What is the purpose of the hospital admission process. How does the admission procedure differ for routine and emergency cases. What are the key responsibilities of healthcare professionals during patient admission and discharge.

Understanding the Purpose and Types of Hospital Admissions

The hospital admission process serves several crucial purposes in healthcare delivery. It aims to prepare patients both physically and mentally for their hospital stay, ensure their comfort and safety, and create a positive impression of the healthcare facility. This initial interaction sets the tone for the patient’s entire hospital experience and can significantly impact their cooperation with treatment and nursing care.

There are primarily two types of hospital admissions:

• Routine Admission: Planned admissions for treatments, diagnostic tests, or recovery. Examples include patients with chronic conditions like diabetes, hypertension, or those requiring scheduled surgeries.
• Emergency Admission: Unplanned admissions for critical care monitoring, often following accidents, heart attacks, or poisoning incidents.

Understanding the distinction between these admission types is crucial for healthcare professionals, as it influences the urgency and nature of the care provided.

The Step-by-Step Hospital Admission Procedure

The hospital admission procedure involves several key steps that healthcare professionals, particularly nurses, must follow diligently:

1. Patient Assessment: Upon admission, a registered nurse performs a comprehensive assessment of the patient’s condition.
2. Documentation: The nurse records essential information such as the patient’s name, admission date and time, chief complaints, and medical diagnosis in the admission file.
3. Medical History Review: Any previous hospitalizations or major illnesses are noted and documented.
4. Vital Signs Measurement: The patient’s pulse, temperature, respiratory rate, height, and weight are recorded.
5. Valuables Documentation: Any valuables brought by the patient are documented and, if necessary, handed over to relatives for safekeeping.
6. Orientation: The patient and family members are oriented to the hospital unit, visiting areas, and informed about patient rights and responsibilities.

How does this procedure differ for emergency admissions? In emergency cases, the primary focus is on stabilizing the patient’s condition. The formal admission process may be expedited or completed retrospectively to ensure immediate medical attention.

Patient Rights and Responsibilities During Hospital Admission

During the admission process, it’s crucial to inform patients about their rights and responsibilities. This not only empowers patients but also promotes a collaborative approach to healthcare.

Key patient rights include:

• The right to receive respectful and non-discriminatory care
• The right to privacy and confidentiality
• The right to make informed decisions about their care
• The right to refuse treatment or leave against medical advice

Patient responsibilities typically include:

• Providing accurate and complete information about their health
• Following the treatment plan and hospital rules
• Showing respect to healthcare providers and other patients
• Fulfilling financial obligations related to their care

How can healthcare professionals effectively communicate these rights and responsibilities to patients? Clear, concise explanations and providing written materials can help ensure patients understand their role in the healthcare process.

The Role of Advance Directives in Hospital Admissions

Advance directives play a crucial role in the hospital admission process, particularly for patients with chronic or life-threatening conditions. These legal documents outline a patient’s wishes for medical care if they become unable to make decisions for themselves.

Types of advance directives include:

• Living Will: Specifies the types of medical treatments a patient does or does not want in specific situations.
• Healthcare Power of Attorney: Designates someone to make healthcare decisions on the patient’s behalf if they’re incapacitated.
• Do Not Resuscitate (DNR) Order: Instructs healthcare providers not to perform CPR if the patient’s heart or breathing stops.

During the admission process, healthcare professionals should inquire about existing advance directives and provide information on creating them if the patient hasn’t already done so. This ensures that the patient’s wishes are respected and helps guide medical decisions in critical situations.

Common Tests and Procedures During Hospital Admission

Upon admission, patients often undergo various tests and procedures to assess their condition and guide treatment plans. These may include:

• Blood tests: To check for infections, assess organ function, and measure blood cell counts.
• Urinalysis: To detect urinary tract infections, kidney problems, or diabetes.
• Chest X-ray: To examine the lungs, heart, and chest wall structures.
• Electrocardiogram (ECG): To evaluate heart rhythm and detect any cardiac abnormalities.
• CT scans or MRIs: For more detailed imaging of specific body areas, if necessary.

