Hospitalization
Overview
Hospitalization (入院, hospitalization) refers to a patient staying for a certain period in a bed at a medical institution and receiving medical services for the diagnosis, treatment, surgery, rehabilitation, etc. of a disease. It is carried out when management through outpatient care alone is difficult or when continuous observation and intensive treatment are necessary, and depending on the patient's condition it is classified into acute-phase hospitalization, chronic-phase hospitalization, isolation hospitalization, hospitalization at a psychiatric institution, and the like. Hospitalization is not merely the act of 'staying in a hospital' but a treatment process in which the medical staff's examination, nursing, testing, medication, diet, and rehabilitation operate as one interconnected system, and at the same time it is also a legal and institutional relationship in which the rights and duties of the patient and guardian operate together.
Main Content
Purpose and Types of Hospitalization
The core purposes of hospitalization are ① intensive observation and monitoring, ② treatments difficult to perform on an outpatient basis such as intravenous injection, oxygen therapy, and mechanical ventilation, ③ management before and after surgery and procedures, ④ isolation for infectious diseases, ⑤ rehabilitation and recuperation, and ⑥ acute-phase treatment of mental illness and management of the risk of self-harm and harm to others. Types are largely divided into emergency hospitalization (via the emergency room), planned hospitalization (reservation through outpatient care), transferred hospitalization (transfer from another hospital), and involuntary hospitalization carried out according to legal requirements irrespective of the person's own will. Hospitalization under the Mental Health Welfare Act is subdivided into voluntary hospitalization, hospitalization by a person with a duty of protection, hospitalization by the head of a city, county, or district office, and emergency hospitalization.
Hospitalization Procedure
The general procedure proceeds in the order of outpatient examination or emergency room examination → decision to hospitalize and completion of a consent form → bed assignment → admission formalities (patient registration, verification of insurance eligibility, selection of caregiving and meals) → handover to the responsible medical staff and initial assessment → establishment of a testing and treatment plan. At the time of admission, it is advisable to prepare an identification card, health insurance card (or documents confirming eligibility), a referral letter, existing medical records, and a list of medications being taken. In particular, since arbitrarily stopping medications being taken can be dangerous, the medical staff must be informed of them.
Types and Grades of Hospital Rooms
Hospital rooms are generally divided into multi-patient rooms (4–6 beds), two-patient rooms, single rooms, special rooms, and the like, and higher-grade rooms are not covered by health insurance, resulting in large cost differences. Intensive care units (ICU), neonatal intensive care units (NICU), ventilator care rooms, isolation rooms, and sterile rooms are assigned according to the patient's condition. Recently, as wards for the integrated nursing and caregiving service have expanded, the form in which nurses provide integrated care without a guardian or caregiver is increasing.
Composition and Roles of Medical Staff
Inpatient treatment is carried out through collaboration among various professions. The attending physician and residents (or specialists) oversee diagnosis and treatment plans, while nurses are in charge of medication, measurement of vital signs, wound care, and patient education. In addition, clinical pathologists, radiologic technologists, physical therapists, occupational therapists, dietitians, social workers, pharmacists, clinical psychologists, and others participate. For patient safety, prevention of medication errors, fall prevention, pressure ulcer prevention, and infection control are operated through standardized procedures.
Inpatient Life and Precautions
During hospitalization, one must follow the fixed rounds schedule, medication times, meal times, and testing schedules, and entering or leaving the ward and going out or staying overnight outside require the permission of the responsible medical staff. Since falls are a common accident among inpatients, it is necessary to raise the bed rails, check the location of the call bell, and be careful of slippery floors. To prevent hospital-acquired infections (nosocomial infections), it is important to observe hand hygiene and visitation restrictions, and especially during periods when respiratory infections are prevalent, restrictions on visitors may be implemented.
