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My Child Is Recommended For Hospital Admission: What Now?

According to the American Academy of Pediatrics, hospital care accounts for “ more than 40% of all pediatric health care expenditures.” Of those (commonly unplanned) hospital visits, one in four children is admitted directly to an inpatient bed without first receiving care in the hospital’s emergency department (ED). If you didn’t know, the usual “way in” to an inpatient bed is via the emergency department, where patients are stabilized to make sure they can be safely managed on a regular hospital unit. If they need a higher level of care, they might be admitted to an ICU or intermediate care unit. In addition to this clinical assessment, a “work up” is often done in the emergency department – this refers to the tests and interventions that are performed to identify the diagnosis, or the reason the person is sick.

Some patients can bypass this process and go straight to their inpatient bed. Known as direct admission, this can be quite beneficial to patients and their families as it allows them to avoid the chaos of EDs and can promote streamlined care and communication between community- and hospital-based clinicians. In other words, direct admission has the potential to be a lot more patient-centered and less stressful than a visit to the ED. If you ever find yourself in a situation that requires bringing your child to the hospital for likely admission – crossing my fingers this doesn’t happen! – you might be presented with the option of direct admission. Here is some guidance for navigating this high-stakes situation. 

What is Happening?

First and foremost, ask the person recommending the inpatient stay if your child will be treated in the emergency department first or admitted directly to the hospital. Depending on the answer, you will want to find out the next steps. In case of direct admission, ask about transportation logistics – how will your child be getting to the inpatient bed? What is your role in this transfer? The answer to this will depend on your hospital size, configuration, and policies. Find out if your child can eat or drink anything during the trip or if there any other specific instructions.If your child is already in an emergency department and needs to be transferred elsewhere (if they need subspecialty care or need to go a children’s hospital, for example), they may be taken to their inpatient bed via ambulance or a specialized pediatric transport team.

Why is This Happening?

Communicating with your healthcare providers is incredibly important here. Write down what you hear and ask questions. Ideally, there should be clear and direct communication between the referring emergency department and the accepting hospital staff so there is alignment on the plan. As various tests are being performed and your child’s condition becomes clearer, make sure to keep asking about the evolving diagnosis and its implications. Don’t be shy – you are your child’s advocate, and you are entitled to know exactly what is happening.

What Can We Do?

Depending on your child’s condition, there will be various recommendations and restrictions you will need to be aware of. Can your child eat or drink throughout the (sometimes lengthy) admission process?  Are there things you, the caretaker, can do to help relieve pain or risk? The more you know about the situation, the more you can do to help your child’s care team ensure the best results. 

The Question of Cost

It might not feel appropriate to be concerned about money when your child’s health is threatened, and as parent we will all do whatever is needed in a critical scenario, but I think it’s wise to understand your family’s individual insurance coverage for hospitalizations. It’s actually best to get a picture of what is covered and what you might be responsible for BEFORE any potential situation presents itself.

Calming Their Fears

It’s natural for everyone, including your child, to be apprehensive about going to the hospital. Depending on the urgency of the situation and how sick your child is, ask whether or not your child can bring along their favorite stuffed animal, blanket, or pajamas to have something familiar to comfort them during this stressful time.

The silver lining of all of this is that your child is getting the care they need in the place they need, and getting them there is managed by folks who are professionals and will guide you every step of the way. The pediatrics community is always trying to find new ways to improve our systems, and recently the American Academy of Pediatrics has published revised guidelines for making the direct admission process as safe and smooth as possible. Want to know more? Read here!