The specific tests ordered depend on the patient’s symptoms, medical history, and the reason for admission. Healthcare professionals should explain the purpose and process of each test to alleviate patient anxiety and ensure informed consent.

Managing Patient Transfers and Discharges

Patient transfers and discharges are integral parts of the hospital admission process. Transfers may occur within the hospital (e.g., from one department to another) or to a different healthcare facility. The procedure for internal transfers often mirrors the discharge and readmission process.

Types of discharges include:

• Routine discharge: When the patient has recovered and no longer needs hospital care.
• Discharge against medical advice (DAMA): When a patient chooses to leave before the recommended treatment is complete.
• Transfer to another facility: For specialized care or long-term recovery.

The discharge process involves several key steps:

1. Obtaining a written discharge order from the physician
2. Preparing discharge records and summaries
3. Providing the patient with necessary medications and follow-up instructions
4. Ensuring the patient’s personal hygiene and clothing are appropriate for leaving
5. Handing over discharge slips and any relevant documentation to the patient or their relatives

How can healthcare professionals ensure a smooth discharge process? Clear communication, thorough documentation, and proper patient education are essential for facilitating a successful transition from hospital to home or another care setting.

Legal and Ethical Considerations in Hospital Admissions

Hospital admissions involve various legal and ethical considerations that healthcare professionals must navigate carefully. These include:

• Informed Consent: Ensuring patients understand and agree to proposed treatments and procedures.
• Privacy and Confidentiality: Protecting patient information in accordance with HIPAA regulations.
• Capacity Assessment: Determining if a patient is mentally capable of making healthcare decisions.
• Ethical Decision-Making: Balancing patient autonomy with the duty to provide necessary care.

In cases where patients wish to leave against medical advice, healthcare providers must ensure that the patient understands the risks involved and signs the appropriate release forms. This protects both the patient’s right to make decisions about their care and the healthcare institution from legal liability.

How can healthcare professionals navigate these complex legal and ethical issues? Ongoing education, clear institutional policies, and consultation with ethics committees or legal advisors can provide guidance in challenging situations.

The Importance of Proper Documentation in Hospital Admissions

Accurate and comprehensive documentation is a critical aspect of the hospital admission process. It serves multiple purposes:

• Ensuring continuity of care by providing a clear record of the patient’s condition and treatment
• Facilitating communication between healthcare team members
• Supporting billing and insurance claims
• Providing legal protection for both patients and healthcare providers

Key elements of admission documentation include:

1. Patient identification information
2. Reason for admission and chief complaints
3. Medical history and current medications
4. Physical examination findings
5. Admission orders and initial treatment plan
6. Consent forms and advance directives

How can healthcare professionals improve their documentation practices? Implementing electronic health records (EHRs), using standardized templates, and regular audits can enhance the quality and consistency of admission documentation.

The Role of Interprofessional Collaboration in Hospital Admissions

Effective hospital admissions require seamless collaboration between various healthcare professionals. This interprofessional approach ensures comprehensive patient care and smooth transitions between different aspects of the admission process.

Key team members involved in hospital admissions may include:

• Admitting physicians
• Nurses
• Patient care technicians
• Social workers
• Pharmacists
• Dietitians
• Physical and occupational therapists

Each team member plays a unique role in the admission process, from initial assessment to care planning and implementation. Clear communication channels and defined responsibilities are essential for ensuring that all aspects of patient care are addressed during admission.

How can healthcare institutions foster effective interprofessional collaboration? Regular team meetings, shared electronic health records, and collaborative care planning sessions can enhance teamwork and improve patient outcomes during the admission process.

Addressing Cultural and Language Barriers in Hospital Admissions

In today’s diverse healthcare landscape, addressing cultural and language barriers is crucial for ensuring equitable and effective hospital admissions. Healthcare professionals must be prepared to provide culturally competent care and overcome language differences to ensure patients fully understand and participate in their care.

Strategies for addressing these barriers include:

• Providing interpreter services for non-English speaking patients
• Offering translated written materials for common procedures and patient rights information
• Training staff in cultural competence and sensitivity
• Accommodating religious or cultural practices when possible
• Involving family members or cultural liaisons in the admission process when appropriate

How can healthcare institutions assess and improve their cultural competence? Regular staff training, patient satisfaction surveys, and community outreach programs can help identify areas for improvement and enhance the admission experience for diverse patient populations.

