Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Admission, Discharge, Transfer, and Referrals

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Admission, Discharge, Transfer, and Referrals Admission, Discharge,

Transfer, and Referrals


• Entering a health care agency for nursing care and medical or surgical treatment

Admission Admission


• Admission involves:

– Authorization from a physician that the person requires specialized care and treatment

– Collection of billing information by the admitting department of the health care agency

Admission Process Admission Process


• Completion of the agency’s admission data base 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

Admission Process (cont’d) Admission Process (cont’d)


QuestionQuestion

•Is the following statement true or false?

The first step of admission is the collection of billing information by the admitting department of the health care agency.


AnswerAnswer

False.

The first step of admission is the authorization from a physician that the person requires specialized care and treatment.


Admission Process (cont’d)Admission Process (cont’d)

• Medical authorization

• The admitting department

– Preliminary data collected

– Addressograph plate


Admission Process (cont’d)Admission Process (cont’d)

• Initial nursing plan for care

• Medical admission responsibilities


Nursing Admission ActivitiesNursing Admission Activities

• Preparing the client’s room

• Welcoming the client

• Orienting the client

• Safeguarding valuables and clothing

• Helping the client undress

• Compiling the nursing data base


Psychosocial Responses on AdmissionPsychosocial Responses on Admission

• Anxiety and fear

• Decisional conflict

• Situational low self-esteem

• Powerlessness

• Social isolation

• Risk for ineffective therapeutic regimen management


Types of AdmissionsTypes of Admissions


The Discharge ProcessThe Discharge Process

• Discharge is the termination of care from a health care agency

• Discharge planning

• Special considerations related to discharge planning


Steps in the Discharge ProcessSteps 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


Discharge ProcessDischarge Process

(Refer to Skill 11-2 in the textbook).


The Transfer ProcessThe Transfer Process

• Transfer: discharging a client from one unit or agency; admitting him or her to another without going home in the interim

• 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


Steps Involved in TransferSteps 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


Advantages of TransferAdvantages of Transfer


QuestionQuestion


Transfer involves discharging a client from one unit or agency and allowing him to go home.


AnswerAnswer

False.

Transfer involves discharging a client from one unit or agency and admitting him or her to another without going home in the interim.


Extended Care Facilities Extended Care Facilities

• Skilled nursing facilities

• Intermediate care facilities

• Basic care facilities


Determining the Level of Care Determining the Level of Care

• Minimum data set (MDS)

– Standard form developed by the Health Care Financing Association

– MDS is repeated every 3 months or whenever a client’s condition changes

– Problems identified on the MDS are then reflected in the nursing care plan


Determining the Level of Care (cont’d)Determining the Level of Care (cont’d)

• Minimum data set factors

– Cognitive patterns, communication/ hearing patterns, vision patterns

– Physical functioning and structural problems

– Continence patterns in the last 14 days

– Psychosocial well-being


Determining the Level of Care (cont’d)Determining the Level of Care (cont’d)

• Minimum data set factors (cont’d)

– Mood and behavior patterns, activity pursuit patterns, disease diagnoses

– Health conditions, oral/nutritional/dental status, skin condition

– Medication use

– Special treatments and procedures


QuestionQuestion

•What is the appropriate action for the nurse to take with a client’s valuables?

a. Hand them over to the supervisor

b. Ask the client to keep them with himself or herself

c. Hand them over to the admitting department

d. Place them in the hospital’s safe temporarily


AnswerAnswer

d. Place them in the hospital’s safe temporarily

The nurse should place the client’s valuables in the hospital’s safe temporarily. Losing a client’s personal items can have serious legal implications for both the nurse and health care agency; therefore the nurse should not hand them over to the supervisor, ask the client to keep them himself, or hand them over to the admitting department.


The Referral ProcessThe 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


Community Services Where Referrals Are Made

Community Services Where Referrals Are Made


QuestionQuestion


Skilled nursing facility provides 24-hour nursing care under the direction of a registered nurse.


AnswerAnswer

True.

Skilled nursing facility provides 24-hour nursing care under the direction of a registered nurse.


Home Health CareHome 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


Home Health Care (cont’d)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


Responsibilities Assumed by Home Health Nurses

Responsibilities Assumed by Home Health Nurses


QuestionQuestion


Home care nursing services help shorten the time spent recovering in the hospital.


AnswerAnswer

True.

Home care nursing services help shorten the time spent recovering in the hospital.


General Gerontologic Considerations General Gerontologic Considerations

• Older adults may minimize their symptoms

• Consider methods to facilitate/minimize alterations: planning a transfer to an institutional setting

• Allow additional time when admitting, discharging, or transferring older adults

• Pets are an integral social support system


General Gerontologic Considerations (cont’d)


• Early discharge planning and appropriate community resources may return older adults to their own homes




• Barriers to use of community-based services:

– Lack of finances or reluctance to spend for service payment

– Unwillingness to admit need; mistrust of service providers

– Lack of time, energy, or ability to find appropriate services

Documents

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Admission, Discharge, Transfer, and Referrals