Hospital Medicine

RedAirplane

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Hello all, I've been offline for a while but now working 911/IFT on top of what I was doing before. I'm trying to wrap my head around the course our patients take once they reach a medical facility.

1. There are some public/charity hospitals that serve needs of the uninsured/underinsured. However, it is also my understanding that complex medical cases can enroll for Medicaid retroactively. So, what role do these public facilities serve if a patient can get their care covered retroactively from any facility? Do Medicaid or uninsured patients routinely get transferred out?

2. Do physicians directly admit their patients to hospital anymore? If not, how does continuity of care work? Not infrequently a 911 patient calls because their doctors office told them to call. We will then transport according to protocol and there will generally not be any record, besides the patients account, of the patients previous history, what's wrong now, and perhaps why a headache is now requiring possible admission. Further their doctor may not have visiting privileges at the hospital we end up at, probably making following the patient even harder.

3. Silly question, but I'm struggling to figure out the answer. For a hospital with no emergency services, how do you get in? Is it admissions from a physicians office only? What services would require a hospital stay but not an ER visit?

Any insight you have would be great. Not directly related to EMS, but would help me get a better picture of the experience my patients have with the healthcare system.
 

Akulahawk

EMT-P/ED RN
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1. There are some public/charity hospitals that serve needs of the uninsured/underinsured. However, it is also my understanding that complex medical cases can enroll for Medicaid retroactively. So, what role do these public facilities serve if a patient can get their care covered retroactively from any facility? Do Medicaid or uninsured patients routinely get transferred out?
This is something I have no idea about. I'm an ED RN and I don't do billing or handle insurance stuff. I don't care if my patients are insured. I let others deal with that aspect of things.
2. Do physicians directly admit their patients to hospital anymore? If not, how does continuity of care work? Not infrequently a 911 patient calls because their doctors office told them to call. We will then transport according to protocol and there will generally not be any record, besides the patients account, of the patients previous history, what's wrong now, and perhaps why a headache is now requiring possible admission. Further their doctor may not have visiting privileges at the hospital we end up at, probably making following the patient even harder.
The facility I work at has a bit over 100 inpatient beds. We admit, through the ED, between 10 and 20 per day. The vast majority of our inpatients aren't there longer than 2-3 days so if the hospital depended upon the ED for the majority of the admits, we'd have lots of open beds. I suspect that the majority of beds are filled via planned admits. Not all physicians have admit privileges at all hospitals, and I would suspect that more than a few do not have hospital privileges. Those physicians that do have admit privileges, they have to coordinate with the hospital's bed control to ensure that a needed bed is available. For instance, my hospital does NOT have an inpatient urology service. While we may have a urologist on staff or on call for difficult urinary catheterization, we have to refer or transfer patients that require a urology specialist to a facility that does have that service available.

Physicians that do refer their patients to the ED from their offices are supposed to send the patient's medical record with the patient. In the instance where the patient calls the office about a problem and is referred to 911, usually we can request the medical record from the physician's office but if nobody is available, we cannot get the records all that quickly. One other way we can get records is that we do have an electronic records sharing agreement with some other hospitals so if the patient has been to a hospital where we have such an agreement and we get permission from the patient, we can nearly instantly get those records. If none of that stuff is available, we have to go by what the patient, family, EMS, or some other proxy can tell us about the patient.
3. Silly question, but I'm struggling to figure out the answer. For a hospital with no emergency services, how do you get in? Is it admissions from a physicians office only? What services would require a hospital stay but not an ER visit?
Hospitals that do not have an ED accept patients into their hospital either by a direct admit process through a physician that has admit privileges or they'll accept transfer patients from another hospital. I suspect the majority of their admits are interfacility transfers from other hospitals. These kinds of hospitals are probably "Long Term Acute Care" that provide care for patients that, for whatever reason, cannot stay in a regular acute care hospital, and that's probably due to the "long term" part of the name. ;)
 

SpecialK

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Acute admissions generally go through the emergency department; the GP (or whomever) will ring the relevant Registrar and discuss the patient and notify them they are being sent to the hospital. The Registrar will generally send their House Surgeon or SHO down to investigate and work them up and they're often quickly moved into the short stay area away from ED. In the future, there will be a greater role for ambulance personnel to speak directly to the relevant Registrar and discuss patients directly.

Parts of the national electronic medical record are live now so things like discharge summaries can be seen including by ambulance personnel. Within the next couple of years this will be expanded into a true single national health database which everybody can see.

Some of the small rural facilities do not have an ED; they are more "step down" sites with maybe 10-12 beds or whatever; or a local hub for outpatient appointments from visiting specialists from the base hospital. They are usually managed by the local GPs or Rural Hospital Medicine Registrars who ar ealso often dual GP Registrars or GPs.

And there is no bill at a public hospital.
 

Tigger

Dodges Pucks
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^In New Zealand.
 

DrParasite

The fire extinguisher is not just for show
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I one had a patient who received a letter in the mail from her doctor saying she had abnormal lab results, and needed to go to the hospital. So she called a 911 ambulance to take her in.
 
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RedAirplane

RedAirplane

Forum Asst. Chief
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I one had a patient who received a letter in the mail from her doctor saying she had abnormal lab results, and needed to go to the hospital. So she called a 911 ambulance to take her in.

Not even a phone call? :0
 
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