The Impact of Technology on Hospital Admission Processes

Technological advancements have significantly transformed hospital admission processes, streamlining workflows and improving patient care. Key technological innovations include:

• Electronic Health Records (EHRs): Allowing for quick access to patient information and reducing paperwork
• Patient Portals: Enabling patients to access their health information and communicate with providers
• Automated Check-In Kiosks: Speeding up the registration process and reducing wait times
• Wearable Devices: Providing real-time patient data to inform admission decisions
• Artificial Intelligence: Assisting in triage and risk assessment during admissions

While these technologies offer numerous benefits, they also present challenges such as data security concerns and the need for staff training. How can healthcare institutions balance the benefits of technology with potential drawbacks? Implementing robust cybersecurity measures, providing comprehensive staff training, and regularly updating systems can help maximize the benefits of technology in the admission process while minimizing risks.

Preparing Patients for Hospital Admission: Pre-Admission Processes

Pre-admission processes play a crucial role in ensuring smooth hospital admissions, particularly for planned procedures or treatments. These processes help patients prepare for their hospital stay and allow healthcare providers to gather necessary information in advance.

Key elements of pre-admission processes include:

• Pre-admission testing: Conducting necessary lab work or imaging studies before admission
• Medication reconciliation: Reviewing and documenting current medications
• Insurance verification: Ensuring coverage and addressing financial concerns
• Patient education: Providing information about the upcoming procedure or treatment
• Advance directive discussions: Encouraging patients to consider and document their healthcare wishes

How can healthcare providers optimize pre-admission processes? Implementing online pre-registration systems, offering virtual pre-admission consultations, and providing comprehensive pre-admission information packets can enhance patient preparation and streamline the admission process.

Addressing Patient Anxiety During Hospital Admissions

Hospital admissions can be a source of significant anxiety for many patients. This anxiety can impact patient well-being, cooperation with care, and even treatment outcomes. Healthcare professionals play a crucial role in managing and mitigating patient anxiety during the admission process.

Strategies for addressing patient anxiety include:

• Clear communication about what to expect during the hospital stay
• Empathetic listening to patient concerns
• Providing reassurance and emotional support
• Offering relaxation techniques or referrals to support services
• Creating a welcoming and calming environment in admission areas
• Involving family members or support persons in the admission process when appropriate

How can healthcare professionals assess and address patient anxiety effectively? Incorporating anxiety screening tools into the admission process and providing staff training on anxiety management techniques can help identify and support patients experiencing admission-related anxiety.

Continuous Improvement in Hospital Admission Processes

The hospital admission process is not static; it requires continuous evaluation and improvement to ensure optimal patient care and operational efficiency. Healthcare institutions should implement quality improvement initiatives focused on enhancing the admission experience.

Key areas for continuous improvement include:

• Reducing wait times and streamlining registration procedures
• Enhancing communication between departments involved in admissions
• Improving the accuracy and completeness of admission documentation
• Increasing patient satisfaction with the admission process
• Optimizing resource allocation during peak admission times

How can healthcare institutions effectively implement and sustain improvement initiatives? Utilizing data analytics to identify bottlenecks, conducting regular staff and patient feedback surveys, and implementing Plan-Do-Study-Act (PDSA) cycles can drive continuous improvement in hospital admission processes.

Hospital Admission Procedure – Guide for Nurses

​
Purpose :

1. Prepare the patient both physically and mentally for his stay in the hospital.

2. To help the patient to be comfortable and to provide him with a clear and safe environment for preventing infection.

3. To give a good impression of the hospital and its service so that the patient will fully co-operate with the treatment and nursing care.

Routine Admission :

Admission of a patient is planned and gets admitted in the hospital on routine basis for treatment, diagnostic test and recovery. E.g. fever, fracture, diabetes, hypertension, bronchitis etc.

Transfer In (within the hospital) :

Referral to another department within the hospital.

1. when the patient has to be shifted from medical to surgical department, the patient is discharged and readmitted. The procedure is the same as for “discharging the patient” and “admitting the patient”.

