Inpatient care is the care of

patient A patient is any recipient of health care services that are performed by healthcare professionals. The patient is most often ill or injured and in need of treatment by a physician, nurse, optometrist, dentist, veterinarian, or other hea ...

s whose condition requires admission to a

hospital A hospital is a health care 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 emerge ...

. 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 Trauma most often refers to: * Major trauma, in physical medicine, severe physical injury caused by an external source * Psychological trauma, a type of damage to the psyche that occurs as a result of a severely distressing event *Traumatic i ...

Progress

Patients enter inpatient care mainly from previous

ambulatory care 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 proce ...

such as referral from a

family doctor Family medicine is a medical specialty within primary care that provides continuing and comprehensive health care for the individual and family across all ages, genders, diseases, and parts of the body. The specialist, who is usually a primary ...

, or through

emergency medicine Emergency medicine is the medical speciality concerned with the care of illnesses or injuries requiring immediate medical attention. Emergency physicians (often called “ER doctors” in the United States) continuously learn to care for unsche ...

departments. The patient formally becomes an "

inpatient A patient is any recipient of health care services that are performed by healthcare professionals. The patient is most often ill or injured and in need of treatment by a physician, nurse, optometrist, dentist, veterinarian, or other health car ...

" at the writing of an

admission note An admission note is part of a medical record that documents the patient's status (including history and physical examination findings), reasons why the patient is being admitted for inpatient care to a hospital or other facility, and the i ...

. Likewise, it is formally ended by writing a discharge note.

Planning for patient discharge

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. A 2016 Cochrane review showed some benefit to patient health when using individualised discharge planning over a standard format, though no reduction in health care costs.

History

Inpatient care goes back to 230 BC in India where

Ashoka Ashoka (, ; also ''Asoka''; 304 – 232 BCE), popularly known as Ashoka the Great, was the third emperor of the Maurya Empire of Indian subcontinent during to 232 BCE. His empire covered a large part of the Indian subcontinent, ...

founded 18 hospitals. The

Romans Roman or Romans most often refers to: *Rome, the capital city of Italy * Ancient Rome, Roman civilization from 8th century BC to 5th century AD *Roman people, the people of ancient Rome *''Epistle to the Romans'', shortened to ''Romans'', a lette ...

also adopted the concept of inpatient care by building a specialized temple for sick patients in 291 AD on the island of

Tiber The Tiber ( ; it, Tevere ; la, Tiberis) is the third-longest List of rivers of Italy, river in Italy and the longest in Central Italy, rising in the Apennine Mountains in Emilia-Romagna and flowing through Tuscany, Umbria, and Lazio, where ...

. It is believed the first inpatient care in North America was provided by the

Spanish Spanish might refer to: * Items from or related to Spain: **Spaniards are a nation and ethnic group indigenous to Spain **Spanish language, spoken in Spain and many Latin American countries **Spanish cuisine Other places * Spanish, Ontario, Can ...

in the

Dominican Republic The Dominican Republic ( ; es, República Dominicana, ) is a country located on the island of Hispaniola in the Greater Antilles archipelago of the Caribbean region. It occupies the eastern five-eighths of the island, which it shares wit ...

in 1502; the

Hospital de Jesús Nazareno The Church and Hospital of Jesús Nazareno buildings are located in the Historic center of Mexico City, in México, D. F., Mexico. The hospital is still in operation, housed in a Modernist building, located in front of the original one, and beside ...

Mexico City Mexico City ( es, link=no, Ciudad de México, ; abbr.: CDMX; Nahuatl: ''Altepetl Mexico'') is the capital and largest city of Mexico, and the most populous city in North America. One of the world's alpha cities, it is located in the Valley o ...

was founded in 1524 and is still providing inpatient care. Perhaps the most famous provider of inpatient care was

Florence Nightingale Florence Nightingale (; 12 May 1820 – 13 August 1910) was an English Reform movement, social reformer, statistician and the founder of modern nursing. Nightingale came to prominence while serving as a manager and trainer of nurses during t ...

who was the leading advocate for improving medical care in the mid-19th century. Nightingale received notoriety during the

Crimean War The Crimean War, , was fought from October 1853 to February 1856 between Russia and an ultimately victorious alliance of the Ottoman Empire, France, the United Kingdom and Piedmont-Sardinia. Geopolitical causes of the war included the ...

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 The Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care is an academic faculty within King's College London. The faculty is the world's first nursing school to be continuously connected to a fully serving hospital and medi ...

continues today and her image is the one depicted each year on nurses' day.

Hospitalist medicine

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 Robert M. "Bob" Wachter is an academic physician and author. He is on the faculty of University of California, San Francisco, where he is chairman of the Department of Medicine, the Lynne and Marc Benioff Endowed Chair in Hospital Medicine, and ...

in an article written for ''The'' ''New England Journal of Medicine'' in 1996. 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.

Statistics

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 Medicaid in the United States is a federal and state program that helps with healthcare costs for some people with limited income and resources. Medicaid also offers benefits not normally covered by Medicare, including nursing home care and per ...

bore responsibility for 63 percent of these total aggregate costs. 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.

References