What Is Required for Inpatient Admission?

Physicians use a standard set of guidelines to determine if inpatient admission to a hospital is warranted for a patient. Doctors consider the severity of the condition, if it is likely to worsen without hospitalization, and the need for diagnostic tests. All criteria for inpatient admission usually must be documented to show it is medically appropriate and necessary. Insurance coverage and government-sponsored health care services might be denied if inpatient admission requirements are not met.

Doctors and hospital staff typically use screening tools to determine whether outpatient services, observation services, or inpatient admission meets set guidelines. Outpatient services might be provided in a section of the hospital, at a clinic, or in a doctor’s office. Some outpatient services are appropriate in the patient’s home.

Observation services typically occur in the hospital, and may or may not lead to admission. In most regions, guidelines dictate how long a patient may be kept under observation for evaluation or medical treatment. Nursing staff typically monitors the patient within the outpatient department of a hospital to gauge the seriousness of an illness or injury.

Typical observation services cover no more than a 24-hour period. The time period might be extended for certain conditions, such as symptoms of heart problems, difficulty breathing, urinary tract infections, or signs of kidney disease. Some hospitals keep patients under observation when they suffer from diabetes, high blood pressure, back pain, and broken bones.

When considering inpatient admission, a determination typically shows outpatient or observation services fail to meet the patient’s needs. The patient might become worse under observation and need more intense medical treatment or diagnostic testing requiring admission to a hospital. Inpatient admission might also occur if complications arise from outpatient procedures or when vital signs are abnormal and fail to improve.

Other criteria for inpatient admission include instances when a woman is in active labor and delivery is expected. If a patient needs sedation for testing or a procedure, and he or she is too unstable to receive outpatient care, admission could be ordered. Another reason a patient might be admitted to the hospital involves declining health that needs to be monitored by technologically advanced equipment unavailable outside a hospital setting.

Medical records of a patient admitted to a hospital typically meet criteria set by insurance companies and government health programs. They detail the medical needs of the patient and explain test results. These documents usually include a patient’s medical history and the severity of the illness or injury requiring hospitalization.