According to the Encyclopedia of Surgery (2010), admission to a hospital can result from a positive experience such as delivering a child, elective surgery, or other therapeutic procedures or due to an emergency experience in the emergency department. Admission into the emergency room is the most hectic of the situations mentioned earlier due to its unexpectedness and the fact that it could be life-threatening.
The duration of hospitalization may vary, but to qualify as an inpatient, the individual has to stay in the facility for at least a day. Herein is a description of the processes that take place during a typical hospitalization or emergency department visit for a consumer under the Affordable Care Act – ACA – from admission to discharge, including aftercare, rehab, and medication acquisition, comparing the hospitalization experiences before and after the implementation of the ACA.
An admitted patient has to stay in a hospital room for the entirety of the time they will spend at the hospital. It is the doctor’s mandate to determine which cases are for admission and which ones are not. The hospital personnel needs to perform admitting procedures before the patient can go to their room. The initial admitting procedure involves recording and entering the patient’s personal information into the hospital’s system. The information recorded includes the patient’s name, address, contact information, date of birth, employment information, occupation, next of kin, insurance information, religious affiliations, and reason for admission (Encyclopedia of Surgery, 2010).
Other than recording personal data, there are several forms that the personnel fill. One such form is the detailed medical and medication history form. This form takes in the patient’s history of hospitalizations and/or surgeries. A patient who provides this information readily helps to hasten the admission and treatment process, and allow for ease of assisting them. The personnel may also enquire whether the patient has any Advance Directives.
Advance Directives are pre-filled forms that indicate the medical decisions the patient wishes other people to make on their behalf. The Living Will, for instance, outlines the patient’s most preferred resuscitation procedures to save or elongate their life. The Durable Power of Attorney is a form that states the patient’s choice of the person they would wish to make decisions on their behalf should they not be in the capacity to make those decisions.
In some facilities, patients make the designations above in blank forms the hospitals provide. In other cases, the hospital staff asks the patients if they have such forms, and if they have them, they make copies and add them to the patient’s record. Once the admitting officer has all the information required by the facility’s protocols, they place a plastic bracelet on the patient’s wrist.
The bracelet bears the patient’s “name, age, date of birth, room number, and medical record number on it” (Encyclopedia of Surgery, 2010, par. 6). Additionally, if the patient has any allergies, the officer adds a separate bracelet bearing the list of allergies the patient has. For the patient to grant their consent to the hospital staff to take care of them during their hospital stay, they have to sign and complete all these forms. During subsequent admissions, the patients have to append their signatures on new consent forms. Guardians and parents fill out all the requisite forms on their children’s behalf.
After providing their admission information, next, the personnel – usually a nurse – takes the patient to their room. Many times patients stay in semi-private rooms – one room shared by two patients. In some instances, the patient has to stay alone in a private room. In other instances, and when private rooms are available, the patient may choose to stay in a private room provided that they pay the extra cost because insurance covers semi-private room cost only. Nonetheless, hospitals try to create as much privacy in the semi-private rooms as possible, including measures such as putting drawable curtains around the patients’ beds.
Two critical activities ensue once the patient is in their room. The nurse tendering to the patient’s needs first goes over the patient’s history and then orients them with the room. At this point, the nurse tells the patient how to adjust bed height, how to utilize the call button, where the bathroom is, and how to use the telephone and television. Insurance does not cover the cost of telephone services, and the nurse should divulge such information to the patient. In some instances, the doctor limits the patient from using the bathroom, depending on their condition. If the doctor does not feel like the patient should leave their bed, then the nurse can put up the side rails of the bed. These rails also help to prevent the patient from falling. At all times, the caregiver should keep in mind the patient’s safety and medical condition.
After the nurse orients the patient with their room, they proceed to review the doctor’s orders. These orders include scheduled tests, whether the patients can leave the bed or not, the medications to administer to the patients, and any feeding restrictions that the doctor may put in place. The facility provides towels and bedding, but some patients prefer to bring their personal effects from home. To prevent the contraction of facility-acquired infections, patients who bring their items to the hospital should wash them with hot or warm water and soap to ensure that they do not take germs home from the hospital.
In case a patient requires exceptionally close monitoring, they stay at the Intensive Care Unit, ICU. In the ICU, doctors restrict visits due to the severity of the patient’s condition. However, when the patient improves, and their conditions become less life-threatening, they transfer to regular rooms with lesser restrictions than the ICU. In the case of a patient from surgery, they have to stay in the recovery area for some time before they end up in the regular wards. No visitation occurs while the patient is in the recovery area, and they spend most of the time asleep as the anesthesia wears off. In many facilities, guardians and parents can stay overnight at the facility with the child, and they can be there all day long. Many hospitals also have children’s playrooms to allow children playtime and relaxation.
