HOSPITAL ADMISSION

& DISCHARGE.
BY:
DR.RAAFAT AL-AWADHI
 ADMISSION:-

 Theentrance of a patient into a health care agency such as

hospital or a private clinic is termed as admission.

 Admissionis the entry of an individual into a hospital/

ward for diagnostic, therapeutic or rehabilitative
purposes.
 DEFINITION OF ADMISSION:-

 Receiving a patient to stay in a hospital for

observation, investigation, diagnosis, treatment and
care.
 Purposes of admission:-
 To provide immediate care.
 To provide safety and comfort to the patient.
 To manage and improve the general condition of patient.
 To diagnose the condition by observing signs and symptoms of a disease
condition.
 To be ready for any emergency.
 To facilitate follow up of the patient.
 To obtain information about patient such as any information that serves
as a basis of care e.g. Allergy, Diabetes etc.
 To establish IPR (INTERPERSONAL RELATIONSHIP).
 Indications of admission:-

 Diagnostic purposes.

 Therapeutic aspect for treatment.

 Surgical interventions.

 Conditions requiring expert care.

 Types of hospital admission:-

 There are various types of admission:-

EMERGENCY/ UNPLANNED/ NON ELECTIVE ADMISSION.
 When patient requires immediate treatment.
 E.g. accident, poisoning.
ROUTINE/ PLANNED ADMISSION.
 Patient who requires long term care.
 E.g. surgeries, cancer or any chronic condition.
 TYPES BASED ON STAY:-

 IN PATIENT (IPD):-
 Length of stay generally more than 24 hours.
 Includes planned, emergency and direct admission.

 OUT PATIENT (OPD):-

 Length of stay less than 24 hours.
 Includes observational admissions.
 Unit & its preparation:-

 The patient care unit is the area of hospital in which the patient
receives care during the hospital stay after hospital admission.
 The patient unit is of three types:-
 1. Private room:- only one patient is admitted.
 2. Semi-private room:- two patients are admitted.
 3. Ward:- three or more patients admitted.
 Components of patient unit:-

 FURNITURE- Bed (with side rails), bedside stand, bedside table.

 LINENS- Mattress, sheets, pillow cases, blankets, bath blanket, face towel, wash cloth
and gowns.

 TOILET EQUIPMENTS- Wash basin, soap dish, toothbrush, tooth paste, mouth wash,
emesis basin, bedpan and urinal for male patient.

 Other ARTICLES- Call bell, screen, telephone, waste basket/dustbin, built in blood
pressure setup, suction and oxygen on the wall.
 PREPARATION OF UNIT/ ADMITTING
THE PATIENT:-

 While admitting the patient into ward the nurses completes a

number of procedures includes:-

 Prepared admission bed.

 Orientation of the patient to ward and unit procedures.
 Collection of history and physical assessment.
Data required for the admission of the patient:-

 Name of the patient-

 Age, sex/gender,-
 Marital status-
 Address-
 Occupation-
 Income-
 Mobile number-
 ARTICLES:-

 Prepared bed.
 Vital signs assessment tray.
 Weighing machine(scale).
 Admission advisory form.
 Documents such as:-
 Doctor’s order sheet
 TPR sheet.
 Nursing assessment form.
 Nurses record sheet.
 ARTICLES:-

 Additional sheets as indicated:-

 Intake output chart.
 Diabetic urine chart.
 Admission consent form.
 Kidney tray or emesis basin.
 Tissue paper.
 Bedpan/urinal
 Bath towels & wash cloth.
Preparation of articles:-

Articles:- Rationale:-
 Prepared bed.  To receive the patients.
 Vital signs tray.  To monitor vital signs of patient.
 Weighing machine.  To measure weight of patient.
 Kidney tray.  To collect waste product.
 Documentation sheet.  For proper documentation.
 Screen.  To provide privacy.
 Emergency trolley.  For any emergency.
PROCEDURE-ADMISSION:-

 In routine admission:-
 OPD
 Gathers info of the patient & record.
 DOCTOR’S OFFICE
 Doctors make decision for admission.
 ADMISSION OFFICE
 For allocation of ward & bed.
 WARD
PROCEDURE-ADMISSION:-

 In emergency admission:-
 This is the situation in which every second is precious.
 So patient is directly admitted in the causality/
emergency department.
 The bed should be prepared and the emergency tray
and trolley should be ready.
 The equipment should be checked and should be in a
working condition to save time.
 ADMISSION PROCEDURE- NURSING ACTION:-

 Receive the patient cordially.

