.

Indications: acute diseases, exacerbations of chronic diseases, conditions requiring intensive care and round-the-clock medical supervision, other conditions that threaten the life and health of the patient or the life and health of others.

E emergency inpatient medical care is provided without delay - around the clock and without hindrance to anyone who needs it. Hospitalization in a hospital for emergency indications is carried out at the direction of doctors of medical organizations of any form of ownership (including individual entrepreneurs engaged in medical activities), at the direction of paramedics-obstetricians, ambulance teams (medical, paramedical). MHI policy in such cases is not required(Federal Law 326-FZ "On Compulsory Medical Insurance in the Russian Federation"). It is enough to go to the emergency department of the hospital or call an ambulance on your own.

Planned hospitalization – diagnostics and treatment requiring round-the-clock medical supervision. This type of treatment in a hospital is preceded by an examination by specialists, including the delivery of tests, x-rays, CT, MRI, etc.

Planned hospitalization is carried out within the time limits established by the territorial program of state guarantees for the provision of medical care, but not more than 30 days from the date of issuance by the attending physician of the referral for hospitalization(with the exception of high-tech medical care, in the provision of which the terms may be exceeded).

In the direction of the clinic issued to the patient, the hospital doctor indicates the date of the planned hospitalization. Planned hospitalization is carried out if the patient has the following documents: a passport or other identity document, a valid compulsory medical insurance policy, a referral from a medical organization for primary health care, the results of diagnostic studies that can be carried out on an outpatient basis.

In the event of a planned hospitalization of a patient, the volumes and timing of therapeutic and diagnostic measures are determined after his examination by a doctor on the day of admission in accordance with the approved standards for the provision of medical care, patient management protocols, and the patient's condition.

In case of violation of the terms of hospitalization

If it is impossible to comply with the stipulated waiting periods, the patient must be provided with the necessary medical care in other medical organizations operating in the CHI system.

If the deadlines are violated or if the patient does not know how long to wait, then, as advised by the Ministry of Health, you must immediately contact the employees of the medical insurance organization in which the patient is insured or the territorial CHI fund.

Hospital selection

During planned hospitalization. With a planned form of hospitalization, the choice of a medical organization is carried out in the direction of the attending physician. However, if several medical organizations providing medical care in the relevant profile participate in the implementation of the territorial program of state guarantees of free provision of medical care to citizens, the attending physician is obliged to inform the patient about which hospitals operating in the CHI system provide the necessary medical care. help, and give a referral to the hospital that the patient has chosen (Federal Law-323 “On the Basics of Protecting the Health of Citizens in the Russian Federation”).

For advice on choosing a hospital, the patient can also contact his insurance company. If the doctor does not want to discuss possible options and give a referral based on your choice, then the patient should contact the head of the department, the head physician of the polyclinic, or their insurance company.

During emergency hospitalization. The right to choose a hospital in the compulsory medical insurance system is valid not only for planned hospitalization, but only if it is not a threat to the patient's life. In a life-threatening condition, the patient must be taken as soon as possible to the nearest hospital providing assistance of the required profile.

In all other cases, the patient has the right to choose. The patient has the right to ask a question about where he is planned to be hospitalized, to be reminded of his right to choose, and he must be offered a choice of at least two hospitals. However, ambulance and emergency stations serve certain areas of settlements. The ambulance doctor has the right to refuse to satisfy the patient's demand for hospitalization in a hospital specifically named by the patient, located on the other side of the city, while there are several hospitals nearby that have departments of the necessary profile.

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

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

Department of hospitalization

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

For example, children with infections are placed in a children's (pediatrics) infection ward specifically designed to limit the spread of infectious diseases.

Depending on the etiology and type of disease, patients may be hospitalized in the department of cardiology (cardiovascular diseases), gastrointestinal department (for diseases of the digestive system), nephrology (kidney), pulmonary department (for respiratory diseases). In the hematology department there are patients with diseases that affect the blood and lymphatic system.

In the presence of injuries affecting the nervous system with an inflammatory, degenerative, idiopathic, autoimmune nature, patients are referred to the neurological department. For planned preoperative or urgent surgical treatment, patients are placed in 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 main purpose of hospitalization is to meet the needs of the patient and maintain optimal health, treatment and recovery, both physically and mentally. Depending on your specific situation and needs, you will receive the necessary medical care.

In the hospital, in addition to doctors (your primary care physician and other specialists), you will also meet nurses (perhaps the first healthcare workers you encounter as you cross the threshold of the hospital).

