CHAPTER 4

Hospital Admission
and Discharge
 ❑ Define admission ❑ Describe the role of nurse in
❑ Enlist the purposes of admission process
admission and types of ❑ Define discharge and explain
admission the type of discharge
❑ Enlist the steps of health ❑ Describe the procedure of
Learning assessment discharge and role of nurse
Objectives ❑ Explain the procedure of in discharge
admission
 ❑ Admission to the ❑ Discharge from the
Hospital Hospital
Definition, Purpose, Purposes
Types of Admission Types: Planned
Unit and Its Discharge, LAMA and
Preparation Abscond,
CHAPTER Special Considerations
Admission Procedure
Referrals and Transfers
Discharge Planning
OUTLINE Medico-Legal Issues
Roles and
Discharge Procedure
Special Considerations
Responsibilities of The Medico—Legal Issues
Nurse Roles And
Responsibilities of The
Nurse
Care of The Unit After
Discharge
 MEANING OF ADMISSION

Admission of a patient means allowing

and facilitating a patient to stay in the
hospital unit or ward for observation,
investigation and treatment of the
disease he/she is suffering from.
DEFINITIONS
OF HOSPITAL
ADMISSION
PURPOSES OF ADMISSION
 PURPOSES OF ADMISSION

Observation - To keep in round the clock supervision patient is

admitted e.g., the patient with chest pain, palpitations.

Immediate Care – Patients requiring urgent medical treatment for

cardiac arrest, respiratory arrest and accidental cases require admission.

Investigate – Patient is admitted to perform certain medical test before

a line of treatment can be extended.
 PURPOSES OF ADMISSION

Treatment - For further management after diagnosis is made.

Meet needs - Patients who can’t meet their physical needs on their
own such as terminally ill patients and patients suffering with
chronic diseases.

Ready for emergency - Patients requiring watchful monitoring of

medical experts in case of sudden exigency of hospital care need to
be admitted to the hospital.
TYPES OF HOSPITAL ADMISSION
BASED ON THE PURPOSE OF THE ADMISSION

Diagnostic admission: Admission

when the patient has to undergo
some procedure and require
investigation like biopsy.
Therapeutic admission: Patient
has already been diagnosed with
medical condition and requires
medical care for the improvement.
 Short-term admission: Patient is
admitted for a 24-48 hours in the
BASED ON hospital.
THE LENGTH
OF THE
HOSPITAL
STAY Long-term admission: Patient
suffers from a disease condition
and needs more than 48 hours to
recover from the disease
condition.
 BASED ON THE CONDITION OF THE PATIENT

Emergency admission: Patient is

suffering from life threatening
condition like cardiac arrest,
respiratory arrest, etc and requires
Routine admission: Patient is immediate treatment.
suffering from any disease
condition like cholelithiasis and
need to undergo any treatment and
surgery.
CATEGORIES OF THE PATIENT
ADMITTED IN THE HOSPITAL
UNIT AND ITS PREPERATION

Meaning of unit: A unit or ward is defined as

the division of the hospital or a room or hall in
the hospital which has number of beds and
shared by a number of patients, who require
similar care. There are different types of wards
or units in the hospital like medical and surgical
wards.
 UNIT PREPERATION
• Bed should be functioning properly. Linens and blanket should be clean.
Prepare the admission bed Make unoccupied bed.

• Equipments like cardiac monitor, oxygen flow meter, suction machine

Ensure equipment should be functioning properly as per the needs of the patient.

Ensure patient privacy • Ensure the privacy of the patient and do not expose the patient unnecessarily.

• Perform the initial assessment to assess the risk factors like risk of fall, risk
Patient safety of developing pressure sores, pain assessment, etc.

• Identify the categories of patient. assess the financial constraints and explain
Financial burden the estimated cost of the treatment to the patient and the family.

• The suspected patient or the patient with mild symptoms of COVID-19 and tuberculosis
Patient isolation require isolation. Chart visiting time outside the unit. Instruct the family members to wear
appropriate personal protective equipment (PPE) while meeting with patient.
 Ways to reduce the anxiety among patients:

• Be empathetic with client.

