Nursing Process and Admissions Quiz

Introduction to Admission, Transfer, Discharge, & Referral

• Admission is the entry into a healthcare agency for nursing care, medical or surgical treatment.
• Effective management of inpatient admissions and discharges is critical for high-quality patient care across all healthcare sectors.
• Team-based working and partnerships are crucial to ensure that patient-centered care, ensuring quality and fairness, is planned, managed, and delivered effectively.
• Nursing care during admission must meet patients' holistic healthcare needs and establish a pathway for evaluating patient responses to treatment.

Principles Underpinning Best Practice in Hospital Admissions

• Patient-centered services must be accessible to the population without compromising safety, quality, and clinical standards, aligning with the appropriate people, location, and time frame.
• Patients are to be included in all decisions concerning their care.
• Clinical practice and care should rely on the most up-to-date evidence.
• Effective collaboration and clinical networking are essential between hospitals and care groups, particularly in addressing complex care issues to optimize outcomes.
• The service should be based on good clinical governance principles

Admission Types

• Emergency admissions
• Elective admissions
• Observational admissions
• Day-case admissions
• Direct admissions
• International admissions

Emergency Admissions

• An unplanned hospital admission due to trauma or acute illness unable to be treated as an outpatient.
• Only emergency patients should be admitted through the Emergency Department.
• The focus should shift from admission to patient assessment to ensure appropriateness and maximize bed availability for elective admissions.

Importance of ED Admission

• Extended access to rapid assessment clinics and outpatient radiology and pathology services
• Prompt access to diagnostics and senior medical decision-making at the point of admission.
• Multidisciplinary team collaboration is essential.
• Standardised triage processes for clinical prioritisation of patients upon arrival in the Emergency Department are necessary for timely and appropriate care delivery.
• Effective care pathways for streamlining definite admissions to minimise delays.

Before Admission

• A clear pre-admission process is needed for both emergency and elective admissions.
• The decision to access hospital services should ideally be shared between the patient and the primary care team (PCT).
• Pre-admission services should be integrated into secondary care delivery.
• Pre-admission assessments should be undertaken on an outpatient basis wherever possible, possibly with the help of the PCT, to optimize a patient's health status before planned admission.
• The patient and their caregivers must be adequately informed about their medical condition, proposed treatment, and any associated hospital procedures.
• General Practitioners (GPs) and the PCT should be involved in the pre-admission process.

ED Patient Categories

• Resuscitation
• Minor illness and injury stream (patients unlikely to be admitted)
• Paediatric cases
• Specialist medical/surgical team assessment for patients needing admission
• Psychiatric case assessment service

Key Processes for Effective Elective Admissions

• Centralised waiting list management aligned with clinician parameters for scheduling theatre lists
• Pre-admission assessment is necessary to facilitate proper planning of the entire patient journey.
• Anticipated length of stay should be indicated early for elective admissions planning.
• Increased day surgery can be facilitated with pre-admission assessments with the aim of minimising transfers to inpatient beds.
• Discharge lounges can aid early discharges

Before Admission (cont.)

• Discharge planning should begin at the pre-admission visit for the patient with the aim of coordinating the patient's care during both admission and discharge.
• Patient information should be efficiently and quickly accessible to relevant providers.
• Pre-admission planning should be set in place to facilitate "day of surgery" admission if possible.
• Dedicated individuals such as Admissions Managers may be required to support pre-admission services.
• Strengthening referral pathways for primary care can enhance overall service provision.

Nursing Action

• Recognize and address a patient's anxiety through therapeutic communication.
• Account for the entirety of the patient's life, encompassing factors beyond their medical condition, such as family needs, financial status, and future prospects.
• Treat each patient as an individual, respecting their identity, values, and cultural/religious background.
• Involve the patient's family in the decision-making processes relating to their care

Nursing Action (cont.)

• During admission process, the nurse acts as an advocate concerned about the wellbeing of the patient and family.
• A thorough and detailed assessment of patient needs is necessary and should cover their biophysical, psychosocial, environmental, self-care, educational, and discharge planning factors.

Admission Process (cont.)