2. The procedure of discharge and readmission is not usually necessary for the patient who is to be shifted from one medical or surgical ward to another.

 

Discharge :

It is the preparation of the patient and discharge records to leave the hospital.

Purpose :

1. To ensure continuity of care to the patient after discharge.

2. To assist the patient in discharge process.

Types of Discharge :

1. cured and discharged.

2. Discharged against medical advice (DAMA).

3. Discharged on request.

4. Absconded.

5. Transferred to other hospital.

6. Death.

Nursing Procedure :

1. No patient should be discharged without doctors written orders.

2. Handover the case sheet and other record to the medical record department.

3. See that the patient personnel hygiene is maintained and change the dress into their own clothing.

4. Inform the hospital authorities about the discharge.

5. Hand over the discharge slip to the patient or relatives.

Leaving Against Medical Advice :

A client can decide to leave the hospital against medical advice. For this client must sign a form that releases the physician and the health care institution from any legal responsibility for his/her health status. The client is informed of any possible risks before signing the form.
 

Abscond :

To leave quickly and secretly and hide oneself. Often to avoid arrest or legal prosecution.

Referrals :

The act of sending of a patient to another physician for ongoing management of a specific problem, with the expectation that the patient will continue seeing the original physician for co-ordination of total care.

COMPLETE NURSING PROCEDURE LINKS CLICK HERE 

Hospital Admission Procedure includes preparation of admitting patient, perform admission procedure, emergency admission, Routine admission, transfer in and discharge. Nurses need to follow strict protocol regarding admission and discharge in the hospital.

1. Preparation of Admitting Patient :

 Entrance of a patient into the ward or unit for evaluation or treatment is called admission.

2. Perform Admission Procedure :

A. At the time of admission, the registered nurse perform complete assessment of the patient.

B. Enter patient name, date and time of admission, chief complains, medical diagnosis in the admission file or patient file.

C. Document – the source of information (family, patient, care giver or health care person or significant person).

D. Check the document if patient has previous hospitalization and past major illness.

E. Indicate if the patient was admitted from emergency room, home, clinic and accompanied by whom.

F. Take patient vital signs (pulse, temperature, respiratory rate, height and weight).

G. Document if patient and family has valuables brought to the hospital. If yes, hand it over to the relatives with their signatures.

H. At the time of arrival to the unit or ward patient and family will be given orientation regarding the unit, visiting rooms, patients right and responsibilities.

Emergency Admission :

The patient is admitted on emergency basis for critical care monitoring. E.g. poisoning, heart attack, accidents etc.

It is unplanned.

Stabilize in emergency room (chest pain or accidents).

MORE NURSING PROCEDURE – NURSE PEDIA CLICK HERE

Hospital Admission Procedure – A Simple Guide for Nurses

The Admission Checklist: The key steps and responsibilities for the admitting resident

• Journal List
• Ann Med Surg (Lond)
• v. 75; 2022 Mar
• PMC8978045

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the contents by NLM or the National Institutes of Health.

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Ann Med Surg (Lond). 2022 Mar; 75: 103388.

Published online 2022 Feb 22. doi: 10.1016/j.amsu.2022.103388

Author information Article notes Copyright and License information Disclaimer

Data Availability Statement

The process of admitting patients from the emergency department to the general medicine floor is foundational to the medical training process and medical practice more generally. Yet this process is rife with potential error if not approached systematically, and residents rarely receive explicit teaching in this area. The creation of an “Admission Checklist” proposed by the authors could serve the function of reducing error and enhancing inter-provider communication throughout this process. Such a checklist could improve trainee experience and education, and ultimately allow for improved outcomes for patients during transitions of care.

Keywords: Admission, Quality improvement, Residency, Medical education

While recent quality improvement research has focused on optimizing the inpatient medical admission process, the role that residents play in this task remains unexamined, despite their central importance at academic medical centers [1]. The admitting resident’s role is rife for potential error given the heterogeneity of house staff experience, perceived barriers in seeking help from attending physicians, and contextual factors specific to the local institution and patient being admitted [1,2].

