Knowledge Is Power

Hospitals have instructions in writing and online for how to plan for an admission. You should also discuss with your doctor how to prepare for your admission and what to bring with you. In all cases, you will need the following:

In a sudden emergency you may not have time to gather everything on this list. Keep a packet with your New York State Health Care Proxy, lists of your medications and physicians, and other important contact information somewhere where it can be easily picked up and brought along in case of a rushed situation. WELC’s Be Prepared Kit can be a very helpful tool.

Learn more about preparing for a planned admission.

When you are admitted to the hospital you will be assigned a doctor – your hospital physician. He or she will be in charge of your care while you are in the hospital. It may be your usual primary physician, or it may be a hospitalist.

A hospitalist is a physician who is employed to work at the hospital. Many physicians no longer go into the hospital to care for their patients. Instead, they have a hospitalist partner who is assigned to your care and who communicates regularly with your primary care doctor.

Make sure you give the name of your primary care or internal medicine physician to the admissions nurse. Also, give the names of any other providers you are seeing (for example, oncologist, pulmonologist, renal specialist, cardiologist, palliative medicine specialist, neurologist). If you are admitted to a hospital where your physician is not on staff and does not have a hospitalist partner, your care will be assigned to a physician who works at that hospital. It is important to provide your physician’s name and contact information to the hospital staff so that your assigned physician can get your medical history.

Bring a copy of your advance directives with you to the hospital. This includes your health care proxy as well as any other advance directives you may have (for example, DNR and MOLST). During the admission process, make sure you give your advance directives to the admissions nurse so that they become part of your hospital chart.

Your hospital chart is a medical record documenting everything important about your care from admission to discharge.

Speak to your hospital physician about your advance directives and choices so that they are part of your plan of care while you are in the hospital.

During the admission process, share the names of all the medications you are taking, including prescription, over-the-counter, and herbal remedies. Tell the admissions nurse if they are taken daily or as needed. This information needs to be entered into your chart.

Be sure to mention if you are on pain medication – pills or a patch system. These medications should not be stopped suddenly. You can ask if your pills or patch will continue while you are in the hospital or if they will be changed to an IV (intravenous device).

Discharge planning starts at the time of admission. Tell the hospital physician and admissions nurse if you were receiving care in the home from a CHHA (Certified Home Health Agency) or a hospice agency. Knowing your care situation at the time of admission is helpful in planning your discharge.

Getting a new diagnosis or having a change in your medical situation in the hospital can feel unsettling. Make sure you have a clear understanding from your doctors about any new diagnoses. Ask for information about any tests or treatments they are recommending and the role of any new physicians (consultants) in your care. Additional information about diagnosis and treatment similar to those you would ask in a doctor’s office.

Your hospital physician is the leader of your medical team while you are in the hospital. He or she summarizes all of the information from the other consultants, tests and treatments and makes sense of them. This is the person you should look to for detailed information and for your plan of care.

Sometimes your hospital physician may ask another specialist (for example, a cardiologist or an oncologist) to share the role of team leader in the hospital. This should be discussed with you and the reasons explained.

Be sure to share your experience with pain or other symptoms with your physician. Ask him or her to explain what the medical team plans to do to help you. Additional information about symptoms and talking to your doctor.

In addition to your physicians and nurses, many other services and resources are available in the hospital. They may include patient representative, case manager, patient advocate, pastoral care, or social work services. Information about these support services is usually in your admission folder. Do not hesitate to contact them.

Changes in your medical status are common in the hospital and new health care decisions often need to be made. Most medical decisions will be discussed with you or your health care agent if you are unable to make decisions on your own. However, based on the urgency of the situation, the medical team may have to make some decisions on its own.

Every individual approaches decisions differently. If it makes you more comfortable, include your family or friends in the discussions with the medical team. Make sure your health care agent is present or informed of any decisions.

To make decisions, you will need clear information about your situation and an understanding of your options. You can begin by asking your medical team these questions:

If an individual is in critical condition, some decisions may be focused on life-sustaining treatments (for example, CPR, feeding tubes, dialysis, or artificial breathing machines).  

Unless told otherwise, medical staff in the hospital will do CPR on all patients whose heart or lungs stop functioning. If you have a high risk of failure of breathing or cardiac (heart) failure, the medical team may ask about your choices regarding CPR and if you would consent to a Do Not Resuscitate (a “DNR”) order.

With a serious illness, CPR may not improve a person’s symptoms or life expectancy and may actually cause suffering. Before you make any decision regarding a DNR, you can discuss with the physician what the likely effect would be if CPR were performed on you. If you have a DNR in place, you will still get all medical care and support. It means only that aggressive measures of intubation or chest compressions will not be performed if you stop breathing and have no pulse.

Depending on the situation, you may have already made decisions about life-sustaining measures and have documented them in your advance directives (health care proxy, MOLST, or in a conversation). If this is a new discussion, it is important to understand the advantages and disadvantages of these interventions based on your circumstances.

Make sure the medical team explains about a proposed life-sustaining treatment, including the following:

If faced with a difficult decision, often the health care agent and family members need a meeting with the medical team (a “family meeting”) to discuss the situation and get additional information and support. A family meeting can help everyone “get on the same page” about what is going on, what to expect, and where the focus of care should be going forward. It is important to understand all options for care – now and in the future.

It can be helpful to ask your physician for a consultation with the hospital’s palliative medicine services. Assistance with medical decisions is one of its areas of expertise.

In addition to doctors and nurses, other services in the hospital (for example, chaplaincy, social work, health advocacy) can offer support and assistance. Feel free to ask for them.