Unplanned Hospital Admission 

The HMViP team has created a series of short films to support patients. This one looks at an unplanned hospital admission. 

Being admitted to hospital can be a scary experience at the best of times. But for those who use HMV, planning ahead can help to make this a less daunting experience.

We have therefore produced a short film to guide you through the process and to provide first-hand experience of hospital admissions. 

We’ve also provided a Q&A with Dr Becky D’Cruz from the Lane Fox Unit at St Thomas’ hospital who appears in this film.

Q&A with Dr Becky D’Cruz, Consultant at Guy’s and St Thomas’ Hospital

Could you introduce yourself and your background?
I’m Dr Rebecca D’Cruz and I’m a Respiratory Medicine Consultant at Guy’s and St Thomas’ NHS Foundation Trust. I am a specialist in home mechanical ventilation, and I’m here to guide you through the aspects of emergency admissions for users of home mechanical ventilation.

Could you tell us why it’s important for our viewers to watch this video?
We prepared this video to help prepare and support people who might feel worried about what might happen during an emergency hospital admission. Attending hospital when you’re feeling unwell can be a scary time for you and your caregivers, and we hope this information can provide you with information on what you might expect to happen with respect to your ventilator, and to empower you to ask your clinicians questions.

Could you outline the general process a patient can expect upon hospital admission in an emergency situation?
It is very important to remember that if you attend hospital because you are unwell, it is crucial that you bring your ventilator machine, and its attachments including the tubing, mask and power pack. This will help the clinicians caring for you to understand your therapy when you are well, and modify it if necessary, when you are unwell. If you have a weak cough and use a cough assist machine to help clear your phlegm, you should also bring this with you.

Accident and emergency departments are busy and noisy areas. Once you arrive at the hospital, you will typically be triaged to help prioritise the order that patients are seen. You will be moved into a suitable clinical area, like the one we’re in now. A clinician will then talk to you about your condition and arrange relevant tests to help identify the reason you are unwell and to guide your treatment.

If you are unwell because of worsening breathing issues, one of these tests is likely to include an arterial blood gas. This is a blood test, usually taken at the wrist, which gives information on your oxygen and carbon dioxide levels and helps to guide whether changes need to be made to your ventilator while you are unwell. It can be a temporarily painful test and if local anesthetic is not offered to you to numb the skin, you should ask for it. You are also likely to have blood tests from a vein and a chest x-ray. Other tests may be performed, depending on your particular circumstances.

How can the patient assist in this process?
It is important to tell the hospital clinicians that you use home ventilation and show them your equipment. This will notify them to contact the relevant specialists with experience in using your machine and guide whether you need to be switched to a hospital ventilator while you are unwell.

If you keep a folder of your health records, such as a list of your medical conditions, medications and clinic letters, this can be helpful to bring with you just in case the hospital doctors do not have ready access to this information. This can be especially helpful if your local hospital is not the same hospital that supports your home ventilation, so the clinicians can understand more about you and your ventilator and know who to contact if they have questions about it.

You mentioned having someone accompany the patient. Why is that important, and what role can this companion play?
Having a friend, family member or carer accompany you can be incredibly helpful. They can speak on your behalf if you’re finding it difficult to communicate, such as if your breathlessness, sleepy or frightened, as well as offer emotional support. This person can also provide us with additional information about your current condition from their perspective which can be helpful in guiding tests and treatments.

What are some of the common concerns patients have about emergency hospital admissions?
A common concern for patients is whether they will have the necessary disability equipment at hand in the hospital. Hospitals will usually have a range of hoists, wheelchairs and aids, but it can take some time to source them. We therefore recommend to bringing as much of your own equipment with you as possible. If this can’t practically be done on the day you come to hospital unwell, it would be helpful to plan for it to be brought in after you are admitted to a hospital ward.

What about medical records? How can having those on hand impact the admission process?
It’s a good idea to have your medical records on hand. It enables you to easily answer questions and share important health-related details with the medical team. This step streamlines the process and ensures that we have a comprehensive understanding of your situation.

Could you elaborate on what additional information is helpful to have in emergency documentation?
We’ve put together a list of crucial information, like allergies, medications, and any chronic conditions you have. This information helps us make informed decisions swiftly. We’ve also included a guide on the general process of emergency admissions, a list of questions we might ask, and questions you might want to ask us. This guide can be found in the ‘living with HMV’ section of our website.

Any final words of reassurance for our viewers who might be feeling anxious about the possibility of an emergency hospital admission?
Remember, you’re not alone. Our medical team is here to support you every step of the way. By being prepared and informed, you’re already making a significant contribution to your own well-being.

Our thanks to Lee Evans who took part in the film. Lee has Duchenne Muscular Dystrophy and has written about his experiences in his book “I’m Still Standing’. If you would like to read it, you can buy it through Amazon. Lee’s second book is due to be published in 2024 so keep an eye out for this one as well!