Education Medicine Observations Systems

What is a Hospital?

So what is a hospital? (Just work with me here.)

Hospitals are physical structures. They are buildings that have rooms and beds. People, who become “patients”, are “admitted” into a hospital and assigned a bed. Because patients receive a bed, there is an assumption that they will be in the hospital for at least one night. This is called an “inpatient” admission, because the patient is “in” the hospital. (Contrast this to a visit to a clinic, which is called an “outpatient” encounter.)

Hospitals provide acute health care. “Acute” can mean “intense” (like cutting someone open to remove an organ or the delivery of a baby in a mother who has major medical problems) or “fast” (like giving a patient antibiotics through a vein to fight an infection or using a machine to help filter blood when a patient’s kidneys suddenly stop working).

Because most hospitals offer services from nearly every medical specialty, patients can experience “one stop shopping” for acute health care issues. Patients might see four different kinds of doctors, have numerous tubes of blood drawn, undergo five imaging studies, receive education from dieticians, undergo strength training with physical therapists, and talk with pharmacists about their medications.

Hospitals permit around-the-clock observation of patients. This is directly related to the previous point and is arguably the primary reason why people are in hospitals. If someone does not require frequent and regular observation, then she doesn’t need to be in the hospital. All that staffing and equipment in the hospital serve to monitor patients and their health (heart function, breathing, infection, etc.). If medical staff observe an acute change, they can then deliver an acute intervention.

Hospitals are businesses. Hospitals, like hotels, want a low vacancy rate, as this is how they make money. Sometimes patients are ushered out of the hospital sooner than expected because other patients are waiting for open beds. (I’ve worked in hospitals where, in the morning, the operators announced over the intercom a “code” about bed status. This was a discreet message to hospital staff about the census. If the census was high, then we were to try to discharge patients if we could.) Sometimes patients are welcome to stay in the hospital for another night because the census is low. This is not actually a good thing. (The longer someone stays in the hospital, he is at higher risk of developing an infection from the hospital. This is bad because infections that originate in the hospital are often resistant to available antibiotics. Furthermore, patients often get “deconditioned” because they aren’t moving around as they usually do. As muscles, stamina, and endurance weaken, that can cause problems with mobility and function.)

Hospitals are not places of rest. While it is true that people can recover in hospitals, that doesn’t mean that people recover in peace. Hospitals are often noisy places with frequent, unexpected intrusions because of all the observation, testing, and services that occur there.

Now that we have a general sense of what hospitals are, we’ll talk next about all the people who work in hospitals.