Hospital Admission and Discharge: Everything You Need to Know

Overview of Admission & Discharge

Hospital admission refers to the process of being formally admitted to a hospital for medical care. When an individual’s medical condition requires treatment that cannot be provided on an outpatient basis or at home, they may need to be admitted to a hospital. Admission involves the patient staying in the hospital unit or ward for observation, examination, investigation, and treatment of their illness or injury. This process typically involves completing paperwork, undergoing medical tests and assessments, and meeting with medical staff to determine the appropriate course of treatment. Depending on the severity and nature of the medical condition, the admission may be voluntary or involuntary. During hospital admission, patients are assigned to specific departments or wards based on their medical needs, such as medical/surgical units, intensive care units (ICU), or specialty units. The goal of hospital admission is to provide patients with the necessary medical care and support to address their health concerns and facilitate their recovery.

THINGS TO BRING TO THE HOSPITAL

1. Identification: Bring a form of identification, such as a driver’s license, ID card, or passport, to verify your identity during the admission process.
2. Emergency Contact Information: Provide the names and contact information of emergency contacts who can be reached in case of urgent situations or important decisions.
3. List of Allergies: Make a list of any known allergies to medications, foods, or environmental factors to inform healthcare providers and prevent potential allergic reactions.
4. Medication List: Compile a list of all medications you currently take, including prescription drugs, over-the-counter medications, vitamins, and supplements. Include the dosage and frequency of each medication.
5. Medical History: Write down any relevant medical history, including past surgeries, chronic conditions, and significant health events. This information helps healthcare providers understand your medical background and tailor treatment accordingly.
6. Primary Care Provider Information: Provide the name and contact information of your primary care provider (PCP) or any specialists involved in your care.
7. Insurance Information: Bring your insurance card and any relevant insurance information, such as policy numbers and contact details for insurance providers.
8. Advance Directives: If you have completed advance directives, such as a living will or healthcare power of attorney, bring copies to ensure your healthcare preferences are respected during your hospital stay.
9. Personal Comfort Items: Pack personal items to enhance comfort during your hospital stay, such as comfortable clothing, slippers, toiletries, eyeglasses or contact lenses, and personal hygiene items.
10. Entertainment: Bring items for entertainment and relaxation, such as books, magazines, electronic devices, headphones, or puzzles, to pass the time during recovery.
11. Important Documents: Carry any relevant documents, such as medical records, imaging reports, or referral letters, that may assist healthcare providers in understanding your medical history and current condition.
12. Financial Information: Bring any necessary financial information, such as payment methods or assistance program documentation, to facilitate billing and financial arrangements during your hospital stay.

Leave all valuables at home

REASONS WHY ONE CAN BE ADMITTED

There are various reasons why an individual may be admitted to a hospital for medical care. Some common reasons include:

1. Serious Health Conditions: Hospital admission may be necessary for individuals with serious or life-threatening health conditions that require immediate medical attention, monitoring, or treatment. Examples include heart attacks, strokes, severe infections, or acute respiratory distress.
2. Surgery: Admission to the hospital is often required for surgical procedures that cannot be performed on an outpatient basis. This may include elective surgeries, such as joint replacements or cosmetic procedures, as well as emergency surgeries to address acute medical conditions or injuries.
3. Medical Observation or Monitoring: In some cases, individuals may be admitted to the hospital for observation or monitoring of their health condition. This could be necessary to assess the progression of a disease, evaluate the effectiveness of treatment, or identify any complications that may arise.
4. Adjustment to Medical Conditions: Hospital admission may be recommended for individuals who need assistance in adjusting to a new medical condition or managing symptoms. This could include patients with newly diagnosed chronic illnesses, individuals undergoing rehabilitation after a medical event, or those requiring specialized care for complex medical needs.
5. Complications or Worsening Health Conditions: If a patient’s health condition deteriorates or complications arise, hospital admission may be necessary for more intensive medical care and management. This could occur in individuals with chronic illnesses experiencing disease exacerbations or in patients with acute illnesses experiencing complications.
6. Abnormal Diagnostic Tests or Physical Exams: Hospital admission may be warranted if diagnostic tests or physical exams reveal abnormal findings that require further evaluation, treatment, or monitoring. This could include abnormal laboratory test results, imaging findings suggestive of serious conditions, or physical exam findings indicating acute medical problems.
7. Deranged Vital Signs: Significant abnormalities in vital signs, such as high fever, low blood pressure, rapid heart rate, or altered mental status, may necessitate hospital admission for further assessment and treatment. These abnormalities could indicate serious underlying health conditions requiring immediate medical attention.
8. Prognosis and End-of-Life Care: In cases where a patient’s prognosis is poor or end-of-life care is needed, hospital admission may be necessary to provide palliative care, symptom management, or support for the patient and their family during this difficult time.