Given these challenges and the consequences of mismanaged admissions [3] it is curious that there is typically an absence of formal education on a systematic approach to the process of inpatient admission in residency [1]. Indeed, most explicit education for residents occurs in medical school, where students are taught the standardized process of taking a history and performing a physical exam, whereas the actual process of admitting a patient often falls under the domain of “experiential learning” in residency, fraught with possible knowledge gaps [4].

One approach to standardizing complex medical processes is that of “checklist” creation, which has found particular favor among the surgical subspecialties [5]. Checklists standardize complex processes and ultimately allow for both enhanced efficiency and improved outcomes if applied appropriately [6].

Given the complexity of the medical admission process and the lack of formal resident education in this area, creating an “admission checklist” could serve to both streamline this task for residents and improve patient safety, particularly during the first hours of the admission process where the heightened risk of medical errors tends to occur [1,3].

As with any systematic attempt to improve outcomes, one should begin by defining the purpose of the process in question [7]. While recent work has sought to explicitly clarify the goals of inpatient admission to improve patient outcomes [8], these efforts have examined the processes that occur after the patient has been admitted, rather than explicating the purpose of the admission process itself. Thus, it is crucial to explicitly clarify the main purpose of the resident physician in any admission, which we propose is to ensure a safe transition from the emergency department (ED) to the general medicine floor. This overarching purpose gives rise to three distinct responsibilities of the admitting resident which must be met for every admission:

• •

  To confirm that the general medicine floor is the appropriate disposition for the patient based on preliminary assessment of vital signs, laboratory and imaging findings, and putative admitting diagnosis.

• •

  To ensure that the patient has been appropriately resuscitated in the ED prior to transfer to the floor.

• •

  To ensure that any further resuscitative measures following admission from the ED are implemented once the patient arrives to the floor to prevent decompensation.

In light of this overarching purpose and the three corollary responsibilities, we propose the following process as a checklist to accomplish for every inpatient admission to achieve these goals ().

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The admission checklist.

3.1. Prepare for the admission

When the admitting resident receives the admission page, systematic preparation is crucial to prevent the mistakes that occur due to time pressure and heavy inpatient census numbers [2]. The resident, through chart review, should make an initial assessment of whether responsibilities one and two are accomplished prior to calling back the admission page, performed in an efficient manner to accord respect to the emergency provider for whom timely sign-out is an important consideration.

3.

2. Assess vital signs

There is no single piece of objective information that more directly informs patient disposition than vital signs. Review of vital signs serves as the initial lens through which the resident can perform her preliminary triage for admission appropriateness, as early floor-to-ICU transfer has been shown to result in longer hospitalizations and higher mortality rates [9].

This review should be comprehensive, assessing for temperature, heart rate, blood pressure, respiratory rate, and oxygen saturation. The resident should moreover note whether the patient is requiring support for maintenance of vital signs, including respiratory support or resuscitative fluids. In the course of this comprehensive review, if vital sign derangements raise concern for clinical conditions of shock or respiratory failure, the resident must seek clarity on disposition in her subsequent conversation with the admitting ED clinician [10].

Yet it is rare that patients with such vital signs are flagrantly mis-triaged; rather, it is the so-called “borderline” patients who are more challenging to triage appropriately [3]. In these instances, paying attention to vital sign trends and ensuring repeat vital signs are recorded in the EMR following initial resuscitation is integral.

3.3. Assess labs, imaging, and medication administration record

After initially assessing the vital signs, the admitting resident should next examine lab results in her chart review. The resident’s goal is now to ensure that there are no laboratory derangements or imaging findings that might preclude general medicine floor admission, as patients may also meet ICU indications for conditions that require frequent lab draws or closer nursing supervision, such as severe hyponatremia. It is also true that imaging that is pertinent to the admitting diagnosis can affect patient readiness for admission, such as a chest CT for a stable but hypoxic patient indicative of a pleural effusion requiring chest tube placement prior to admission.

In addition to determining whether laboratory or imaging findings warrant ICU admission, it is crucial for the resident to note any pending test which may change patient disposition when it returns or may warrant further primary resuscitative measures prior to admission. An example might be a patient who is being admitted for hypoxia of unclear etiology whose chest x-ray has yet to be performed.

