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Inpatient care is the care of patients whose condition requires admission to a hospital. Progress in modern medicine and the advent of comprehensive out-patient clinics ensure that patients are only admitted to a hospital when they are extremely ill or have severe physical trauma. [1]
Patients enter inpatient care mainly from previous ambulatory care such as referral from a family doctor, or through emergency medicine departments. The patient formally becomes an "inpatient" at the writing of an admission note. Likewise, it is formally ended by writing a discharge note.
Health care professionals involved in rehabilitation are often involved in discharge planning for patients. When considering patient discharge, there are a number of factors to take into consideration: the patient's current state, their place of residence and the type of support available. When considering the patient's current state, although the patient may be eligible for discharge it is important to examine factors such as the likelihood of re-injury to avoid higher health care costs. Patients' homes should also be visited and examined before they are discharged from the hospital to determine any immediate challenges and corresponding goals, adaptations and assistive devices that need to be implemented. Follow-up appointments should also be coordinated with the patient prior to discharge to monitor the patient's progress as well as any potential complications that may have arisen. [2] A 2016 Cochrane review showed some benefit to patient health when using individualized discharge planning over a standard format, though no reduction in health care costs. [3]
Inpatient care goes back to 230 BC in India where Ashoka founded 18 hospitals. The Romans also adopted the concept of inpatient care by building a specialized temple for sick patients in 291 AD on the island of Tiber.
It is believed the first inpatient care in North America was provided by the Spanish in the Dominican Republic in 1502; the Hospital de Jesús Nazareno in Mexico City was founded in 1524 and is still providing inpatient care.
Perhaps the most famous provider of inpatient care was Florence Nightingale who was the leading advocate for improving medical care in the mid-19th century. Nightingale gained fame and credibility during the Crimean War where she and 38 women volunteer nurses traveled to Crimea to treat wounded soldiers. During her first winter at the hospital 4077 soldiers died in the hospital there. She would use this experience to change the course of inpatient care by focusing on improving sanitary conditions and better living conditions within the hospital. Nightingale became known as "The Lady with the Lamp" and is still considered the founder of modern nursing. The Nightingale School of Nursing continues today and her image is the one depicted each year on nurses' day.
The original model for inpatient care required a family physician to admit a patient and then make rounds and manage the patient's care during their hospital stay. That model is rapidly being replaced by hospitalist medicine a term first used by Robert Wachter in an article written for TheNew England Journal of Medicine in 1996. [4]
The concept of hospitalist medicine provides around-the-clock inpatient care from physicians whose sole practice is the hospital itself. They work with the community of primary care physicians to provide inpatient care and transition patients back to the care of their primary care provider upon discharge. Using this approach, primary care physicians are no longer required to make rounds or be on call.
Today, hospitalist medicine is the fastest growing segment of medicine and is being adopted by hospitals worldwide for inpatient care.
In 2011, there were approximately 39 million inpatient stays in the United States, with a national aggregate cost of $387 billion. U.S. programs Medicare and Medicaid bore responsibility for 63 percent of these total aggregate costs. [5]
In 2011, approximately one quarter of hospital stays in the United States were in the intensive care unit; these accounted for nearly half the aggregate total hospital charges that year. [6]
Intensive care medicine, usually called critical care medicine, is a medical specialty that deals with seriously or critically ill patients who have, are at risk of, or are recovering from conditions that may be life-threatening. It includes providing life support, invasive monitoring techniques, resuscitation, and end-of-life care. Doctors in this specialty are often called intensive care physicians, critical care physicians, or intensivists.
Ambulatory care or outpatient care is medical care provided on an outpatient basis, including diagnosis, observation, consultation, treatment, intervention, and rehabilitation services. This care can include advanced medical technology and procedures even when provided outside of hospitals.
Hospital medicine is a medical specialty that exists in some countries as a branch of family medicine or internal medicine, dealing with the care of acutely ill hospitalized patients. Physicians whose primary professional focus is caring for hospitalized patients only while they are in the hospital are called hospitalists. Originating in the United States, this type of medical practice has extended into Australia and Canada. The vast majority of physicians who refer to themselves as hospitalists focus their practice upon hospitalized patients. Hospitalists are not necessarily required to have separate board certification in hospital medicine.
A children's hospital(CH) is a hospital that offers its services exclusively to infants, children, adolescents, and young adults from birth up to until age 18, and through age 21 and older in the United States. In certain special cases, they may also treat adults. The number of children's hospitals proliferated in the 20th century, as pediatric medical and surgical specialties separated from internal medicine and adult surgical specialties.
Against medical advice (AMA), sometimes known as discharge against medical advice (DAMA), is a term used in health care institutions when a patient leaves a hospital against the advice of their doctor. While leaving before a medically specified endpoint may not promote the patient's health above their other values, there is widespread ethical and legal consensus that competent patients are entitled to decline recommended treatment.