 Introduce yourself and greet them.
 Check’s the patient identification and general condition.
 Make the patient feel comfortable.
 Prepare all required equipment and bring the articles to the bedside.
 Orient the patient to physical setup of ward and nurse’s station.
 Assist the patient to bed and provide comfortable position.
 Complete necessary records according to hospital policy which includes
nursing history and assessment (vitals, height & weight etc).
 Preliminary observation of the patient:-
 Patient’s general facial expressions – denote not only their emotional
reactions but also the presence of pain or fatigue.

 Any discoloration of the skin such as yellowish or pale –denotes-

jaundice, bluish-denotes-cyanosis.

 Observe the patient if undernourished/ malnourished.

 Further observation can be made while rendering care to the patient.

 Special considerations:-

 Isolate the patient if suffering from communicable disease.

 Orient the patient and his/her relatives to hospital/ward policies.

 Avoid physical or psychological trauma.

 Be cautious and kind to the patient & relatives.

 Observe policies in dealing with medico-legal cases.

 Never leave the patient alone in the causality.

 MEDICO-LEGAL CASES/ISSUES
(MLC):-
 An 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 are
warranted to ascertain circumstances and fix responsibility regarding
the said injury or ailment according to law”.
 Simply it is a medical case with legal implications for the attending
doctor where the attending dr. after eliciting history and examining
patient, thinks that some investigation by law enforcement agencies
is essential.
 Or a legal case requiring medical expertise when brought by the
police for examination.
 Examples of medico-legal cases:-

 Accidents (RTA, industrial accidents).

 Burns and scalds.
 Sexual offences.
 Criminal abortions.
 Attempted suicide.
 Poisoning, alcohol intoxication.
 Cases of trauma with suspicion of foul play.
 Electrical injuries, chemical injuries.
 Domestic violence, child abuse.
 Legal implications in admission:-

 Immediately inform the physician.

 OPD records, admission cards should be kept under lock and
key and do not show records to anyone else from the health
care team.
 All the belongings should be kept under custody.
 Accurate recording of the body discharge should be there.
 Do not discard or destroy any evidence without discussing
with the physician.
 Take the consent from the relatives before any procedure.
 ROLES & RESPONSIBILITIES OF THE
NURSE:-
 When the patient comes, take case sheet & receive patient in
admission bed.

 If patient is very ill, inform dr. incharge immediately.

 Complete the admission register & other admission records side by

side.

 Make general observation from head to toe, check height, weight &
vital signs.
 ROLES & RESPONSIBILITIES OF THE
NURSE:-
 Hand over the patient’s belongings & valuables to relative or ward incharge
for safe custody.
 Assist the physician in examining patient and carry out the orders &
investigations.
 Subsequently learn the patient’s habits, interests, hobbies & health history.
 If patient is admitted for operation or any treatment requiring anesthesia,
take the consent.
 If patient is on specific diet, encourage patient to take diet from hospital
only.
 DISCHARGE FROM THE HOSPITAL.

 Discharge of patient from the hospital means, relieving a person from

hospital setting, who admitted as an inpatient in that hospital.

 This is the stage when patient is shifted from hospital to home. A

formal statement in written form is given from the hospital.
 TYPES-

 Planned discharge/cured & discharge:

Patient is cured and leaves hospital after physician’s advice.

 DAMA/LAMA: Discharge Against Medical Advice/Leave Against

Medical Advice.

 TRANSFER:- transfer to other unit or hospital.