Finally, to complete the “objective” assessment of the patient’s chart, the resident should examine the medication administration record to see the therapies that have been implemented. The purpose here is to determine whether the patient in the ED has in fact received appropriate resuscitation for their admission diagnosis, for example ensuring that patients whose labs and imaging are concerning for community-acquired pneumonia receive antimicrobials while in the ED [11].

3.4. Document problems

While the resident is assessing a patient’s vital signs, labs, imaging, and medication administration record, she should note any derangements and catalogue these as “problems” on her problem list. Early synthesis of the “problem list” promotes a systematic approach to the earliest stages of clinical reasoning, including dual process thinking, alignment with known illness scripts, problem categorization, and metacognition [12]. This exercise prevents her from committing anchoring bias which may arise by first reading the ED clinician’s assessment.

3.5. Read the emergency provider’s note

Once the resident has gathered all the above objective information, begun to formulate her problem list, and hypothesized the reason for admission based upon this data, her next task is to read the emergency provider’s note. This should be done to clarify the emergency provider’s assessment and to check this against her own interpretation of the objective data.

It is important to note that this process of assessing for findings which might preclude admission to the general medicine floor may lead to tension between ED clinicians and hospitalists, given the competing respective goals of expeditious disposition and putative diagnosis and initial management [13]. Yet the purpose of such a systematic approach is to make these potential areas of disagreement more objective, focused on specific vital sign, lab, or imaging findings rather than more subjective appraisals of a patient’s candidacy for floor admission.

4.1. Call back the admission page

After the resident has gathered the above objective information and created a preliminary problem list, she should prepare to call back the admission page. It is crucial that the resident view this communication with the emergency provider strategically, with particular goals in mind.

The resident’s first responsibility is to carefully attend to the emergency provider’s description of the patient’s presentation, particularly if there is no recorded note yet. After receiving signout, the resident should raise any concerns about findings from her preliminary chart review which might call into question the patient’s candidacy for floor admission. If there are no such concerns, any further questions should only be for the purpose of clarifying information relevant to pending studies or resuscitation. Throughout this process, the resident should not view the ED clinician as her antagonist, and should avoid asking any questions that are not directly pertinent to the overall goal of facilitating a safe transfer to the general medicine floor.

As noted above, there is potential for discord in the handoff process between the ED clinician and the admitting resident, due to the sometimes competing goals of emergency and floor clinicians [14]. This may take the form of so-called “triage discordance,” or a disagreement in the appropriate level of acuity for the patient being admitted, or in some cases, whether a patient should be admitted at all [15].

It is for this reason that the admitting resident should base her assessment on the appropriateness of the admission on objective information and ask questions relevant to this, rather than raising concerns that are not immediately relevant to the safe transfer of the patient from the ED to the general medicine floor.

5.1. Identify the “must not miss” problems

After the admitting resident has accepted the patient for admission and performed a thorough history and physical exam, her final task is to identify and address the most time-sensitive and dangerous medical problems. The task of admitting patients with multiple acute medical problems or comorbidities can prove quite challenging for admitting residents, particularly those with busy services and high inpatient censuses.

While the resident should be comprehensive in attempting to identify all present problems, her overriding task should be to identify the most relevant problem or problems that require time-sensitive intervention. These problems may involve presenting signs or symptoms or lab derangements, or may be existing problems for which home therapies must be continued. It is only through identifying these “must-not miss” problems that the resident can truly accomplish her overall goal of facilitating safe transition to the floor and stabilization.

One alternative way to frame this goal is for the admitting resident to ask herself, “Which problems, if missed, will result in this patient decompensating and requiring a higher level of care overnight?” Most residents likely learn this process of consolidating their diagnostic thinking amidst complicated patients and busy censuses implicitly, but it is important to explicitly identify this goal such that it always “checked off. ”

5.2. Seek help when help is needed

There is likely great variability between academic institutions with respect to when and how admissions are communicated to the attending physician, and residents must clarify institutional and individual attending preferences in this area. Regardless of attending preferences, however, it is crucial that residents feel empowered to reach out to others for help if problems or questions arise in the admission process. The virtue of humility and ability to ask for help is of crucial importance in today’s increasingly complex medical training environment, particularly for supervising residents new to this role.

