This chapter discusses hospital admission and discharge procedures. It defines admission as allowing a patient to stay in the hospital for treatment. The main purposes of admission are observation, immediate care, investigation, treatment and meeting patient needs. Types of admission include diagnostic, therapeutic, short-term and long-term admissions. The nurse's roles in admission include preparing the unit, receiving the patient, performing assessments, coordinating care, and orienting the patient. Discharge planning involves discussing care after discharge with the patient. Types of discharge include planned discharge and discharge against medical advice. The nurse's roles in discharge include reviewing orders, educating patients, and preparing the unit for the next patient.

1. CHAPTER 4
Hospital Admission and
Discharge

2. Learning
Objectives
❑ Define admission
❑ Enlist the purposes of
admission and types of
admission
❑ Enlist the steps of health
assessment
❑ Explain the procedure of
admission
❑ Describe the role of nurse in
admission process
❑ Define discharge and explain
the type of discharge
❑ Describe the procedure of
discharge and role of nurse
in discharge

3. CHAPTER
OUTLINE
❑ Admission to the
Hospital
Definition, Purpose,
Types of Admission
Unit and Its
Preparation
Special Considerations
Admission Procedure
Medico-Legal Issues
Roles and
Responsibilities of The
Nurse
❑ Discharge from the
Hospital
Purposes
Types: Planned
Discharge, LAMA and
Abscond,
Referrals and Transfers
Discharge Planning
Discharge Procedure
Special Considerations
Medico—Legal Issues
Roles And
Responsibilities of The
Nurse
Care of The Unit After
Discharge

4. MEANING OF ADMISSION
Admission of a patient means allowing
and facilitating a patient to stay in the
hospital unit or ward for observation,
investigation and treatment of the
disease he/she is suffering from.

5. DEFINITIONS
OF HOSPITAL
ADMISSION
•Hospitalization is admission to the
hospital as a patient.
•Admission is defined as the entry of
a patient in the hospital for
diagnostic or therapeutic purposes.
•Admission is the process where
patient needs admission in the
hospital for observation,
investigation, treatment and care.

6. PURPOSES OF ADMISSION

7. PURPOSES OF ADMISSION
Observation - To keep in round the clock supervision patient is
admitted e.g., the patient with chest pain, palpitations.
Immediate Care – Patients requiring urgent medical treatment for
cardiac arrest, respiratory arrest and accidental cases require admission.
Investigate – Patient is admitted to perform certain medical test before
a line of treatment can be extended.

8. PURPOSES OF ADMISSION
Treatment - For further management after diagnosis is made.
Meet needs - Patients who can’t meet their physical needs on their
own such as terminally ill patients and patients suffering with
chronic diseases.
Ready for emergency - Patients requiring watchful monitoring of
medical experts in case of sudden exigency of hospital care need to
be admitted to the hospital.

9. TYPES OF HOSPITAL ADMISSION

10. BASED ON THE PURPOSE OF THE ADMISSION
Diagnostic admission: Admission
when the patient has to undergo
some procedure and require
investigation like biopsy.
Therapeutic admission: Patient
has already been diagnosed with
medical condition and requires
medical care for the improvement.

11. BASED ON
THE LENGTH
OF THE
HOSPITAL
STAY
Short-term admission: Patient is
admitted for a 24-48 hours in the
hospital.
Long-term admission: Patient
suffers from a disease condition
and needs more than 48 hours to
recover from the disease
condition.

12. BASED ON THE CONDITION OF THE PATIENT
Routine admission: Patient is
suffering from any disease
condition like cholelithiasis and
need to undergo any treatment and
surgery.
Emergency admission: Patient is
suffering from life threatening
condition like cardiac arrest,
respiratory arrest, etc and requires
immediate treatment.

13. CATEGORIES OF THE PATIENT
ADMITTED IN THE HOSPITAL

14. UNIT AND ITS PREPERATION
Meaning of unit: A unit or ward is defined as
the division of the hospital or a room or hall in
the hospital which has number of beds and
shared by a number of patients, who require
similar care. There are different types of wards
or units in the hospital like medical and surgical
wards.

15. UNIT PREPERATION
• Bed should be functioning properly. Linens and blanket should be clean.
Make unoccupied bed.
Prepare the admission bed
• Equipments like cardiac monitor, oxygen flow meter, suction machine
should be functioning properly as per the needs of the patient.
Ensure equipment
• Ensure the privacy of the patient and do not expose the patient
unnecessarily.
Ensure patient privacy
• Perform the initial assessment to assess the risk factors like risk of fall, risk
of developing pressure sores, pain assessment, etc.
Patient safety
• Identify the categories of patient. assess the financial constraints and
explain the estimated cost of the treatment to the patient and the family.
Financial burden
Patient isolation
• The suspected patient or the patient with mild symptoms of COVID-19 and tuberculosis
require isolation. Chart visiting time outside the unit. Instruct the family members to wear
appropriate personal protective equipment (PPE) while meeting with patient.

16. DEALING WITH
HOSPITALIZATIO
N ANXIETY
Ways to reduce the anxiety among patients:
• Be empathetic with client.
• Orient the client to the unit or the wards.
• Maintain good interpersonal relationship with the
patient.
• Explain each and everything to the patient.
• Provide privacy to the patient.
• Respect the dignity of the patient.
• Allow the patient to ventilate his/her feelings and
clear the doubts of the patient.

