Managing a Hospital In-patient Stay

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If you need to be admitted to the hospital you are probably either too ill to stay at home or need an operation.

When you are admitted make sure that you know the name of the consultant in charge of your care. Every inpatient has a named consultant responsible for his or her care. In previous times the consultant’s name was written at the end of the bed. Nowadays your care may be overseen by a group of consultants, and this can cause difficulties in communication when problems arise. Ask who they are and make a note of the names and what is their speciality. Is he or she a surgeon who does operations or a physician who uses medication and other forms of treatment?

The healthcare team has the following structure: There are two broad categories…surgery and medicine. The senior person is the consultant who may be a surgeon (called Mr or Miss) or a physician (called Doctor). In the team in order of seniority are the senior registrar, training registrars (called F1 or F2 depending on the stage of their training) and probably a houseman (most junior). These structures are much less distinct since restructuring in the last few years by the Department of Health. In parallel there is a nursing team led by a ward sister, head nurse or charge-nurse and a variety of more junior nurses. When the junior doctors visit ask them which consultants they work with and when they will be discussing your case with the senior team members. Find out when a consultant will be visiting your ward and make sure if possible that any investigations which may take you away from the ward are scheduled at another time.

When you are feeling unwell it is very important that you have a friend or family member “riding shotgun” for you. You need someone, preferably with a little knowledge of medical matters, but otherwise sensible and practical, to keep an eye on you. You really need an advocate who can listen to the staff when they tell you the plans; someone who can check that promised investigations are done as requested, who check that results have been received, shown to the doctors, and filed in your hospital notes. Busy staff have many patients, but your friend has just one. It can be invaluable to have someone ensuring that nothing important is overlooked or delayed.

If you have more than one medical problem, which is now very common, it can be complicated for staff to work out the implications of one on the other. This is where clinical experience comes in and the opinion of a senior doctor is vital.

It can also be difficult if more than one consultant and more than one medical team are involved in managing your care. They may have different priorities and wires can get crossed. Identify what you consider the most important problem (check with staff) and who is the responsible doctor. Establish when that doctor will visit the ward and explain your concern about communication. This is where your friend or family member can really help. Ask them to ring the consultant’s secretary and explain the difficulty.

The consultant’s secretary is a key resource. It is well worth getting to know her/his name and establishing some rapport and name recognition. The secretary is often very experienced and very well versed in managing the practicalities of your condition.

If you have more than one medical problem, it needs to be clear who is in overall charge and you may need to insist that they talk to their colleagues about your care.

If you are the patient ‘advocate’ you have an important role. Get to know your way around the hospital: which lift goes where, which nurse is approachable, are there visiting times or open access, when are meals served and what time are the ‘drug rounds’ when medication is given out.

As patient, make a note as far as you can about what dose of drugs you are taking and why. Keep a close eye on the dose you are given as mistakes here are common. If in doubt, ask to see the ward pharmacist who can take up any queries with the prescribing doctor. Find out what time nurses hand over to the next team (usually 8am and 5pm) It is worth knowing that everything on the ward comes to a halt during these times as it is essential that every member of the team is present to hear the important information about every patient. Ask where best to park and how to get in to the hospital if you need to visit out of working hours or at the weekend. Ask lots of questions and get familiar with the language and the routines. Learn who you can rely on and whom you may need to query. Some staff can be inexperienced, untrained, and overconfident. You may need to keep an eye on them unobtrusively and check their advice with a more experienced professional.

Be courteous but be firm. You may have just one chance to get this right and you will not want to reproach yourself later if you did not ask or did not check. When you (the patient) are discharged from the hospital make sure that you ask for a copy of the ‘Discharge Summary’ which is normally sent a few days later to your GP. This will give the name of your consultant(s) and your hospital number as well as fairly brief details of what took place while you were in hospital. If you are unfortunate to fall ill again soon after discharge the Discharge Summary can be invaluable. If you have not received a copy ring your GP practice and ask for a copy to be emailed or faxed through to any new healthcare team taking over your care. If for example you need to be admitted to another hospital this information will be essential.

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