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

In addition to nurses in a number of hospitals, you will also meet medical students preparing for practice, medical specialists, and others. In addition to doctors and nurses, the core team that will take care of you may include physiotherapists, 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 studies, provide treatment).

Forms of hospitalization

In general, depending on the current situation of the patient, hospitalization can be urgent and planned:

Emergency hospitalization: occurs in conditions that are potentially life-threatening, in need of urgent surgical treatment, or when the patient's general condition is severe, requiring hardware monitoring of basic vital functions. 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, lung collapse, eclampsia, acute appendicitis, and others.
Planned hospitalization: allows you to specify the day of admission to the hospital. It is required to perform elective surgeries, chronic diseases, conduct research, periodic blood transfusions, hemodialysis. An appropriate referral is included in the documentation for hospitalization, 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 right day. Planned hospitalization, for example, is used for the 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 respective physician, with standardized regimens.

Hospitalization in 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 (belief in things that are not true)
problems with certain addictions (alcohol, drugs)
patients do not eat, do not sleep for more than 5 days
the sick 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 main 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 of hospitalization can also be divided into:

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

Regardless of the reasons for hospitalization, an upcoming hospital stay (especially for a first-time hospitalization) hides many questions, uncertainties, and concerns for patients.

What to take to the hospital during hospitalization

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

In the case 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: ID card, prescription booklet (for chronic diseases), referral for hospitalization, epicrisis and documents from previous hospitalizations, recent research results;
Small amount of cash: You are advised not to bring large amounts of cash with you as some other patients may not be particularly friendly and card payment is not always possible. You have food at the hospital, but you may need a little money for coffee, tea, food, newspapers and magazines, and more.
Clothing: you need to take a nightgown, dressing clothes, underwear, slippers,
reading glasses (in case you need it)
A pen and a small notebook: if you have questions for your healthcare 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
Against boredom: during your stay in the hospital you will have a lot of free time, so it is good to find a way to avoid boredom in advance by taking your favorite books, magazines, and in some cases, you can pick up and knitting to fill your time
photographs or small personal items of sentimental value: often leaving your home, especially for a longer period, you may feel lonely and isolated, the list is approximately identical (things are taken to recreate a famous and cozy home, favorite toys, entertaining games).

Hospitalization of children

It is recommended to first familiarize the child with the situation in the hospital, explaining to him in simple terms what he will encounter and what to expect. You don't have to be afraid, you don't have to communicate your fears and worries.

Some children (mostly between the ages of 3 and 6) perceive being in the hospital as a 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 the need to be healthy again, energetic, full of desire to play. Adolescents need a proper approach to prevent the desire to rebel and sabotage medical procedures.

Hospitalization Risks

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

Possible complications as a result of the study (for example, when taking blood), undesirable effects resulting from the use of a particular drug or combination of drugs, postoperative infection or bleeding after a certain surgical procedure, nosocomial infection, and others.

Report all known allergic reactions 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 mostly mild, predictable and subject to correction.

There are risks for the patient in case of refusing hospitalization, refusing treatment or performing certain manipulations. In this case, patients are voluntarily exposed to an unpredictable risk of serious deterioration in 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, if necessary, home therapy, medication-based intake is carried out.

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

If re-hospitalization is necessary within a short time (re-hospitalization) in the same or another hospital, the appropriate procedure is followed. The high number of readmissions in the country is indicative of the poor quality of health care (needing to be readmitted only a couple of weeks after discharge suggests poor primary care).

Unfortunately, no matter how afraid a person is of hospitals and doctors, sooner or later everyone ends up in a hospital ward. If your doctor recommends that you undergo an examination and treatment in a hospital, do not immediately refuse this opportunity. It is best to think it over well, weigh it up and make a decision in a calm atmosphere with a clear and sober head.

Indications for hospitalization

The doctor may recommend hospitalization in the case when the medical and diagnostic procedures necessary for the patient cannot be performed at home or in a polyclinic at the place of residence. Such procedures include the need for constant medical supervision and medical manipulations.

In the case when the patient lives alone and is not able to independently comply with all the recommendations of the doctor and ensure his own safety, hospitalization in a medical facility is also carried out. The provision of emergency medical care is an indication for emergency hospitalization, as otherwise the patient's health may be irreparably damaged.

Surgery and cardiac care are also indication for hospitalization sick. The presence of a viral or bacterial infection, which can adversely 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 in cases where it is necessary to conduct a thorough examination of the patient and determine further treatment tactics.