In prearranged hospitalizations, the patient needs to make some preparations to smoothen the process. They should have a list of all medications they are taking and the reasons they are taking the medications. In case of any allergies to medications, the patient should also make a list of these. The list of medicines should include prescription drugs and over-the-counter medicines as well as supplements and home remedies such as herbs. If the hospitalization involves surgery with a potential for substantial blood loss, the patient can arrange to have blood made ready so that if they require a transfusion, the patient will receive their blood.
Many facilities have flexible terms-of-stay for inpatients. Facilities create an environment to enable the patients to recover within the shortest possible time. Once the physician feels that the patient is not too sick to stay at the facility, they draft a discharge summary and prescribe any other medications that the patient may need to take at home until they recover fully. Depending on the nature of the patients’ conditions, the facility can organize home visits with the patient to monitor their progress, or give a date on which the patient should visit the facility for follow-up. Patients can obtain medications from the hospital pharmacy, and if the required medicines are not in stock, they can make out-of-pocket purchases from commercial pharmacies.
With the implementation of the ACA, there are some changes in the processes described above. Freedman, Nikpay, Carroll, and Simon contend that “As more patients with chronic or complex health problems become eligible for coverage, patterns of hospitalization could change” (2017, p. 2). Currently, physicians and nurses carry a sheet of paper where they list every simple step they perform. This sheet of paper comes as a checklist for caregivers because they get paid in direct proportion to the quality of care they provide. As Ho puts it,
Health care professionals are richly rewarded for performing more open-heart surgeries and angioplasties, while they receive little or no financial compensation for time expended, educating patients to practice the healthy habits that would reduce the need for costly, aggressive medical treatments (2011, p. 818).
Caregivers have to check for minute details such as the time the patient took medications and the timeliness of a catheter coming out (Chow, 2013). Documenting even the simplest of steps significantly lowers medical error. However, hospitals find it hard to implement checklists because the caregivers do not like them. Checklists are better for patients, and they are the hospital’s bottom line.
Before the ACA, Medicare reimbursed hospitals distinctly from the physicians. However, in pilot centers like the Summa Akron City Hospital in Akron, OH, Medicare plans to pay the doctors and the facility as an entity (Chow, 2013). In this way, the facility and the doctors, in equal measure, share in the savings or costs of each hospitalization. This act is a way to foster culture and collaboration while upholding quality care delivery from all those involved.
“Physicians are a dedicated, strong-willed, independent lot, and many of them went into the practice of medicine because traditionally you have been able to be the captain of your ship, and that is not always equated to good care,” he says (Chow, 2013, par. 20).
The ACA has provided doctors with incentives to avert readmissions, a phenomenon that was not there before the ACA. To prevent cases of readmission, doctors commit to their patients once they discharge them because it is in their financial interests to ensure that their patients are healthy even at home. In some incidents, they send nurses to the patients’ homes to check on them until the patients recover fully.
In 2015, the Health and Human Services Secretary announced an ambitious plan to reform the healthcare delivery system. The reformed framework aimed at transforming 90% of all Medicare fee-for-service (quantity-based) payments to value-based payment programs by 2018, making half of Medicare payments through alternative models of payments within the same period (Felland, Cunningham, Doudleday, & Warren, 2016). To succeed under the alternative payment models, hospitals need to function differently from before, because payments are contingent on performance on measures of quality and cost of healthcare services. Accountability is no longer on the patient’s shoulders; it is the responsibility of the hospital to guarantee patient outcomes.
Chow, L. (2013). Three ways Obamacare is changing how a hospital cares for patients [Radio broadcast]. Web.
Encyclopedia of Surgery. (2010). Admission to the hospital – procedure, recovery, blood, time, medication, risk, children, definition. Web.
Felland, L., Cunningham, P., Doubleday, A., & Warren, C. (2016). Effects of the Affordable Care Act on safety net hospitals [PDF file]. Web.
Freedman, S., Nikpay, S., Carroll, A., & Simon, K. (2017). Changes in inpatient payer-mix and hospitalizations following Medicaid expansion: Evidence from all-capture hospital discharge data. PLoS ONE, 12(9), e0183616. Web.
Ho, V. (2011). The Affordable Care Act – A new way forward. AMA Journal of Ethics, 13(11), 817–821. Web.