STEPS TO THE ADMISSION PROCESS

Here’s an overview of the steps involved in the hospital admission process:

1. Registration and Paperwork: Upon arrival at the hospital, patients or their accompanying individuals will be directed to the registration area. Here, they will need to complete various forms and paperwork, including personal information, insurance details, medical history, and consent forms.
2. Medical Assessment: Once the initial paperwork is completed, patients will undergo a medical assessment by a healthcare professional, such as a nurse or physician. This assessment may include taking vital signs, reviewing medical history, performing a physical examination, and assessing the patient’s current health status.
3. Diagnostic Tests: Depending on the reason for admission and the patient’s medical condition, diagnostic tests may be ordered to further evaluate the patient’s health. These tests may include blood tests, imaging studies (such as X-rays or CT scans), electrocardiograms (ECGs), or other specialized tests.
4. Treatment Planning: Based on the medical assessment and diagnostic test results, healthcare providers will develop a treatment plan tailored to the patient’s needs. This may involve medication administration, surgical interventions, therapeutic procedures, or other medical interventions.
5. Consultations and Specialist Referrals: If necessary, patients may be referred to specialists or consulting physicians for additional evaluation or treatment. This could involve consultations with specialists in areas such as cardiology, neurology, surgery, or oncology, depending on the patient’s condition.
6. Assigning a Hospital Room: Once the initial assessment and treatment planning are completed, patients will be assigned to a hospital room or bed in the appropriate unit or ward. Factors considered in room assignment may include the patient’s medical condition, required level of care, and availability of beds in the hospital.
7. Admission Orders: After room assignment, the attending physician will issue admission orders outlining the patient’s care plan, including medication orders, dietary restrictions, activity limitations, and other relevant instructions. These orders are communicated to the nursing staff responsible for the patient’s care.
8. Patient Education: Throughout the admission process, patients and their families will receive education and information about the patient’s condition, treatment plan, medications, potential side effects, and self-care instructions. This education helps empower patients to participate in their care and make informed decisions.
9. Finalizing Admission: Once all necessary assessments, tests, and treatment plans are in place, the admission process is finalized, and patients officially become admitted to the hospital. At this point, they are under the care of the hospital staff and will receive ongoing monitoring and treatment as needed.

These steps may vary slightly depending on the hospital’s policies and procedures, as well as the specific needs of the patient. However, the overall goal of the admission process is to ensure that patients receive timely and appropriate care to address their medical needs.

TYPES OF ADMISSION

Voluntary admission occurs when someone willingly chooses to undergo medical treatment for a period of time, and can leave at any time they desire

Involuntary admission occurs when someone being facilitated in a medical institution against their wishes, and is unable to leave until the medical team is satisfied that the person’s condition has improved

REFUSAL TO BE ADMITTED

Refusal to be admitted to a hospital is a legal concept that pertains to situations where an individual voluntarily declines admission to a healthcare facility, despite the recommendation or necessity for medical treatment. This refusal can occur for various reasons, including personal beliefs, concerns about medical interventions, or a desire to pursue alternative forms of care. However, there are important considerations and implications associated with refusing hospital admission:

1. Informed Decision: Individuals have the right to make informed decisions about their medical care, including whether to accept or refuse recommended treatments or hospital admission. Healthcare providers should ensure that patients understand the risks, benefits, and alternatives of refusing admission.
2. Capacity to Consent: Healthcare providers must assess the patient’s capacity to make decisions regarding their medical care. Capacity refers to the individual’s ability to understand relevant information, appreciate the consequences of their decision, and communicate their choice. Patients who lack capacity may require a surrogate decision-maker, such as a legal guardian or healthcare proxy, to make decisions on their behalf.
3. Risk Assessment: Healthcare providers must assess the potential risks associated with the patient’s refusal of admission. This includes evaluating the severity of the medical condition, the likelihood of deterioration or complications without treatment, and the availability of alternative care options.
4. Documentation and Communication: It is essential for healthcare providers to thoroughly document the patient’s refusal of admission, including the reasons for refusal, discussions with the patient or surrogate decision-maker, and any recommendations provided. Clear communication between the healthcare team, the patient, and their family members is crucial to ensure that everyone understands the implications of the decision.
5. Patient Safety and Well-being: While patients have the right to refuse admission, healthcare providers have a duty to prioritize patient safety and well-being. If there are concerns about the patient’s safety or ability to care for themselves outside of the hospital setting, healthcare providers may need to explore alternative interventions, such as outpatient treatment, home health services, or involuntary admission under certain circumstances.

6. Legal Implications: Healthcare providers must be aware of the legal implications of refusal to be admitted, particularly if the patient’s decision could result in harm or adverse outcomes. In some cases, healthcare providers may need to involve legal authorities, such as guardianship or mental health professionals, to ensure the patient’s safety and access to necessary care.

