Admission and Discharge procedure in Hospital

1. Admission
&
Discharge
Dr. Rahul B. Pandit
Faculty of Nursing
Sassoon General Hospital, Pune

2. Nursing
Nursing encompasses autonomous and
collaborative care of individuals of all ages,
families, groups and communities, sick or well
and in all settings. It includes the promotion
of health, the prevention of illness, and the
care of ill, disabled and dying people.

3. Hospital
 A hospital is a place where people who are
ill are looked after by Nurses and Doctors.
 Hospital is an institution providing
medical and surgical treatment and
nursing care for sick or injured people.

4. Definition
Admission is defined as allowing a patient
to stay in hospital for observation,
investigation, treatment and care.

5. Definition
Admission is the entry of a patient into a
hospital /ward for therapeutic /diagnostic
purposes.

6. Purposes of admission
 To undergo evaluation & treatment
 To know what is really happening in
his/her body right oft it to be fixed
 To provide emotional security to the
newly admitted patient and his family

7. Types of admission
1. Emergency admission
2. Routine admission

8. Emergency admission
In this, patients are admitted in acute
conditions requiring immediate
treatment. Examples. Patient with RTA,
Poisoning, burns and cardiac or
respiratory emergency.

9. Routine admission
In this, patients are admitted for
investigation, diagnostic and medical
or surgical treatment. Treatment is
given according to patients problem.
E.g. Patient with hypertension, diabetes
mellitus etc.

10. Unit and it’s preparation
It is a place where the patient is kept
during hospital stay. The admitting
department notifies the unit prior to the
patients arrival so that room /bed can
be prepared.

11. Unit and it’s preparation
 Prepare the treatment table
 Ensure all the equipment are
completed
 Check ventilation
 Ensure patient privacy

12. Special consideration
 Admission cause undue stress (emotional
factors as well as financial capability must
given utmost importance)
 Be observant consider the individual patient
needs
 Provide an individual admission procedure
 Show may efficiency and concerns

13. Admission procedure
 Meet and receive the patient
 Verify the patient data, by checking the record
sheet, chart.
 Introduce immediate personal
 Assist patient to the treatment area
 Ask the patient to change clothes into hospital
gown if necessary

14. Perform examination and
evaluation procedure
 Perform examination and evaluation
procedure establish base line values like vital
signs, do history taking, physical examination
etc.
 Coordinate with the physician and carry out
initial orders
 Give the treatment and instructions as need

15. Orientation to the patient
and relatives
 The equipments /instruments
 Use of call system and telephone
 Treatment schedule
 Visitors timings
 Other health care team members
 Policy and rules and regulations
 Care of patients valuable etc.

16. Record & Report
 Admission Book
 Preparation of Paper
 Drug Book
 Diet Book
 HMIS Entry
 Cot List

17. Medico – Legal issues
 Medico-legal cases (MLC) are an integral part
of medical practice that is frequently
encountered by Medical Officers
 Proper handling and accurate documentation
of these cases is of prime importance to avoid
legal complications and to ensure that the
Next of Kin (NOK) receive the entitled benefits.

18. Definition
 MLC is defined as “any case of injury or ailment where,
the attending doctor after history taking and clinical
examination, considers that investigations by law
enforcement agencies (and also superior military
authorities) are warranted to ascertain circumstances
and fix responsibility regarding the said injury or
ailment according to the law”.

19. Examples of MLCs.
 Accidents like Road Traffic Accidents
 Cases of trauma with suspicion of foul play (d)
Electrical injuries
 Poisoning, Alcohol Intoxication
 Burns and Scalds
 Sexual Offences
 Attempted suicide

20. Role and Responsibilities of
Nurse in admission procedure
 Nurse should deal every effort to be
friendly and courteous with the patient
and family members
 Make proper observation of patients
condition

21. Role and Responsibilities of
Nurse in admission procedure
 Orient patient and relatives regarding hospital
polices
 Deal with patient carefully who is suffering from
communicable disease or illness. Isolate if
necessary
 Patients valuables and clothes should be handed
over to relatives with proper recording.

