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Chapter 11

Admission, Discharge, Transfer, and Referrals

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Admission

Entering a hospital for nursing care and medical or surgical treatment

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Admission ProcessAdmission involves:

1.Authorization from a physician that the person requires specialized care and treatment (table 11-1)

2.Completion of the hospital’s admission database by nursing personnel

3.Documentation of the client’s medical history and findings from physical examination

4.Development of an initial nursing care plan

5.Initial medical orders for treatment

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Nursing Admission Activities

1. Preparing the client’s room

2. Welcoming the client p. 170

3. Orienting the client p. 170

4. Safeguarding valuables and clothing

5. Helping the client wear hospital’s gown if indicated

6. Compiling the nursing data base

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Psychosocial Responses on Admission

Anxiety and fearDecisional conflictSituational low self-esteemPowerlessnessSocial isolationRisk for ineffective therapeutic regimen

managementLoneliness.Decrease privacy.

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Types of AdmissionsType Explanation Example

1. In patient Length of stay generally more than 24 hours

Acute appendicitis, acute pneumonia.

a) Planned (non urgent) Is scheduled in advance Elective surgery

b) Emergency admission

Unplanned, stabilized in emergency department and transferred to nursing care unit

Unrelieved abdominal or chest pain

c) Direct admission Unplanned, emergency department bypassed

Acute condition as prolonged vomiting and diarrhea

2. Out patient length of stay less than 24 hours Minor surgery " warts"

a) Observational Monitoring required , need for inpatient admission determined within 23 hours

Head injury , RTA , FD

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The Discharge ProcessDischarge is ”the termination of care from a health

care agency“

One discharge planning technique involves using the acronym METHOD as a guide

M =Medication E = Environment T = Treatment H = Health teachingO = Out patient referralD = Diet

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Steps in the Discharge ProcessDischarge planningObtaining a written medical orderCompleting discharge instructionsNotifying the business officeHelping the client leave the agencyWriting a summary of the client’s condition at

dischargeRequesting that the room be cleaned

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The Transfer Process

Transfer: “ discharging a client from one unit or agency and admitting him or her to another without going home”

Transfers are used when there is a need to:Facilitate more specialized care in a life-threatening

situation Reduce health care costs Provide less intensive nursing care

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Steps Involved in Transfer

Informing client and family about the transfer

Completing a transfer summary

Speaking with a nurse on the transfer unit to coordinate the transfer

Transporting the client and his or her belongings, medications, nursing supplies, and chart to the other unit

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The Referral Process

A referral is the process of sending someone to another person or agency for special services

Referrals generally are made to private practitioners or community agencies

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Home Health CareHealth care provided in the home by an employee

of a home health agency

Home care nursing services

Help shorten time spent recovering in hospital

Prevent admissions to extended care facilities

Reduce readmissions to acute care facilities

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Home Health Care (cont’d)

Factors contributing to the increased demand for home health care:

Outcome of limitations imposed by Medicare and insurance companies on number of hospital and nursing home days for which they reimburse care

Growing number of chronically ill older adults in need of assistance