Indications for psychiatric hospitalization

Serious disturbances in the psychological state of a person are indication for hospitalization sick. It should be noted 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, there is a procedure for registering hospitalization by a legal representative or by a court decision, for which the patient's relatives or state bodies 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 the necessary diagnostic examinations and therapeutic manipulations, rehabilitation and a complex of health-improving treatment can be carried out.

It is unacceptable to stay at the day hospital for patients before and after surgery, patients with a cardiological profile and patients with psychological pathologies. Pregnant women with suspected natural termination of pregnancy, 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 get to a medical facility or use the ambulance service. When registering at a state medical institution, it is recommended to have a passport, a medical insurance policy, a doctor's referral and the results of previous examinations with you.

In the case of emergency hospitalization, the patient is registered without presenting documents. Upon admission to a medical institution, the patient is taken blood and urine for clinical studies, X-ray examination, ultrasound and ECG are performed. In the future, the doctor may refer the patient to additional studies that will more accurately and correctly diagnose the disease and conduct effective treatment. The duration of stay in a medical institution 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 of the city, undergo an examination and get advice from specialists in 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.

Indications for emergency hospitalization of patients. Indications for hospitalization for fainting Indications for hospitalization in the pediatric department

You need to define:
- was it fainting or convulsions;
- probable cause of syncope based on assessment of clinical findings and ECG;
Does the patient require hospitalization?

Was it fainting or convulsions?
In order to differentiate between vasovagal syncope, cardiac syncope (Morgagni-Adams-Stokes seizure) and seizures, a thorough history of the patient and any eyewitnesses of the events must be taken. Keep in mind that involuntary movements (including tonic-clonic seizures 30 seconds after cardiac arrest) are common with syncope and do not necessarily indicate epilepsy.

What should be considered when taking anamnesis?

Background states:
Any similar seizure in history.
History of severe traumatic brain injury (for example, with a skull fracture or loss of consciousness).
Birth trauma, febrile seizures in childhood, meningitis or encephalitis.
Epilepsy in next of kin.
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)?
- Seizure conditions, such as exercise, standing, sitting or lying down, sleeping.
- The last action before losing consciousness (for example, coughing, urinating, or turning the head).

Attack:
- Were there any focal neurological symptoms at the onset of the attack: prolonged head turning, or deviation of the eyeballs, or unilateral twitching of the extremities?
- Was there a scream? It can be observed in the tonic phase of seizures.
- duration of loss of consciousness.
- Accompanying an attack of a bite of the tongue, involuntary urination or trauma.
- change in complexion (pallor is often observed with fainting, rarely with convulsions).
- Pathological pulse (can be estimated from reliable testimony of witnesses).

After an attack:
How quickly did the patient come to, or did the confusion or headache persist for some time?
- Evaluation of clinical data and ECG allows you to determine the most likely cause of syncope in about 50% of patients.
- Assess complete blood count, creatinine, electrolytes (including magnesium in patients taking diuretics and antiarrhythmic drugs), and blood glucose.
- If an abnormality is found on a cardiovascular examination or an ECG, take a chest X-ray.

What needs to be addressed 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 noise on the main arteries and the symmetry of the pulse).

Swelling of the jugular veins (if there is increased pressure in the jugular veins, rule out PE, pulmonary hypertension, and cardiac tamponade).
- Heart murmurs (aortic stenosis and hypertrophic cardiomyopathy may cause syncope on exertion; atrial myxoma may masquerade as mitral stenosis).
- Mobility of the neck (does neck movement cause fainting? Is there stiffness of the muscles of the back of the head?).
- Focal neurological signs: at a minimum, evaluate visual fields, limb strength, tendon and plantar reflexes.
- The fundus of the eye (the presence of hemorrhages or edema of the optic nerve head).

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 12-24 hours.

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

Hospitalization often shown with:
Sudden loss of consciousness with trauma or palpitations; or loss of consciousness during physical exertion.
Taking drugs 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 the standing position).
The patient is over 70 years of age.

Indications for hospitalization to the cardiology department and ECG monitoring:
Patients with ECG evidence of conduction disturbance but no absolute indication 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 arrest > 3 s.
Sinus bradycardia< 40 в 1 мин, не купируемая введением атропина.
Violation of the function of a permanent pacemaker.

Suggested organic cause of syncope:
Arrange for appropriate investigations to confirm or refute your tentative diagnosis (eg, echocardiography [aortic stenosis], ventilation perfusion lung scan [PE]).
If test results are equivocal or negative, management is the same as for syncope of unclear origin.

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