• Orient the client to the unit or the wards.
DEALING WITH • Maintain good interpersonal relationship with the
HOSPITALIZATION patient.
ANXIETY • Explain each and everything to the patient.
• Provide privacy to the patient.
• Respect the dignity of the patient.
• Allow the patient to ventilate his/her feelings and
clear the doubts of the patient.
 Meet and receive the patient

PROCEDURE Perform examination and initial

OF assessment
ADMISSION Coordinate with health care team
OF A members
PATIENT
Orientation to the patients and
others
 MEET AND RECEIVE THE PATIENT
• Verify the patient data, by checking the record sheet, chart.
• Introduce yourself and other members of health team on duty.
• Assist patient to the treatment area.
• Ask the patient to change clothes into hospital gown if necessary.
• Put the identity bracelet.
 PERFORM EXAMINATION AND INITIAL
ASSESSMENT
• Conduct general head to foot examination.
• Check the height and weight of the patient.
• Assess the allergic history of patient.
• Send the investigation as prescribed by the physician.
• Do the initial assessment which includes pain assessment, risk
of pressure ulcer assessment and fall risk assessment.
 COORDINATE WITH HEALTH CARE
TEAM MEMBERS
• Coordinate with all healthcare team members like physician,
physiotherapist and dietician.
• Carry out the initial orders or instructions given by the
physician.
• Provide the treatment as instructed.
 THE EQUIPMENT Orient the patient to the equipment and instruct the patient not to touch
them unnecessarily.

USE OF CALL Educate the patient regarding use of call bell and telephone.
SYSTEM AND
TELEPHONE

TREATMENT Explain the treatment schedule to the patient.

SCHEDULE
ORIENTATION
TO THE VISITOR’S TIMINGS Explain the hospital policy regarding visiting to the family members.
PATIENT AND
THE OTHERS OTHER HEALTH Orient the patient to the other healthcare team members.
CARE TEAM
MEMBERS

POLICIES, RULES Inform the patient about the policy as well as rules and regulations of the
AND REGULATIONS hospital.

CARE OF PATIENT’S Make the list of the patient’s valuables in the patient valuable
VALUABLES handover form and hand it over to the family members at the time of the
admission.
 ARTICLES
REQUIRED FOR
ADMISSION
 ARTICLES
REQUIRED FOR
ADMISSION
PROCEDURE OF RECEIVING A NEW
z
PATIENT

Private
Emergency
clinics

Outpatient
department Referral
(OPD) PATIENTS CAN
BE ADMITTED
FROM VARIOUS
HOSPITAL
DEPARTMENTS
 • The duty manger will inform the head nurse regarding admission
of the patient.
• The nurse will prepare the needed equipment and will make sure
PROCEDURE that all the equipment are functioning properly.
• Introduce yourself to the patient and welcome the patient.
OF • Adjust the height of the bed as per the condition of the patient.
• Escort the patient to the bed.
RECEIVING • Arrange the help if patient arrives on stretcher for shifting.
• Identify the patient using at least two identifiers like patient
A NEW name, UHID No. (Unique hospital identification data) or MR
PATIENT No. (Medical record number).
• Orient the patient (fig. 3).
• Complete the process of the admission and change
• the status of the bed from vacant to occupied.
ORIENTATION OF THE PATIENT
 • Provide hospital clothes to the patient and perform
initial assessment.
• Check the medications that patient have brought from
PROCEDURE the home to the hospital. Keep record of the
medication and label it as patient’s own medications.
OF • Check the order of the doctor for treatment
RECEIVING • Send initial investigations as prescribed by
physician.
A NEW • Inform to the doctor on duty and the dietician
PATIENT regarding patient admission.
• Tell the patient about any scheduled procedure or
• treatment.
• Document the patient’s condition and nursingaction
that has been taken.
 • Keep the articles ready required for the
admission of the patient in the intensive
care unit or emergency department and
ensure that all the equipment are
functioning properly.
• Keep the patient’s file ready
• Perform initial assessment and observe the
condition of the patient.
ADMISSION OF • Reassure the patient and explain what is
being done.
THE PATIENT IN • Shift the patient to the ICU or emergency
INTENSIVE CARE bed.
• Provide privacy to the patient and put
UNIT OR identity bracelet to the patient.
EMERGENCY • Review the allergic history and put allergy
identity bracelet if required.
DEPAERTMENT
 • Make the patient wear hospital clothes.
• Make a list of the valuables and handover
them to the primary caregiver and take a
witness sign.
• Perform thorough physical examination
and document the patient’s condition.
• Connect the cardiac monitor to the patient.
ADMISSION OF • Access an IV line and start maintaining
THE PATIENT IN intake output.
• Provide recovery position (left lateral) to
INTENSIVE CARE the patient.
UNIT OR • If unconscious keep the mackintosh towel
under the face to collect secretions.
EMERGENCY
DEPAERTMENT
• Explain about the transfer and its purpose to the patient and family members.
• Inform to the unit or ward where the patient has to be transferred and receiving
nurse regarding patient’s condition and the equipment needed.
• Identify the method of transfer like wheelchair, stretcher and bed.
• Make sure all the documents are updated before shifting the patient.
• Inform the patient arrival to the unit.
• Transport the patient. Assist the patient in transfer to the bed. Match the
patient identification details with the record sheets and accompany the patient to
the area of shifting.
• Handover all the documents as well as patient valuables to the receiving nurse.
MEDICOLEGAL ISSUES IN ADMISSION OF
THE PATIENT

