This is the healthcare delivery providers part of the healthcare marketplace specialization. This is Module 2.1.3, Services Hospitals Provide. Learning outcomes for this lecture are to review the services that hospitals provide. And also discuss the most common clinical conditions that hospitals treat. Emergency department, intensive care units, operating room. So let's start with the emergency department. As we discussed in the previous lecture, this is usually the gateway where the most sick patients come in. So an emergency department or ED treats acute conditions injuries and illnesses. Typically the patients will have an unplanned presentation and that is key. So typically patient's do not make appointments to come in, but just show up. Sometimes they're brought in by an ambulance, sometimes they come in on their own or brought in by family, and again by virtue of the emergency nature, it's a 24/7 operation. So there has to be coverage by physicians, and physicians and nurses need to be available around the clock. The most common conditions that emergency departments see are injuries of various types or trauma. A major trauma to smaller injuries and then chest pain is another condition that emergency departments see a lot. The type of equipment that is available in the emergency department is private beds. They could be resuscitation equipment to try to save the life of a patient that is critically ill. Also many other types of equipment are available. Typically, the emergency department is right next to the radiology services. So for example, a patient who is suspected to have a stroke, when every second counts, the patient can rapidly be transferred to the radiology suite to get a CT scan or a MRI of the head. Also the lab is typically right there or there could be a nomadic shoot to send the lab work directly and rapidly to the lab. The staff, typically there are physicians, registered nurses, pharmacists, case managers, social workers, volunteers, physical, respiratory and other therapists, and many other staff just like the inpatient setting. For surgery, and the operating room typically it is a single operating room under sterile conditions. There's an operating table with all of the instruments. The resuscitating equipment sometimes a heart and a lung machine. The anesthesiology machines to give anesthesia to the patient. And the patient and the staff surround the patient as the surgeon is performing the surgery. The equipment we've talked about and staff typically would be the surgeon and the assistants would be nurses, would be technicians, and other personnel that are needed during the course of surgeries. Special type of a unit within hospital that takes care of the sickest of the sick, the most severely ill and life threatening illnesses is called the Intensive Care Unit. This is for continuous monitoring and treatment. And typically the layout of a intensive care unit is that the nursing station would be in the center, so these are all nurses. And the rooms are surrounding with glass walls so that the nurses are easily able to see the patients, and each of these will have a bed with one patient in it. And so a circular layout, and each of the patient rooms would have resuscitation equipment, IV lines, oxygen supply, and all of the other equipment to try to help the patient when they're severely ill. There could be cardiac intensive care unit, neurological intensive care unit or a general intensive care unit. Now after the patient is admitted from the emergency department or after they've had the surgery or after they get well enough, after the intensive care unit they come into the general medical and surgical unit. So typically the layout here would be there will be a nursing station and then rooms of patients. So the nurses would be out and about taking care of these patients and inside each room would be a bed with a patient on it. A place for the family to sit, and all of the other equipment to take care of the patients. So typically, this is the layout of a general medical and surgical unit. The nurses are available 24/7 to assess and treat the patients. Patient care rounds typically happen where there's a physician, a nurse, a therapist, a pharmacist, a social worker, a chaplain and other disciplines that discuss the patients case. And then the whole team Would go and visit the patient, into the patient's room, assess the patient, discuss the treatment plan. And then everybody comes back and documents their plan into the electronic health record. So again, this is the concept of the patient care rounds. Let's do a brief quiz. Today, I want to talk to you about this concept of observation care that is relatively new in the United States. So not all the patients that come into the hospital through the emergency department need to be admitted to the acute care hospitals. And so there is a category of patients that are observed in the hospital and this is on an outpatient basis. So typically the patient stay for one to two days and then they are continuously reassessed. If they can go back out into the community, or if they need to be admitted to the hospital as an inpatient. So again, remember this is an outpatient deal and this is billed and paid under outpatient methods. So the reimbursement is lower than if the patient were to be admitted directly as an inpatient. This chart, also taking from MEDPAC and looking at Medicare observation visits and in-patient claims. So this is the observation and this is the in-patient as you can see, that the observation numbers are steadily going up and over the last few years, the in-patient numbers have been stable, just lightly up. But the point here was that, look at the observation numbers of patients that are going up year by year. Some of the other services and departments in the hospital that we've already covered a little bit, there's a radiology department that has X-rays and magnetic resonance imaging, MRIs, a CAT Scan, a CT Scan, computerized tomography scans, ultrasound and other radiological techniques available. There is a lab typically which can, depending on how big the hospital is, can do either basic labs or sometimes for sophisticated and larger tertiary hospitals can do the whole host of labs that the patients need from very simple to very complicated. And then finally, there is this concept of hospital based outpatient clinics. So this part is the typical hospital that we've discussed and on the same campus there might be a clinic where patients are seen by physicians and the patients are coming in just to be seen in the clinic and then they leave. So it functions like an outpatient clinic, the only difference is that it is hospital based. And those are treated differently they're reimbursement or payment is different and also the regulations that regulate them are more stringent than the outpatient care clinic or specialty clinic. To let you know a little bit about the most common conditions that hospitals see and treat. Circulatory is heart, this would be Harlan Reeves' heart and blood vessels, 21%. Respiratory is lungs, there would be 15%. Musculoskeletal is bones and muscles is 31%. Digestive system is the stomach and intestines, that's 11%. Nervous system is the brain and spinal cord, that's 8%. And kidney's, are the two kidney's and the urological tract is 8% with infections and infectious diseases being at 7%. So the top three of the four that make up over 50% of the circulatory, respiratory, musculoskeletal, and digestive. Summary hospitals have many different specialized services and departments. The conditions that make up over 50% are circulatory, that is heart. Respiratory that is lung, musculoskeletal that is bones and muscles, and digestive that is stomach and intestines. These make up over 50% of the conditions that typical hospitals see.
