Transcript ادارة الخدمات الصحية HEALTH SERVICES MANAGMENT

Chapter 11
Admission, Discharge, Transfer,
and Referrals
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Admission
 Entering a hospital for nursing care and medical or
surgical treatment
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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
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Nursing Admission Activities
1.
2.
3.
4.
5.
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
6. Compiling the nursing data base
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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.
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Types of Admissions
Type
Explanation
Example
1. In patient
Length of stay generally
more than 24 hours
Acute appendicitis,
acute pneumonia.
a) Planned (non urgent)
Is scheduled in advance
Elective surgery
b) Emergency
admission
Unplanned, stabilized in
Unrelieved abdominal
emergency department and
or chest pain
transferred to nursing care unit
c)
Unplanned, emergency
department bypassed
Direct admission
Acute condition as
prolonged vomiting and
diarrhea
2. Out patient
length 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
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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
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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
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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
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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
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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
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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
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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
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