Neonatology is a subspecialty of pediatrics that consists of the medical care of newborn infants, especially the ill or premature newborn. It is a hospital-based specialty and is usually practised in neonatal intensive care units (NICUs). The principal patients of neonatologists are newborn infants who are ill or require special medical care due to prematurity, low birth weight, intrauterine growth restriction, congenital malformations, sepsis, pulmonary hypoplasia, or birth asphyxia.
Outpatient surgery, also known as ambulatory surgery, day surgery, day case surgery, or same-day surgery, is surgery that does not require an overnight hospital stay. The term “outpatient” arises from the fact that surgery patients may enter and leave the facility on the same day. The advantages of outpatient surgery over inpatient surgery include greater convenience and reduced costs.
Acute medicine, also known as acute internal medicine (AIM), is a specialty within internal medicine concerned with the immediate and early specialist management of adult patients with a wide range of medical conditions who present in hospital as emergencies. It developed in the United Kingdom in the early 2000s as a dedicated field of medicine, together with the establishment of acute medical units in numerous hospitals. Acute medicine is distinct from the broader field of emergency medicine, which is concerned with the management of all people attending the emergency department, not just those with internal medicine diagnoses.
An intensive care unit (ICU), also known as an intensive therapy unit or intensive treatment unit (ITU) or critical care unit (CCU), is a special department of a hospital or health care facility that provides intensive care medicine.
University of Missouri Health Care is an American academic health system located in Columbia, Missouri. It's owned by the University of Missouri System. University of Missouri Health System includes five hospitals: University Hospital, Ellis Fischel Cancer Center, Missouri Orthopedic Institute and University of Missouri Women's and Children's Hospital — all of which are located in Columbia. It's affiliated with Capital Region Medical Center in Jefferson City, Missouri. It also includes more than 60 primary and specialty-care clinics and the University Physicians medical group.
Spartanburg Regional Healthcare System(SRHS) is one of South Carolina's largest healthcare systems. SRHS draws patients primarily from the areas of Spartanburg, Cherokee, Union, and Greenville counties (all located in the Piedmont region of South Carolina), as well as Rutherford and Polk counties (located in western North Carolina). Spartanburg General Hospital was organized under the authority of the South Carolina General Assembly in 1917. It officially became the Spartanburg Regional Health Services District, Inc., a political subdivision of the State of South Carolina, by the charter granted by the Secretary of State of South Carolina on May 1, 1995.
The Duke University Health System combines the Duke University School of Medicine, the Duke University School of Nursing, the Duke Clinic, and the member hospitals into a system of research, clinical care, and education.
MelroseWakefield Hospital is a 174-bed non-profit hospital located in Melrose, Massachusetts. MelroseWakefield Hospital and Lawrence Memorial Hospital of Medford function as one hospital entity with two campus locations. The MelroseWakefield Hospital campus provides many different areas of inpatient patient care including general surgery, interventional cardiovascular services, gynecology, maternity, special care nursery, orthopedics, and urology. It also offers outpatient care such as same day surgery, endoscopy, imaging and emergency services as well as serving as the region's Level III Trauma Center.
A hospital is a healthcare institution providing patient treatment with specialized health science and auxiliary healthcare staff and medical equipment. The best-known type of hospital is the general hospital, which typically has an emergency department to treat urgent health problems ranging from fire and accident victims to a sudden illness. A district hospital typically is the major health care facility in its region, with many beds for intensive care and additional beds for patients who need long-term care.
The Society of Hospital Medicine (SHM) is a membership society for hospitalists, physicians, and other caregivers who practice the specialty of hospital medicine.
The Healthcare Cost and Utilization Project is a family of healthcare databases and related software tools and products from the United States that is developed through a Federal-State-Industry partnership and sponsored by the Agency for Healthcare Research and Quality (AHRQ).
Oroville Hospital provides health coverage to the City of Oroville. It is the main hospital for the city of Oroville, California. The building is the City of Oroville in Butte County. It is also a Level III trauma care center. The hospital was founded in 1962 and has grown from a modest community hospital supported by a small staff of doctors into a 133-bed acute care facility specializing in a broad range of inpatient and outpatient services, including multiple physician practices. Oroville Hospital is a private, non-profit corporation serving the Oroville area and Butte County by OroHealth Corporation.
Post-Hospitalist Medicine is the discipline concerned with the medical care of patients residing in Post-Acute, Long-Term Care, Rehabilitation and Assisted Living Facilities. The Physicians whose primary professional focus is the post-hospital medical care of these patients are called Post-Hospitalists.
An obstetric hospitalist is an obstetrician and gynaecologist physician who is either employed by a hospital or a physician practice and whose duties include providing care for laboring patients and managing obstetric emergencies. Some obstetrics hospitalists also have responsibilities including resident and medical student teaching; providing backup support for family practitioners and nurse midwives, assisting private physicians with surgery, assuming care for ob-gyn patients unassigned to a physician and providing vacation coverage for the private practicing physician.
In the domain of hospital medicine, interdisciplinary bedside rounds are a collaborative approach to patient care that involves the participation of the bedside nurse, primary provider, and the patient. They are often joined by family members and allied health professionals such as the patient's pharmacist and case manager.
