STUDENT Admission, Discharge & Transfer

ADMISSION, DISCHARGE, TRANSFER, AND REFERRALS

Overview

  • Author: C. Graves, BSN, RN, CEN

OBJECTIVES

  • Identify the four major steps in the admission process.

  • Recognize four common responses during patient admission.

  • Outline steps involved in the discharge process.

  • Provide three examples of patient transfers in care.

  • Distinguish between patient transfers and referrals.

  • Describe three levels of care in nursing homes.

  • Explain the purpose of a Minimum Data Set (MDS).

  • Identify two factors increasing demand for home health care.

ADMISSION PROCESS

General Admission Steps

  • Physician Admits Patient: Admission to the facility is initiated by a physician.

  • Billing Information: Managed through the admission department.

  • Medical History and Physical: Collection of comprehensive history and physical examination.

  • Medical Orders: Physicians provide necessary orders upon admission.

  • Types of Admission:

    • Scheduled Admission

    • Emergency Admission

  • Patient Identification: Patient I.D. bracelet is provided for identification.

Nursing Admission Activities

  • Preparation of Room: Ensuring the room is ready for the patient’s arrival.

  • Welcoming: Greeting the patient upon arrival to create a comforting environment.

  • Orientation: Familiarize patient with:

    • Location of nurses’ station

    • Bathroom facilities

    • Personal storage availability

    • Procedure to call the nurse

    • How to adjust the bed

    • Lights and telephone usage

    • Daily routine (e.g., meal times, medical rounds, scheduled tests/surgery)

Safeguarding Patient Valuables

  • Assisting in the safekeeping of personal belongings and clothing.

  • Helping the patient to undress comfortably.

Compiling Admission Database

  • Collecting required data for medical admissions.

  • Common Patient Responses:

    • Anxiety about hospitalization.

    • Feelings of loneliness.

    • Decreased sense of privacy.

    • Loss of identity upon admission.

DISCHARGE PROCESS

Initiation of Discharge

  • Defined as the termination of care from the healthcare facility.

  • Discharge planning begins at admission to ensure smooth transition.

  • Written Orders: Requirement for discharge orders written by MD.

  • Patient Instructions: Provide discharge instructions clearly.

  • Notify Business Office: Ensure billing and finalization of records.

  • Summary Documentation: Write a summary of the patient's condition at discharge.

  • Room Cleaning Request: Ensure the patient’s room is cleaned post-discharge.

Leaving Against Medical Advice (AMA)

  • Circumstances where the patient leaves without formal discharge by the MD.

  • Reasons for leaving may include dissatisfaction with care.

  • Negotiation Attempts: Attempt to resolve issues before discharge.

  • AMA Form: Have patient sign to document leaving against medical advice.

  • Documentation Requirement: Thoroughly document the situation and patient decision.

DISCHARGE PLANNING

  • Focus on enhancing client outcomes after leaving the facility.

  • Addresses post-discharge needs effectively.

  • Coordination of Community Resources: Linking patients to necessary external services.

  • Special Considerations: Taking into account unique patient needs for effective discharge.

DISCHARGE INSTRUCTIONS

  • Clear teaching methods for patient understanding (Refer to METHOD, page 171).

  • Prescriptions: Provide detailed information on medications.

  • Follow-Up Appointments: Schedule and clarify the importance of follow-up care.

  • Discharge Orders Summary: Document key points from discharge instructions.

DISCHARGING A CLIENT

  • Gathering Belongings: Assisting the client in collecting personal items.

  • Transportation Arrangement: Ensuring adequate transportation for client discharge.

  • Client Escorting: Safely escorting the client out of the facility.

  • Writing Discharge Summary: Documenting important details regarding discharge.

  • Terminal Cleaning: Ensuring a thorough cleaning of the room post-departure.

TRANSFERRING PATIENTS

  • Transfer Activities: Overview of the process in patient movement.

  • Types of Care Facilities for Transfers:

    • Extended Care Facilities

    • Skilled Nursing Facilities

    • Intermediate Care Facilities

    • Basic Care Facilities

    • Nursing Homes

  • Referrals: Linking patients to home health care services as part of the transfer process.