As noted previously, the area of medical transitions, particularly inpatient admissions, has received newfound attention as a focus for quality improvement in hospital medicine, and is of specific importance to resident physicians with varying degrees of experience [1].

Given these challenges, the systematic “checklist” approach delineated above might serve as an important tool for clinician-educators or residents themselves while admitting patients to make explicit the goal of the admission process, as well as the corresponding responsibilities of the admitting clinician. In addition to enhancing both efficiency and patient safety, adoption of such a “checklist” approach might improve communication between ED clinicians and hospitalists and mitigate so-called “professional tension” [13] which often arises when disagreements regarding admissions surface. Finally, the implementation of this framework might serve the crucial role of allowing senior residents to more readily and systematically teach junior trainees and students a replicable and durable method to succeeding in a task that is as challenging as it is ubiquitous.

Not commissioned, externally peer reviewed.

The authors have no declarations to disclose.

The authors received no funding for development of this manuscript.

The authors have no conflicts of interest or competing interests to disclose.

Not applicable.

All authors made sufficient contributions to the concept design and writing of the original version and subsequent revisions to warrant inclusion as authors.

Not applicable.

Not applicable.

Not applicable.

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Articles from Annals of Medicine and Surgery are provided here courtesy of Wolters Kluwer Health

The order of hospitalization and discharge of the patient | Free medical assistance

IMPORTANT INFORMATION

1. Hospitalization in a hospital is carried out in the following forms:

• in the direction of planned hospitalization;
• for emergency indications in the direction of doctors of medical institutions and doctors of emergency medical care;
• in the order of transfer from other medical institutions;
• self-treatment of patients.

2. Planned hospitalization of patients at the expense of compulsory medical insurance is carried out upon presentation of an insurance policy of compulsory medical insurance.

3. For scheduled hospitalization, you must have the following documents with you:

• referral from a polyclinic doctor,
• birth certificate or passport (from 14 years old),
• medical insurance policy,
• passport of the legal representative (for patients under the age of 14).

4. Children admitted to hospital must have no contact with infectious patients within 21 days prior to admission.

5. Patients are admitted to the hospital:

• emergency hospitalization of patients – around the clock;
• scheduled patients since 09:00 to 16:00, except Saturday, Sunday.

Hospitalization of children under 3 years of age is carried out with one of the parents, over 4 years of age, the issue of hospitalization with a legal representative is decided depending on medical indications.

6. Scheduled hospitalization is carried out in agreement with the heads of departments.

7. In case of hospitalization of a patient in a hospital, the doctor of the admission department is obliged to find out information about the epidemic environment, to issue an informed voluntary consent of the patient for treatment and examination in a hospital in accordance with the requirements of current legislation.

8. Upon admission to hospital, an inpatient medical card is issued.

9. The issue of the need for sanitization is decided by the doctor on duty.

Sanitary treatment of the patient in accordance with the established procedure is carried out by junior or middle medical staff of the hospital admission department.
When a patient is hospitalized, the duty staff of the admission department is obliged to show sensitivity and attention to him, carry out transportation taking into account the severity of his state of health and accompany the patient to the appropriate departments with a personal transfer to the nurse on duty. Nursing staff is obliged to familiarize the patient and / or his parents with the internal regulations for hospital patients against signature, pay special attention to the prohibition of smoking and drinking alcohol in the hospital and on its territory.

10. If the patient refuses to be hospitalized, the doctor on duty provides the patient with emergency medical care and makes a record of the patient’s condition, the reasons for refusing hospitalization and the measures taken in the register of admissions and refusals of hospitalization.

11. Discharge is made daily, except weekends and holidays, by the attending physician in agreement with the head of the department. Hospital discharge permitted:

• upon improvement, when, for health reasons, the patient can continue treatment in an outpatient clinic or at home without harm to health;
• if it is necessary to transfer the patient to another healthcare facility;
• at the written request of the parents or other legal representative of the patient, if the extract does not threaten the life and health of the patient and is not dangerous to others.

Discharge documentation is issued to the patient on the day of discharge from the hospital.

12. After the patient is discharged from the hospital, the medical record of the inpatient is drawn up and deposited in the archive of the hospital.