Before deciding not to be admitted, it is important that one receives enough information to make a sound decision, for example

Reason for being admitted

Treatment to be given for the condition

Advantages and disadvantages of being admitted compared to going home

DISCHARGE AGAINST MEDICAL ADVICE

When a patient chooses to leave the hospital or medical facility against medical advice or without authorization, it is known as a “discharge against medical advice” (DAMA). This typically occurs when the patient refuses to adhere to the doctor’s recommended course of treatment or when they feel they have received enough care and they would be better served leaving the hospital. In either case, a patient who chooses to be discharged against medical advice may be putting their health and well-being at risk, as the treatments prescribed by the doctor may not be completed. It is important for healthcare providers and patients to work together to ensure that any potential risks are discussed and managed appropriately.

If someone refuses to be admitted:

· A ‘discharge against medical advice-(DAMA)’ or ‘patient self-discharge’ form will have to be signed by the patient or guardian

· The form will be attached to the patient’s medical record

· The health care institution and team will be relieved of any liability or responsibility, should the patient’s condition complicate

· The insurance company may not cover the costs for the visit

· Can return to the institution at any time for admission, however may be required to retake all the diagnostic testing (to determine whether the condition worsened)

· Prescription and relevant information on self-care and danger signs regarding the condition will be clearly provided before the person leaves

Making a wrong decision can put one at risk of complications such as disability, worsening health condition or death

Be sure to ask the doctor for the best advice to care for the problem

ADVANCE DIRECTIVES WITHIN A HOSPITAL

When it comes to making decisions about healthcare, it is important to be proactive and make sure that your wishes are known. Advanced Directives are an important tool to ensuring that your wishes are respected and honored within a hospital setting. Advanced Directives are documents that outline the type of medical care you would like to receive in the event of an illness or injury. These documents can include instructions for end-of-life care, organ donation, and other important healthcare decisions. By having an Advanced Directive in place, you can ensure that your wishes will be respected and followed, even in a hospital setting.

If one is unable to express his wishes, the relatives are responsible for making decisions about his/her medical care

Living will: a statement, written by the patient, to specify the person’s desires regarding the medical care, if they turn out to be incapacitated with a severe illness

Medical power of attorney (health care proxy): a legal document which allows a person, appointed by the patient, to make decisions regarding the medical care if he/she becomes unable to make decisions them self

Do not resuscitate (DNR): a legal document which allows the patient to decide the procedures which one does not want when they become severely ill

CONTENTS OF THE DNR

The contents of a DNR order may vary depending on jurisdiction and healthcare facility policies, but typically include:

1. Cardiopulmonary Resuscitation (CPR): The DNR order specifies that CPR should not be performed in the event of cardiac arrest. This includes chest compressions, rescue breathing (ventilation), and defibrillation (shock therapy) to restore heart rhythm.
2. Mechanical Ventilation: The DNR order may indicate that mechanical ventilation or intubation should not be initiated or continued if the patient stops breathing or experiences respiratory failure.
3. Other Life-Sustaining Measures: The DNR order may extend to other life-sustaining interventions, such as artificial nutrition and hydration, dialysis, or invasive medical procedures that are unlikely to provide significant benefit to the patient.
4. Clarification of Intent: The DNR order should clarify the patient’s intent regarding end-of-life care and resuscitation preferences. This may include statements expressing the patient’s desire for comfort-focused care or avoidance of aggressive interventions.
5. Scope and Limitations: The DNR order may specify any limitations or exceptions to the directive. For example, the patient may indicate preferences for certain types of medical interventions or treatments that they do or do not want to receive.
6. Signature and Date: The DNR order must be signed and dated by the patient or their authorized representative (such as a healthcare proxy or legal guardian) to indicate their informed consent and understanding of the directive.
7. Physician’s Order: A DNR order must be issued by a licensed healthcare provider, typically a physician, nurse practitioner, or other qualified clinician authorized to make medical decisions on behalf of the patient.
8. Documentation and Communication: The DNR order should be documented in the patient’s medical record and communicated to all members of the healthcare team involved in the patient’s care, including emergency medical services (EMS) personnel, nursing staff, and other providers.
9. Review and Reevaluation: The DNR order should be reviewed periodically to ensure that it accurately reflects the patient’s current preferences and medical condition. Patients or their representatives may request changes to the DNR order based on evolving healthcare needs or goals of care.

10. Patient and Family Education: Healthcare providers should provide education and counseling to patients and their families regarding the implications of the DNR order, including the expected course of action in the event of a medical emergency and alternatives to resuscitative measures.