Visitation and Caregiving
Visiting hours and the number of visitors differ by hospital, and visits to intensive care units and isolation rooms are strictly limited. Caregiving takes various forms, such as caregiving by family, hiring a private caregiver, the integrated nursing and caregiving service, and dispatch of long-term care workers. When hiring a caregiver, one must confirm qualifications and fee standards, and comply with rules on personal information protection and infection control.
Discharge Procedure and Post-Discharge Management
Discharge is decided after the responsible medical staff evaluates the patient's condition, and the patient receives a discharge summary, prescription, medical expense receipt, and schedule for future outpatient appointments. After discharge, one must become familiar with the medications to take, diet, activity restrictions, and wound care methods, and must contact the hospital immediately if abnormal symptoms occur. The readmission rate within 30 days after discharge is used as a quality indicator of medical institutions, and many studies show that establishing a discharge plan early is effective in reducing readmissions.
Costs and Health Insurance
Inpatient medical expenses are divided into items covered by health insurance and items not covered. For covered items, the patient's copayment rate applies, and hospitalization tends to have a higher copayment rate than outpatient care (generally differentiated according to the type of medical institution and the patient classification). Fees for higher-grade rooms, selective treatment (designation of a specialist), some tests and treatments, and caregiving expenses are either not covered or only limitedly covered. If the disease falls under those subject to the special case for calculation (cancer, severe burns, rare diseases, etc.), the patient's copayment is greatly reduced. Since indemnity medical insurance compensates covered and non-covered items according to certain standards, it is advisable to check in advance the documents required for claims (medical expense receipt, itemized medical expense statement, medical certificate, etc.).
Rights and Legal Aspects
Under the Medical Service Act and the Patient's Rights Charter, patients have the right to receive explanations about diagnosis and treatment, the right to self-determination, protection of personal information, and the right to request access to and copies of medical records. Under the Life-Sustaining Treatment Decision Act, terminally ill patients may leave decisions such as the withdrawal of life-sustaining treatment in writing in advance. The hospitalization of mentally ill persons must follow the requirements and procedures set by the Mental Health Welfare Act, and a system of review of the appropriateness of hospitalization and review of discharge is in operation. In addition, under the Patient Safety Act, serious patient safety accidents are subject to reporting and disclosure.
Latest Trends
In 2024–2025, the hospitalization environment is moving along two axes: 'reorganization centered on severe cases' and 'technology-based management.' First, due to instability in the supply and demand of medical personnel and the aftermath of residents leaving, tertiary general hospitals reorganized beds around severe and emergency patients, while policies were pursued to distribute mild patients to regional hospitals and home-based medical care. The government carried out bed efficiency and reorganization of the transfer system through the tertiary general hospital structural transformation pilot project and measures to strengthen regional and essential medical care.
Second is the spread of smart hospitals. With wearable sensors and AI-based patient monitoring, abnormalities in vital signs are detected early, and handovers between medical staff are becoming faster through remote consultations and mobile electronic medical records. Ward robots and non-face-to-face nursing assistance systems are also being piloted in some hospitals.
Third is the continued expansion of the integrated nursing and caregiving service and the strengthening of management of the appropriateness of hospitalization at long-term care hospitals. To reduce unnecessary long-term hospitalization, review of the appropriateness of hospitalization and establishment of discharge plans are being emphasized, and linkages with community-based care such as home medical care centers, visiting nursing, and hospice and palliative care are increasing.
Fourth is the routinization of infection control standards. After COVID-19, hospital visit standards, operation of isolation beds, and verification of vaccinations have become established as standard procedures, and during periods when respiratory infections are prevalent, restrictions on visits are trending toward becoming routine. Lastly, as patient experience (PX) and patient safety indicators are reflected in hospital evaluations, procedures for explanation and consent and activities to prevent falls, pressure ulcers, and medication errors are becoming more sophisticated.
Related Topics
- [[Medical Insurance]]
- [[Discharge]]
- [[Emergency Room]]
- [[Nurse]]
- [[Long-term Care Hospital]]
- [[Patient Safety]]
- [[Life-Sustaining Treatment Decision Act]]
- [[Nosocomial Infection]]