Admissions at Rome American Hospital

Admissions at Rome American Hospital follow a well-defined procedure. Ours is a center specializing in orthopedic, general and cardiac surgery. It is also at the forefront of outpatient and dental surgery, performed every day.

Admissions

Admissions (inpatient or day hospital) must in any case be formalized by drawing up a medical record. The patient, or the person acting as guardian at the time of admission, must go to the admissions office with:

• A valid photo ID.
• Details of the insurance company if the patient already has a health insurance policy, whether direct or indirect.

Patients who intend to use an existing agreement must communicate their choice in advance, that is, before the day of admission. This allows the admissions staff to receive the appropriate information and proceed with the booking in the usual way.

Private day hospital admissions

A day hospital stay is a planned admission (or cycle of admissions). Stays last less than 12 hours, with multi-professional and multi-specialty services and daytime care (morning visits). It is accessed through the following procedure:

• Advance booking with the facility’s Booking and Admissions Service, made by the referring physician, stating a provisional admission diagnosis and any diagnostic or treatment indications;
• Administrative registration at the time of admission at the Booking and Admissions Service, with the patient’s tax code, a valid photo ID and the insurance card in the case of insured patients. Patients who are not insured are asked for a deposit toward the cost of the stay at the time of admission.

At admission, patients are required to sign a general consent form for diagnostic and/or therapeutic procedures, and the authorization to process personal data for statistical and epidemiological purposes under Laws 675/96 and 196/03. The attending physician is responsible for the admission and care of each patient in the hospital, for the prompt completeness and accuracy of the medical record, for any appropriate special instructions, and for reporting on the patient’s condition to the referring physician and to relatives.

Private day surgery

This is an admission lasting less than one day for surgical operations or invasive and semi-invasive diagnostic procedures. For both day hospital and day surgery under a direct or indirect agreement, the same rules set out above apply on advance notification of policy details to the admissions staff.

The operating suite

The operating suite at Rome American Hospital consists of 4 operating rooms, several preparation areas and an anesthesiology team with a very high level of professional expertise. An entire floor of the building is dedicated to day hospital surgery. The intensive care unit, in turn, has 10 beds, including the coronary care and isolation units.

Bookings

The booking service has an attached information desk for admissions. It is open to the public from 8 a.m. to 8 p.m. Monday through Friday and from 8 a.m. to 2 p.m. on Saturday. The office handles bookings for inpatient admissions and outpatient services, including by telephone. It also provides information on the company’s activities and services and on how to access care.

Admission

In addition, at the time of admission every patient, or someone acting on the patient’s behalf, must sign a consent form. If this consent has not been obtained, the attending physician must be informed. The attending physician, in turn, must obtain the patient’s consent before starting any treatment, unless there is an absolute emergency. Informed consent, written and signed by the patient, is collected and placed in the medical record before the surgical operation or any other special procedures, especially invasive ones.

Emergency conditions

This admissions rule does not apply in situations where the patient’s life is in danger and a signature cannot be obtained because of the patient’s condition (state of necessity). In emergencies involving a minor or an unconscious patient, for whom consent to surgery or other special procedures cannot be obtained immediately from those entitled to give it (the person with parental authority, or the guardian), the issue must be set out in full in the patient’s medical record. In these situations a consultation may be advisable before emergency procedures are undertaken, if time allows.

Consent requirement

Surgical operations or other special procedures that require consent include all invasive medical procedures, as well as those that require cutting into tissue. Examples of invasive procedures or procedures that require cutting into tissue are:

• Surgery (major or minor) that requires surgical entry into the body, insertions into the subclavian vein, spinal punctures, exposure of blood vessels.
• Procedures in which anesthesia is used.
• X-ray procedures with iodinated contrast or performed using invasive techniques.
• Procedures that involve the introduction of radioactive isotopes.
• The administration, by any route, of any cytotoxic agent or of any drug for diagnostic purposes.
• Blood transfusions
• All procedures not otherwise mentioned for which the attending physician wishes to obtain consent.

When written consent is not required

• Examples of procedures that do not require written consent are those involving: bladder catheterization with a Foley catheter
• intravenous drips.

Physician’s duties

The attending physician, or another associated physician acting on the attending physician’s behalf, must give the patient specific information about:

• the nature of the illness,
• the nature of the treatment,
• the tests or analyses to be performed
• the calculated risk
• the anticipated results
• alternatives to the treatment.

On this basis the nursing staff will have the patient sign a written consent, if required. If the nurse realizes that the patient is not fully informed or that the patient’s consent is not truly voluntary, the nurse must postpone obtaining the written consent and inform the attending physician of the circumstances of the case.

Second operations

If a second operation is required during the patient’s stay in the hospital, a second, specific consent must be collected. If two or more specific operations are to be carried out at the same time, and this is known in advance, they may all be described and approved on the same form. The patient’s consent to an operation or other procedures is considered valid for two weeks from the date, only if the patient remains hospitalized. If, instead, the patient has been discharged from the hospital and then readmitted, a new consent is required, to be added to the most recent medical record.

Private scheduled inpatient admissions

Inpatient admission is provided in the relevant departments for all conditions, in order of booking (which is why it is also called scheduled admission). It is provided exclusively on a private basis, not under agreement with the National Health Service (SSN). Payment can be made directly by the patient or under agreements with private funds or insurance companies. In particular, patients who intend to be admitted on a “private” basis can use the special agreements the hospital already has in place with the main insurance companies. These, in turn, reimburse approved expenses on a direct or indirect basis.

Accommodation options

Patients can choose among different types of accommodation.

• Single rooms (equipped with a TV, with an extra bed for a family member, with a supplement payable for the person staying);
• Double rooms (two-bed rooms, equipped with a TV) shared with another patient (where family members cannot stay overnight);
• V.I.P. room: a single room with a small sitting area containing a sofa bed for a guest

To be admitted, the following procedure applies:

• Advance booking with the facility’s Booking and Admissions Service, made by the referring physician, stating a provisional admission diagnosis and any diagnostic or treatment indications;
• Administrative registration at the time of admission at the Booking and Admissions Service, with the patient’s tax code, a valid photo ID and the insurance card in the case of insured patients.

Patients who are not insured are asked for a deposit toward the cost of the stay at the time of admission.

The general consent form

At admission, patients are required to sign a general consent form for diagnostic and/or therapeutic procedures. They must also provide the authorization to process personal data for statistical and epidemiological purposes under Laws 675/96 and 196/03, and the interdiction document (if any). Finally, they must undertake to pay promptly the daily room rates for the accommodation option chosen, as set out in the posted price list, in cases of admission not covered by direct insurance.

Responsibilities of the attending physician

The attending physician is responsible for the admission and care of each patient in the hospital, for the prompt completeness and accuracy of the medical record, for any appropriate special instructions, and for reporting on the patient’s condition to the referring physician and to relatives. Responsibilities transferred to another physician, in the order sheet of the medical record, will be entered in a note that highlights the handover. Except in an emergency, no patient is admitted to the hospital without a provisional diagnosis valid for admission, to be entered in the medical record.