1. Chapter 11 Admission, Discharge, Transfer, and Referrals

2. Admission
Entering a hospital for nursing care and medical or surgical treatment

3. Admission Process Admission involves:
Authorization from a physician that the person requires specialized care and treatment (table 11-1)
Completion of the hospital’s admission database by nursing personnel
Documentation of the client’s medical history and findings from physical examination
Development of an initial nursing care plan
Initial medical orders for treatment

4. Nursing Admission Activities
Preparing the client’s room
Welcoming the client p. 170
Orienting the client p. 170
Safeguarding valuables and clothing
Helping the client wear hospital’s gown if indicated
Compiling the nursing data base

5. Psychosocial Responses on Admission
Anxiety and fear
Decisional conflict
Situational low self-esteem
Powerlessness
Social isolation
Risk for ineffective therapeutic regimen management
Loneliness.
Decrease privacy.

6. Types of Admissions Type Explanation Example In patient
Length of stay generally more than 24 hours
Acute appendicitis, acute pneumonia.
Planned (non urgent)
Is scheduled in advance
Elective surgery
Emergency admission
Unplanned, stabilized in emergency department and transferred to nursing care unit
Unrelieved abdominal or chest pain
Direct admission
Unplanned, emergency department bypassed
Acute condition as prolonged vomiting and diarrhea
Out patient
length of stay less than 24 hours
Minor surgery " warts"
Observational
Monitoring required , need for inpatient admission determined within 23 hours
Head injury , RTA , FD

7. The Discharge Process
Discharge 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 teaching
O = Out patient referral
D = Diet

8. Steps in the Discharge Process
Discharge planning
Obtaining a written medical order
Completing discharge instructions
Notifying the business office
Helping the client leave the agency
Writing a summary of the client’s condition at discharge
Requesting that the room be cleaned

9. 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

10. 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

11. 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

12. Home Health Care
Health 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

13. 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