Scott Webb (Host): There are different levels of care once you've been admitted to the hospital, and it's understandable to have some questions about these levels and in general what we can expect during a hospital stay and once we've been discharged. And joining me today to help answer some of these questions is Allison Plata. She's a clinical nurse specialist intern with Summa Health.

 This is Healthy Vitals, a podcast from Summa Health. I'm Scott Webb. Allison, it's nice to have you here today. We're going to talk about hospital stay expectations. In other words, what can people expect, you know, when they're in the hospital? So, a lot of good questions, things to sort through, probably questions on people's minds. Let's start with here. Let's start with the levels of care. I've always wanted to ask an expert. So, you know, ICU versus MS versus PCU and so on. I'll have you discuss the levels of care.

Allison Plata: So when a patient is admitted to the hospital, there are four common different areas that a patient is admitted to. Those are the Clinical Decision Unit, which is the CDU, a medical-surgical unit or med-surg or MS unit, the progressive care unit or PCU, and then there's also the ICU or intensive care units. These areas provide a different level of patient monitoring and interventions based on their illness or injury that they come in with. All four of these areas provide individualized, evidence-based patient care based on their individual needs. Think of these units as different rungs on a ladder, and the higher you go on the ladder, the more monitoring interventions and the lower the patient-to-nurse ratio you get during that phase of care.

So, the bottom rung is the clinical decision unit or CDU, which is an observation unit in which if you're not well enough to go home but you need a little more monitoring or testing, you go to the CDU. The next area is the medical-surgical unit that provides care with more frequent monitoring for patients who have medical or surgical needs, and they prepare you for the next steps after admission. The next higher rung is the progressive care units, and this unit is for patients who require more frequent monitoring and interventions than a patient on a medical-surgical unit, again, all based on their patient condition. And the last and the highest rung on the ladder is the intensive care unit, and that is the highest level of care for our sickest patients.

Host: Yeah, it makes sense. And it makes sense that you guys abbreviate these things, ICU, right? Versus intensive care unit and so forth. And really, it's a good analogy, kind of like working your way up the ladder when you're there and when you're admitted, and I was mentioning to you before we got rolling here, I don't know exactly what that means, right? So, what does it mean to be admitted?

Allison Plata: Yeah, perfect question. So, being admitted means that a doctor has determined that you need medical care that you can't get at home, and you need further testing or interventions to help get you back to your baseline. And being admitted can lead us to be scared and bring up feelings of fear or anxiety, either from your own personal experiences or from family or friends that have been admitted.

And a few ways that we can help those feelings of anxiety or fear is to ask any and all questions about your plan of care. And if you don't understand your plan of care, please ask for an explanation and make sure to let the staff know, the doctors, the nurses, the aides, physical therapy, occupational therapy, anyone that you interact with, know how you're feeling or if you need anything.

Host: Yeah, that's good advice. Just encouraging folks to advocate for themselves. If they don't know the answers, ask the questions, of course. And knock on, I guess, fake wood here at my desk, Alison, but I've never stayed in the hospital, I've never been admitted to the hospital, so I really don't know what to expect. Like on a day-to-day basis, you know, what should my expectations be if I'm admitted into the hospital?

Allison Plata: Well, good for you. I hope that, you know, that we stay away from a hospitalization for the future here for you. Every day, we strive to provide care beyond expectations for every patient. Every day, there are goals that will be set in collaboration with you, the provider, the nurse, physical therapy, occupational therapy, the social work, the transitional care coordinator, and these goals will be personalized to your current situation and based on your needs to get back to your baseline. These may include working with physical therapy or occupational therapy, increasing your ambulating, meaning we get you up and walk you more frequently, being out of bed to the chair during meals, going to Radiology for further imaging, or having tests or procedures completed.

Other things that you could do to help your plan of care if it was not possible and not emergent for why you came into the hospital is to bring a full list of medications that you're currently taking and, if applicable, a living will or a healthcare power of attorney.

Host: Yeah. And you emphasized earlier about asking questions, right? If we have questions, go ahead and ask them of the professionals that are there to take care of us. And you also touched on evidence-based care and you and I were chatting before we got rolling here about what exactly does that mean? And do all hospital systems base everything in evidence and maybe that's a separate podcast. But for Summa Health specifically, maybe you can talk about that again, the importance of asking questions and what does that mean. What does evidence-based care mean?

Allison Plata: So, evidence-based care means that we are striving to make sure that everything that we are doing for our patient is based on the evidence. So, there are studies and articles out there that have people doing great work, research, and that they've published it. And then, we take that evidence that shows all this great work and all these wonderful outcomes, and we provide those in our care, and we make sure that everything that we are doing is based on evidence and not just on a preference.

Host: Yeah, it makes sense. You know, when you say it out loud, like, well, of course it would be based in the evidence, based in science and research and all of those important things. This has been really helpful today. I was telling you before we got rolling, you know, that these podcasts are for folks who want some free medical advice, some free medical information that have these questions and don't get a chance to ask. So, good for me that I get to ask you these questions and just want to finish up and talk about sort of discharge procedures or being discharged home or our SNF plans. Like, how does that work?

Allison Plata: SNF stands for skilled nursing facility. And I think every nursing instructor or NCLEX provider would be happy to hear me say the statement that we think about discharge planning when the patient is admitted. During the hospital stay, the provider, the nurse, social worker, those transitional care coordinators, physical therapy, occupational therapy, are all working together to determine the safest and most appropriate place for the patient to go once they're admitted. There are four common locations that patients can go home, one of those being that SNF or that skilled nursing facility. We love our acronyms in healthcare.

Scott Webb: We sure do.

Allison Plata: Another one is home. Another one is an acute rehab facility. And then, another is an acronym called an LTAC, or a long-term acute care hospital. The difference between these different locations are the amount of physical therapy or occupational therapy time that a patient could have, ability to treat complex wounds. Are they able to provide long-term antibiotics or even take care of a patient who has a tracheostomy, which is a hole in the neck for us to help you breathe and on a ventilator, a machine that helps it acts like a lung to help the patient breathe. So, it varies. At home, you can get in-home rehab, or you can have physical therapy, occupational therapy come to your home to help you, or get your antibiotics at home, or maybe you need a little bit more care, you would go to that skilled nursing facility or maybe you can even tolerate more aggressive rehab, and that would be that acute rehabilitation facility, or maybe you need more intensive care where maybe you're intubated, more complex wounds, more antibiotics, and that would be the LTAC, the long-term acute care hospital.

Host: Yeah. Right. It's like home can mean home. Of course, we all know what home is because it's home. I'm in my home right now. So, there's home. But when you're discharged home, there's different levels of care, multidisciplinary, comprehensive, you know, care, just as we find in the hospitals you went through earlier, the latter, and the levels of care at the hospital. So, this has been really good. Helped me sort all this out of my mind. I'm sure great for listeners as well. So, thanks so much.

Allison Plata: Thank you.

Host: And for more information, go to summahealth.org/cci. And if you enjoyed this episode of Healthy Vitals, we'd love it if you'd leave us a review. Your review helps others find our educational content. I'm Scott Webb. Thanks for listening, and we'll talk again next time.