HOSPITAL SERVICES

Meals based on the diets off each person based on their medical condition such as: kidney failure patients are given low sodium, low potassium, and low protein diets

Visiting hours which vary according to the institution: Restrictions may be placed to protect visitors or patients such as on children, the use of gowns or face masks while visiting

Family members may be allowed to stay overnight in a patient’s room such as parents of admitted children

Medications: oral, IV, intra-muscular, rectally

Television for entertainment purposes

Telephone service to get in touch with relatives

Free wireless internet services (WIFI)

PROCEDURES THAT MAY BE PERFORMED AT A HOSPITAL

Blood work: blood specimen withdrawn from a vein or artery located in the forearm, wrist or thigh

X-rays: Provides a 2-dimensional picture of a body part, to identify fractures, infections or fluid

CT scan: A machine that takes a 360-degree continuous images of a body segment, such as the head, chest, or abdomen

MRI: A machine is used to take a comprehensive image of the internal portion of a body segment

Electrocardiogram (ECG): Used to measure the electrical activity of the heart

Ultrasound: A scan of the internal body parts

Biopsy: A sample of an organ is taken to determine disease status or diagnosis

Intravenous: Placing a catheter in a vein (usually in the arm) to start fluid replacement or administer drugs or blood products

Urinary catheterization: Insertion of a tube or catheter into the bladder to help empty the bladder

Non-Stress Test (NST): A test done for pregnant women to assess the baby’s heartbeat and contractions

Questions to ask the doctor regarding test results

· What do the abnormal test results mean

· The name of the disease

· The long term and short-term effects of the disease

· The treatment plan for the disease

· The effectiveness of the treatment

· The possible side effects to the treatment

· Cost of the treatment

· Alternative treatments

· The length of the treatment

INFORMED CONSENT

This is an important document that outlines the agreement between you and us regarding the use of your personal data. We take your privacy seriously, and your informed consent is essential for us to process your data. By signing this document, you are confirming that you understand the conditions for the use of your personal data, and that you agree to those conditions. We thank you for your cooperation and trust.

An informed consent document provides a patient with all the information regarding the type of procedure, benefits, risks and alternative methods that one needs to decide whether a procedure should be performed on the patient

Thereafter the patient agrees for the procedure without being subjected to any pressure or threat

What one should do before signing a consent document

· Read the informed consent documents carefully

· Request for explanation of confusing information

A patient is obligated to know

· If they have been enrolled in research

· What will be done with any bodily tissue fluids

· What will be done with any photos or video taken

· The name of the test or procedure

· The reason for having the test or procedure

· The results to expect and the meaning of the results

· The advantages and disadvantages of the test or procedure

· What the possible side effects or complications are

· When and where you are to have the test or procedure

· The qualifications of the person conducting the procedure

· The consequence of not having the test or procedure

· Any another tests or procedures to consider

· How the results will be made available

· The name and contact information of a person to call with questions or problems

· The cost of the test or procedure

DISCHARGE FROM HOSPITAL

After a stay in the hospital, the discharge process can be intimidating and difficult to navigate. Fortunately, there are steps that can be taken to ensure a smooth and successful transition from the hospital to home. This guide will provide an overview of the discharge process and offer helpful tips to make the experience as stress-free as possible.

A hospital will discharge someone when they:

Are fully healed, recovered after treatment is received, or no longer needs to receive inpatient care

The discharge process commences when the admitting consultant announces the discharge and marks it on the patient file

The nursing counter will initiate the discharge process by informing the billing and the pharmacy about the impending discharge

The pharmacy and the nursing department will bill all the pending services and consumables by checking the patient file at the time of the discharge

The unused medication will be packaged and handed to the patient upon discharge

Any unused medications which will not be used post discharge will be returned to the pharmacy and the amount reduced from the patient bill

The nurse will carry out a final assessment of the patient

Once the final bill is prepared and any pending payment is done then clearance for discharge is given by the billing department

The nurse would then handover the discharge summary and explain the medications and any other post discharge instructions

What happens during hospital discharge?

During the discharge process, members of the healthcare team will educate the patient and relatives on

The health condition

The follow-up care needed, such as physical therapy

The medications -uses, side effects and how to take them

The proper disposal of unwanted medication

The medical equipment needed, such as crutches- how to use and where to purchase them

Instructions on food and drink, exercise, and activities to avoid

What to expect at the new facility, if you’re not going home

Phone numbers to call with questions

Date for follow-up appointments, or how to make appointments

Answers to questions and concerns

Disclaimer: The information provided in this content is for general informational purposes only. It is not intended as medical or healthcare advice, diagnosis, or treatment. Always seek the advice of a qualified healthcare professional with any questions you may have regarding a medical condition or healthcare decisions.

Admission Discharge Admission Discharge Admission Discharge Admission Discharge Admission Discharge Admission Discharge