 TYPES-

 REFFERAL:- Referred for further management or better treatment by

physician.
 ABSCOND:- when patient leaves hospital without any prior information
to hospital staff & also without clearing dues.
 DOR (Discharge On Request):- discharge is given on personal request
of patient when not willing to take treatment.
 DEATH:- When patient not recovered from illness & dies.
 CONSENT FOR DAMA/LAMA:-

 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:
 DISCHARGE PLANNING:-

 “IDEAL” DISCHARGE PLANNING;

 I:- Include the patient & family members as partner in discharge process.
 D:- Discuss with patient & family 5 key areas to prevent problems.
 1. management of disease at home.
 2. warning signs & problems.
 3. explain test results.
 4. explain medications.
 5. follow up.
 E:- Educate patient & family about discharge process to reduce
anxiety.

 A:- Assess whether patient is able to understand the process.

 L:- Listen to patient & family members and respect their preferences.
 ESSENTIALS OF PLANNED
DISCHARGE:
 Written order by Doctor/physician.
 Discharge card.
 Informing other department.
 Check payment of the bills(no due).
 Hospital glossaries taken back.
 Returning of the personal belongings.
 Arrangement for transport.
 Documentation.
 Points to remember:-

 Ensure that no dues certificate is taken before handling over the

discharge slip to patient.
 Inform the relatives well in advance about discharge.
 Change the dressings when the patient is ready for discharge.
 Provide clear instructions in regard to the use of drugs, diet to be taken,
personal & environmental hygiene and follow up units.
 Keep the record in safe custody & hand over to central registration
office.
 DISCHARGE PROCEDURE:-

 The physician writes on patient’s chart that which patient is to be

discharged.

 The patient & family members are instructed regarding medication,

treatment and follow up.

 Patient’s personal belongings which were entrusted to the hospital

personnel at time of admission should be checked and returned to
them. The nurse should receive a receipt from the patient.
 DISCHARGE PROCEDURE:-

 The articles in patient’s unit should be checked and ensure that they are
complete, including bed linens.
 Check the payment of all hospital bills.

Arrange a wheel chair or stretcher if patient is not able to walk or not

allowed to walk.
 If any patient leaves the hospital against medical advice he/she should be
asked to sign a release form. The form should state that patient is leaving
against the advice of Dr. nor the hospital can be held responsible for any
ill-effects happening after his/her departure.
 MEDICO-LEGAL ISSUES:-

 Inform hospital authorities about discharge of medico legal patients.

 On Discharge:-
 If patient is transferred from one ward to another, it should be
clearly entered & signed.

 Discharge notes must be kept under lock and key.

 MEDICO-LEGAL ISSUES:-

 In case of death of patient:-

 Physician must inform CMO (Chief Medical Officer) and send the body
for post mortem examination.
 Nurse must provide written instructions for handling the body to
mortuary/police officer with complete name, address, identification
number and signature of witness.
 List of all articles of the patient should be maintained.
 ROLES & RESPONSIBILITIES OF THE
NURSE:-

 Preparation for discharge:-

 Planning in the beginning.
 Plan for rehabilitation & follow up need.
 Teach nursing procedures to be continued at home,
get its practice done.
 Arrangement for transport.
 During discharge procedure:

 See doctor’s written order.

 Explanations done.
 Hand over personal belongings.
 Check & receive any hospital property.
 Confirm bill paid.
 Inform other department regarding discharge.
 Arrange transport.
 If DAMA check consent.
 After discharge:-

 After discharge:-
 Documentation.
 Care of patient’s room and articles.
 Nurses responsibility in MLC
discharge:

check for medico legal history of patient.

Notify medical officer in charge.
If abscond case immediately contact MO in charge.
Maintain all documents in proper manner.
Take in written handing over & taking of articles.
Never discharge patient without written order by physician.
 Checklist:- METHOD

 M: MEDICATION
 E: ENVIRONMENT
 T: TREATMENT
 H: HEALTH TEACHING
 O: OUT PATIENT REFFERAL
 D: DIET
 CARE OF THE UNIT AFTER
DISCHARGE:-

 After the patient is discharged, room is cleaned.

 Windows and rooms are opened.
 All the articles used by the patient are washed and sterilized or
disinfected by chemicals.
 Disposable things are discarded and linens send to laundry.
 Mattress, blankets and pillows are posed to the sunlight.
 In c/o communicable diseased patient fumigation of room & articles
should be done.