Concept :
Medicolegal cases (MLC) have Definition :
both medical and legal
implications. Medicolegal cases It can also be defined as the
are the cases where along with cases which require medical
medical treatment of the patient, treatment but at the same
investigation by law is required
to ascertain the responsibilities time needs to be informed to
regarding the present state or the law enforcing authorities.
condition of the patient.
CASES CONSIDERED AS MEDICOLEGAL

Accidental death Accident cases Injuries

Unnatural
events under
Poisoning Violence
suspicious
circumstances

Bullet injury Drowning

 MEDICOLEGAL ISSUE DURING
ADMISSION OF THE PATIENT
Disclosure of Medical
Assault Injuries
the information negligence
• Intentional act • Damage to any • Disclose • Improper or
that cause part of the information unskilled
another body caused about treatment of a
person to fear by violence. patient’s patient by a
that he/she is condition, the medical
about to suffer methods of practitioner
physical harm. treatment and
alternative for
the treatment.
ROLE OF NURSE IN ADMISSION OF
MEDICOLEGAL CASES
 PREPARATION OF UNIT OR Role of nurse is to prepare the unit.
ROOM Keep the bed ready. Linens and blanket
should be clean. Position the bed.

ENTRY OF THE PATIENT Enter the patient’s information in

ROLE OF admission register as well as computer
system.
NURSE IN AVAILABILITY OF THE Ensure that all the articles and

THE EQUIPMENT equipment are available and functioning

properly.

ADMISSION ORIENTATION OF THE PATIENT Orient the patient to the surroundings

and hospital policies and protocols.
OF THE MEETING NEEDS OF THE Recognizing and meeting the various
PATIENT needs of the patient.
PATIENT CARE OF PATIENT’S VALUABLES Handover the patient’s valuables to the
AND CLOTHES family members at the time of
admission.

TREATMENT Carry out the instructions as prescribed

by the physician.
DISCHARGE OF THE PATIENT

Definition:
Discharge of a patient means
departure of a patient from
the hospital. It is also known
as dismissal of patient from
the hospital.
 Purposes of discharge
To ensure continuity of care.

For a safe and effective

return of all the patient’s
PURPOSES clothing and valuables.
OF
Help the patient to adjust
DISCHARGE effectively with the change
of environment.