22. Discharge Procedure
 The patient, the family, medical staff,
nursing staff, social worker, dietician all
work together to coordinate the discharge.
 The doctor plans the discharge with the
patient and leaves a written order on the
patient’s chart.

23. Introduction
 The patient may have concerns regarding managing
own care at home.
 Provisions such as home health care may be needed,
as ordered.
 Assessment needs to be done as to what help the
patient will need at home.
 Discharge planning involves the entire healthcare
team.

24. Definition
“Discharge of patient from the hospital
means, reliving a person from hospital
setting, who admitted as an inpatient
in that hospital”.

25. Types of Discharge
1. PLANNED DISCHARGE:-
Patient completes the initial, actual management in the
hospital and now he or she need not to be under direct
supervision of that hospital.’
2. DAMA/LAMA: Discharge/Leave Against Medical Advice
3. TRANSFER: Transfer to other unit or hospital
4. ABSCOND: Abscond from Hospital
5. REFFERAL : Referred for further management

26. Consent for DAMA
I am leaving the hospital ward against medical advice.
Doctor explained me about my disease condition and
ill effects of discharge against medical advice. Doctors
and Nursing staffs will not be responsible for any ill
effects happening after my departure”.
Name of the patient / relative :-
Relation:-
Signature:-
Date :-
Time:-

27. Discharge planning
1. Nurses play an important role in discharge
planning in the hospital.
2. Continuity of care is important.
3. To achieve continuity of care, nurses use critical
thinking skills and apply the nursing process.
4. Discharge planning is a centralized, coordinated,
interdisciplinary process

28. ESSENTIALS OF PLANNED DISCHARGE
1. Written order by doctor.
2. Discharge card.
3. Informing other departments.
4. Check payment of the bills.
5. Hospital glossaries taken back.
6. Returning of the personal belongings.
7. Arrangement for transport.
8. Documentation.

29. Steps involved in the Discharge Planning
1. Evaluation of the patient by qualified personnel
2. Discussion with the patient or his relatives
3. Planning for homecoming or transfer to other place
4. Determining if caregiver training or for other support
5. Referrals to home care agency or appropriate support
6. Arranging for follow-up appointments or tests

30. Nurses Responsibility in
Discharge
PREPARATION FOR DISCHARGE
 Planning in the beginning.
 Plan for rehabilitation and follow-up need.
 Teach nursing procedures to be continued
at home, get it’s practice done.
 Arrangement for transport.

31. Nurses Responsibility in
Discharge
DURING DISCHARGE PROCEDURE
 See doctor’s written order.
 Explanations.
 Hand over personal belongings.
 Check and receive any hospital property.
 Confirm bill paid.
 Inform other departments regarding discharge
 Arrange transport.
 DAMA:- check consent

32. Nurses Responsibility in
Discharge
AFTER DISCHARGE
 Documentation.
 Care of patient’s room and articles

33. Nurses responsibility in
MLC Discharge
 Check for medico legal history.
 Notify medical officer in charge.
 Abscond cases immediately contact medical officer in
charge.
 Maintain all documents in a proper manner.
 Take in written handing over and taking of articles.
 Never discharge patient without written order by
physician.

34. Checklist
M
E
T
H
O
D

35. Checklist
M = MEDICATION
E = ENVIRONMENT
T = TREATEMENT
H = HEALTH TEACHING
O = OUT PATIENT REFFERAL
D = DIET

37. Summary
 Admission is warranted for patient’s
thorough evaluation and treatment
 Admitted patients should be comfortable
and secured
 Admission should be individualized

38. Summary
 Admission involves patient reception,
history taking, patient orientation,
coordination, patient chart management
and planning individualized treatment
program.

39. Question ????