• Physician authorization for specialized care and treatment is required.
• Billing information is collected by the admitting department of the healthcare agency.
• Completing the agency's admission database by nursing personnel is needed.
• Proper documentation of the client's medical history, including physical examination findings.
• Developing an initial nursing care plan.
• Creation of initial medical orders and authorization for treatment.
• Initial nursing plan and medical admission responsibilities

Nursing Admission Activities (cont.)

• Preparing the client's room
• Welcoming the client
• Orienting the client
• Safeguarding valuables and clothing
• Assisting the client with undressing
• Completing and compiling the nursing database

Psychosocial Responses to Admission

• Anxiety and fear
• Decisional conflict
• Situational low self-esteem
• Powerlessness
• Social isolation
• Risk of ineffective therapeutic regimen management

Transfer

• Transferring a client from one healthcare unit/agency to another without the client leaving their temporary place of residence.
• Facilitating more specialized care during life-threatening situations.
• Reducing healthcare costs
• Providing less intensive nursing care

Steps Involved in Transfer

• Informing the patient and family
• Completing a transfer summary
• Coordinating the transfer with a nurse at the receiving unit
• Transport of the patient, belongings, medications, and clinical charts to the new unit

Discharge

• Discharge is the formal termination of care within a health agency setting.
• Effective discharge management is needed to ensure patient satisfaction, maintain bed availability for emergencies and elective admissions, and maintain quality patient care.
• Discharge planning should begin at admission with the aim of collecting and documenting all necessary patient information.
• Effective communication is needed among the patient, caregivers, and those responsible for the patient's care.
• Nurturing a collaborative approach to care ensures optimal patient transition post-discharge.

Discharge Planning (cont.)

• Patients and their caregivers should be active partners in the discharge planning process.
• Discharge planning processes should be continually updated and improved.
• Discharge lounges can be used to aid early bed capacity and availability.
• Bed management forums can identify and resolve issues concerning bed availability.
• Early involvement of pharmacy professionals to support medication compliance and adherence.

Principles of Effective Discharge Planning (cont.)

• Plan the patient's use of a hospital bed and their expected discharge processes prior to admission.
• Document the estimated date of discharge and communicate this information within 24 hours of admission to the respective personnels involved in the patient care.
• Develop streamlined discharge processes (e.g. prescriptions, letters, transport booking, and prompt release of test results).
• Establish multidisciplinary forums to discuss and resolve complex cases to expedite discharge processes.

Discharge Planning (cont.)

• Discharge planning is vital to ensure that patients return to the community with the appropriate support and care from healthcare personnels.
• The discharge process needs to be a coordinated and holistic approach, rather than a singular event .
• Including family members, caregivers, hospitals, community services, and social workers in a coordinated approach can facilitate patient transition to ensure overall wellbeing.
• Ensure regular monitoring of the discharge processes and the application of innovative solutions to enhance the system effectiveness and improve patient outcomes.

Steps in the Discharge Process

• Assess and identify health care needs
• Set goals with the patient
• Provide education on self-care at home before discharge
• Meets eligibility requirements for home health care
• Obtain and ensure appropriate medical orders are in place
• Complete discharge instructions
• Notify the relevant parties
• Assist client departure from the agency
• Record and summarise client’s condition to ensure continuity of care

Referral

• Referral is the act of sending someone to another person or agency for specific services.
• This can be directed to private practitioners or community agencies, or higher health service institutions.
• Proximity can be a factor for referrals

General Gerontological Considerations

• Older adults may minimize symptoms.
• Consider methods for reducing alterations during hospital transitions.
• Adequate time is necessary when admitting, discharging, or transferring older adults.
• Respect pets as an integral aspect of an older adult's social support system.
• Promote early discharge planning, ensuring access to appropriate community resources to aid the return of older adults to their homes

Barriers to Use of Community-Based Services

• Financial constraints or reluctance to spend
• Resistance to addressing the need
• Mistrust of service providers
• Lack of time, energy, or ability to find appropriate services

Transfer (cont.)

• Transfer means discharging a client from one unit of agency while admitting them to another without going home.
• Transfers are needed for specialized care during life-threatening situations.
• Transfers help reduce healthcare costs and provide less intensive nursing care.