To make sure that the patient

has information about his/her
condition.
TYPES OF DISCHARGE
 PLANNED DISCHARGE

The decision of discharge is taken by the attending doctor or

physician when the patient has completed the initial and actual
management of the disease in the hospital and now patient
does not need the direct supervision.
LEAVE AGAINST MEDICAL REQUEST
(LAMA)
Also known as Discharge Against Medical Advice (DAMA), in this it is
clearly explained by the doctor that taking the patient from the hospital
may impose risk to the life of the patient, but still patient or patient’s
family want to take the patient to some other hospital or to the home
after signing a declaration form saying that the risks and consequences
of taking the patient from the hospital were informed to the patient or
family.
 PAROLE

It is used in psychiatric hospital and patient is sent to home for

2 to 4 days by the approval of psychiatrist in charge.
 REFERRAL

Shifting the patient to other units or to the hospital for further

management.
 DISCHARGE ON REQUEST

Treatment is not complete but there is no immediate danger to

the life of the patient in taking the patient out of the hospital.
 PNEUMONIC – DISCHARGE PLANNING

The pneumonic that is used to describe the discharge

planning is IDEAL.

PNEUMONIC –
DISCHARGE
PLANNING
 Include : Include the patient and the family members in
the process of discharge planning.

Discuss : Five main areas like life at home, medications,

warning signs, test results and follow up visits need to be
discussed with patient and the family.

Educate : Educate the patient and the family members

DISCHARGE regarding the condition, diet, exercise and medications.

PLANNING Assess : Assess how well doctors and nurses has explained
the diagnosis, condition, and the steps in the patient’s care
to the patient and the family members.

Listen : Listen to the patient and his/her families goals,

preferences, observations, and concerns.
 • Review the doctor’s order for discharge in written
form.
• Prepare the cumulative hospital charges and return
the extra medication to the pharmacy.
PROCEDURE
• Send the final cumulative billing sheet to the cashier
OF and process the final bill.
DISCHARGE • Patient settles the bill and receives payment paid
slip.
• Patient or family members goes to the ward to
collect the discharge summary and physician or staff
explains about the medication and follow – up –
date.
 • Remove the lines, tubing, cut off the identity
bracelet and ask the patient to change the
hospital dress.
PROCEDURE • Transfer the patient to hospital lobby and
OF document the return process of the patient in
DISCHARGE progress notes.
• Inform the housekeeping to clean the room.
• Check all the documents of the patient with
medical record, change the status of the
inpatient room and make the room ready for
the next patient arrival.
 Role of the nurse in an MLC during discharge:

• Inform the police on duty in the hospital and to the

Chief Medical Officer (CMO).
• Discharge only after the clearance.
ROLE OF • If patient absconds, inform the nursing supervisor,
CMO and the treating doctor.
NURSE IN • No MLC patient can leave the hospital with LAMA.
DISCHARGE • The care given to the patient should be documented
timely, accurate and duly sign the nurses’ notes.
• Records related to the treatment of the patient has to be
stored safely and should be handed over to the
authorized person as designated by the hospital
authority.
• In case of death, the body is not to be handed over to
the relatives. Label the body properly and sent to the
mortuary and inform CMO and police officer.
ROLE OF NURSE IN DISCHARGE
 CARE OF THE UNIT AFTER
PATIENT DISCHARGE
• When the patient is discharged, inform the housekeeping
staff to clean the room and make it ready for the next
patient arrival.
• Instruct the housekeeping staff to clean the furniture and
windows and send the linens and blanket for the laundry.
• The articles which are used by the patient should be sent to
the utility room for cleaning, sterilization and disinfection.
• Discard the unwanted objects or materials and disinfect
the mattresses.
• In case the room is used by the patient suffering from
communicable diseases then it should be fumigated.
• Prepare the unit for next patient as per hospital policy.
 • Admission is the process of allowing the patient to
stay in the hospital for a diagnostics or therapeutic
purposes. It can be emergency admission or routine
CHAPTER admission.
• Nurse should be skillful to receive the patient in ICU
FOCUS or in the emergency because every second is
important for the patient and should be more careful
POINTS while receiving the medicolegal case.
• Discharge of the patient means departure of the
patient from hospital environment to another
environment. Do not discharge the patient without
doctor’s written order.
“Textbook of Foundation of
Nursing" by Jyoti Kathwal