13 . If it is necessary to obtain a certificate of stay (terms of stay) on inpatient treatment, extracts (copies) from medical documents and other documents, you must contact the head of the department in which the patient was treated on the set days and hours of admission. In this case, the patient must submit an application in writing in advance, and after a week from the date of application, the patient can receive the requested document.

14. In case of delivery to a healthcare organization of patients (injured) in an unconscious state without identity documents (birth certificates, passports), or other information that allows identifying the patient, as well as in the event of their death, medical workers are required to inform law enforcement authorities at the location of the hospital.

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LIST of examinations at the prehospital stage when referring to planned hospitalization
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Hospitalization rules

7. Rules for hospitalization of patients.

7.1. Planned hospitalization of patients is carried out in the admissions department of the medical and diagnostic unit of the Institution at 8:00.

7.1.1. On the day of hospitalization, directly in the admissions office of the institute, applicants are tested in accordance with paragraph 1 of Appendix No. 1 Analyzes and documents for hospitalization

7.1.2. Adult patients before surgery under endotracheal anesthesia with a history of pathology of the broncho-pulmonary system or suspicion of it, a CT examination of the lungs is performed at the Institute. (Order of the Ministry of Health of the Russian Federation dated March 19, 2020 No. 198n)

7.2. Preoperative preparation is carried out in a medical organization at the place of residence and should include a list of necessary tests, the conclusion of a therapist, certified by the seal of the clinic, Appendix No. 1 Analyzes and documents for hospitalization. If the patient is registered with a dispensary or has a concomitant pathology, a conclusion of the relevant specialist is required.

7.3. During hospitalization, all patients should be examined by the internist (pediatrician) of the Institution, and those in need of anesthetic assistance – by an anesthesiologist. Saturation is measured with a pulse oximeter, non-contact thermometry. If, according to the conclusion of the therapist or anesthesiologist of the Institution, it became necessary to clarify the data or there are contraindications for surgery, the patient undergoes the necessary additional examination and treatment at the clinic at the place of residence or, at the request of the patient, on a paid basis, the consultative and diagnostic department of the Institute.

7.4. The nurse of the admission department draws up the passport part of the medical history and enters the necessary data on the source of funding. Body temperature is also measured here and an examination is made for pediculosis, the condition of the skin, etc.

7.5. The doctor of the admission department examines the patient and fills out the examination form.

7.6. After receiving negative test results for a new coronavirus infection, patients with a medical history registered for hospitalization are taken to the department where they are registered by the head nurse in the admission register separately for budget and self-supporting patients. Patients admitted to the department are examined by the attending physician and the head of the department. The case histories of the admitted patients the next day in the morning are endorsed by the deputy. director of clinical work, are transferred by the doctor on duty after the transfer of duty to the appropriate medical unit.

7.7. The day nurse is obliged, against receipt, to familiarize the patient with the internal regulations of the medical unit of the Institution (Appendix No. 2).
Appendix No. 2 Internal regulations

7.8. Upon admission to the hospital of the Institution, the patient must:

• to have a change of footwear, bathrobe, tracksuit, pajamas, personal hygiene items;
• take a hygienic shower;
• male patients are required to shave their face upon admission to surgery, preferably a short haircut.

7.9. Patients’ clothing is stored in the departments in specially designated cabinets.

7.10. In the medical departments of the institution it is strictly prohibited:

• smoke, drink alcohol, take drugs;
• to leave the department independently without the permission of the attending physician and the head of the department. In connection with the prevention of the spread of a new coronavirus infection, all visits to patients in the hospital are prohibited. In the departments of the institute, it is necessary to observe the mask regime.
• It is strictly forbidden to order and carry (including delivery) food from catering establishments, in case of violation, all financial costs are at the expense of the patient.

7.11. The institution is not responsible for personal belongings left unattended. At the request of the patient, expensive items are handed over to the head nurse of the department, about which an inventory of the items handed over is compiled.

7.12. Violations by the patient of the rules of hospitalization and the daily routine are recorded by the attending physician and medical staff in the medical history and the Institution reserves the right to refuse hospitalization or discharge the patient in the prescribed manner with a note on the sick leave “for violation of the hospital regime”.