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: 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

4 Nursing Admission Activities 1.Preparing the client’s room 2.Welcoming the client p Orienting the client p Safeguarding valuables and clothing 5.Helping the client wear hospital’s gown if indicated 6.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 TypeExplanationExample 1.In patientLength of stay generally more than 24 hours Acute appendicitis, acute pneumonia. a)Planned (non urgent) Is scheduled in advanceElective surgery b)Emergency admission Unplanned, stabilized in emergency department and transferred to nursing care unit Unrelieved abdominal or chest pain c)Direct admissionUnplanned, emergency department bypassed Acute condition as prolonged vomiting and diarrhea 2.Out patientlength 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

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