COVID-19 Hospital Admission: Criteria and Protocols

olivia

Understanding when hospital admission becomes necessary is critical. Can anyone explain the typical criteria for admission, the standard treatment protocol followed in hospitals, and what the experience is like for the patient?

drjoseph

Knowing when to go to the hospital is crucial. The decision is primarily based on oxygen levels and breathing difficulty, not just fever or cough.

Typical Criteria for Admission:
The most critical indicator is a drop in oxygen saturation (SpO2) below 94% measured by a pulse oximeter at rest. Other red flags include severe shortness of breath (inability to speak full sentences), persistent chest pain or pressure, and mental confusion or dizziness.

Standard Hospital Protocol:
Upon admission, treatment is tailored to severity:

Moderate Cases (Ward): Patients receive supplemental oxygen (via nasal cannula or mask), steroids (like Dexamethasone) to reduce inflammation, and blood thinners to prevent clots.
Severe Cases (ICU): For patients requiring more support, treatment advances to High-Flow Oxygen, Non-Invasive Ventilation (BIPAP/CPAP), or ultimately, a ventilator. Intensivists closely monitor and manage complications.

The Patient Experience:
The experience is often isolating due to strict infection control protocols. Communication with family is primarily through phone calls. The focus is on continuous monitoring, with frequent checks by healthcare staff. The environment can be overwhelming, but the medical team's goal is to provide stabilized, intensive care while the body fights the infection.

ava

Typical Criteria for Admission
Hospital admission becomes necessary when a patient's condition is too severe, complex, or unstable to be managed safely at home. Key criteria include vital sign instability (e.g., very high fever, low blood pressure, rapid heart rate), severe pain requiring intravenous medication, acute mental status changes (like confusion or drowsiness), the need for close monitoring (e.g., after a fall or head injury), or a requirement for treatments that can only be administered in a hospital, such as intravenous antibiotics, complex surgery, or advanced respiratory support.

Standard Treatment Protocol
The standard protocol begins with triage in the Emergency Department to prioritize the most urgent cases. This is followed by a comprehensive assessment, including history, physical exam, and diagnostic tests like blood work, ECGs, or imaging (X-rays, CT scans). Based on the diagnosis, the treatment plan is initiated. This often involves stabilization (e.g., IV fluids, oxygen), specific medical or surgical intervention (e.g., medications, procedures), and ongoing monitoring by a team of doctors and nurses to adjust the plan as needed.

The Patient Experience
For the patient, the experience often involves a period of waiting in the ER, followed by a flurry of activity during assessment. Once admitted to a ward, the environment can be busy with regular checks of vital signs, administration of medications, and visits from the medical team. Patients may experience a loss of privacy and independence, and the constant activity can disrupt sleep. However, the experience is centered on receiving 24/7 professional monitoring and care, with the goal of stabilizing the condition and creating a safe discharge plan for recovery at home or in a rehabilitation facility.

drjoseph

Hospital admission for COVID-19 becomes critical primarily due to low blood oxygen levels (SpO2 of 94% or less), even if the person doesn't feel short of breath. Other emergency signs include severe respiratory distress, persistent chest pressure, or confusion.

Once admitted, the standard protocol is systematic. The cornerstone is oxygen support, which is escalated from a simple nasal tube to a ventilator in the ICU, depending on the patient's needs. Drug therapy centers on Dexamethasone, a steroid to calm the body's dangerous inflammatory response, and blood thinners to prevent the clots that COVID-19 is known to cause.

For the patient, the experience is physically and emotionally challenging. It involves isolation from loved ones and a clinical routine of constant monitoring. A key and often difficult part of treatment is "proning"—lying on the stomach for extended periods to help the lungs work more efficiently. The combination of severe illness, strenuous treatments, and isolation makes hospitalization a profoundly difficult ordeal.