17. PROCEDURE
OF
ADMISSION
OF A
PATIENT
Meet and receive the patient
Perform examination and initial
assessment
Coordinate with health care team
members
Orientation to the patients and
others

18. MEET AND RECEIVE THE PATIENT
• Verify the patient data, by checking the record sheet, chart.
• Introduce yourself and other members of health team on duty.
• Assist patient to the treatment area.
• Ask the patient to change clothes into hospital gown if necessary.
• Put the identity bracelet.

19. PERFORM EXAMINATION AND INITIAL
ASSESSMENT
• Conduct general head to foot examination.
• Check the height and weight of the patient.
• Assess the allergic history of patient.
• Send the investigation as prescribed by the physician.
• Do the initial assessment which includes pain assessment, risk
of pressure ulcer assessment and fall risk assessment.

20. COORDINATE WITH HEALTH CARE
TEAM MEMBERS
• Coordinate with all healthcare team members like physician,
physiotherapist and dietician.
• Carry out the initial orders or instructions given by the
physician.
• Provide the treatment as instructed.

21. ORIENTATION
TO THE
PATIENT AND
THE OTHERS
THE EQUIPMENT Orient the patient to the equipment and instruct the patient not to touch
them unnecessarily.
USE OF CALL
SYSTEM AND
TELEPHONE
Educate the patient regarding use of call bell and telephone.
TREATMENT
SCHEDULE
Explain the treatment schedule to the patient.
VISITOR’S TIMINGS Explain the hospital policy regarding visiting to the family members.
OTHER HEALTH
CARE TEAM
MEMBERS
Orient the patient to the other healthcare team members.
POLICIES, RULES
AND REGULATIONS
Inform the patient about the policy as well as rules and regulations of the
hospital.
CARE OF PATIENT’S
VALUABLES
Make the list of the patient’s valuables in the patient valuable
handover form and hand it over to the family members at the time of the
admission.

22. ARTICLES
REQUIRED FOR
ADMISSION

23. ARTICLES
REQUIRED FOR
ADMISSION

24. ◤
PROCEDURE OF RECEIVING A NEW
PATIENT
PATIENTS CAN
BE ADMITTED
FROM VARIOUS
HOSPITAL
DEPARTMENTS
Outpatient
department
(OPD)
Emergency
Private
clinics
Referral

25. PROCEDURE
OF
RECEIVING
A NEW
PATIENT
• The duty manger will inform the head nurse regarding admission
of the patient.
• The nurse will prepare the needed equipment and will make sure
that all the equipment are functioning properly.
• Introduce yourself to the patient and welcome the patient.
• Adjust the height of the bed as per the condition of the patient.
• Escort the patient to the bed.
• Arrange the help if patient arrives on stretcher for shifting.
• Identify the patient using at least two identifiers like patient
name, UHID No. (Unique hospital identification data) or MR
No. (Medical record number).
• Orient the patient (fig. 3).
• Complete the process of the admission and change
• the status of the bed from vacant to occupied.

26. ORIENTATION OF THE PATIENT

27. PROCEDURE
OF
RECEIVING
A NEW
PATIENT
• Provide hospital clothes to the patient and perform
initial assessment.
• Check the medications that patient have brought from
the home to the hospital. Keep record of the
medication and label it as patient’s own medications.
• Check the order of the doctor for treatment
• Send initial investigations as prescribed by
physician.
• Inform to the doctor on duty and the dietician
regarding patient admission.
• Tell the patient about any scheduled procedure or
• treatment.
• Document the patient’s condition and nursingaction
that has been taken.

28. ADMISSION OF
THE PATIENT IN
INTENSIVE CARE
UNIT OR
EMERGENCY
DEPAERTMENT
• Keep the articles ready required for the
admission of the patient in the intensive
care unit or emergency department and
ensure that all the equipment are
functioning properly.
• Keep the patient’s file ready
• Perform initial assessment and observe the
condition of the patient.
• Reassure the patient and explain what is
being done.
• Shift the patient to the ICU or emergency
bed.
• Provide privacy to the patient and put
identity bracelet to the patient.
• Review the allergic history and put allergy
identity bracelet if required.

29. ADMISSION OF
THE PATIENT IN
INTENSIVE CARE
UNIT OR
EMERGENCY
DEPAERTMENT
• Make the patient wear hospital clothes.
• Make a list of the valuables and handover
them to the primary caregiver and take a
witness sign.
• Perform thorough physical examination
and document the patient’s condition.
• Connect the cardiac monitor to the patient.
• Access an IV line and start maintaining
intake output.
• Provide recovery position (left lateral) to
the patient.
• If unconscious keep the mackintosh towel
under the face to collect secretions.

30. TRANSFER OF THE PATIENT
FROM ONE UNIT TO ANOTHER
• Explain about the transfer and its purpose to the patient and family members.
• Inform to the unit or ward where the patient has to be transferred and receiving
nurse regarding patient’s condition and the equipment needed.
• Identify the method of transfer like wheelchair, stretcher and bed.
• Make sure all the documents are updated before shifting the patient.
• Inform the patient arrival to the unit.
• Transport the patient. Assist the patient in transfer to the bed. Match the
patient identification details with the record sheets and accompany the patient to
the area of shifting.
• Handover all the documents as well as patient valuables to the receiving nurse.

31. MEDICOLEGAL ISSUES IN ADMISSION OF THE
PATIENT
Concept :
Medicolegal cases (MLC) have
both medical and legal
implications. Medicolegal cases
are the cases where along with
medical treatment of the patient,
investigation by law is required to
ascertain the responsibilities
regarding the present state or
condition of the patient.
Definition :
It can also be defined as the
cases which require medical
treatment but at the same
time needs to be informed to
the law enforcing authorities.

32. CASES CONSIDERED AS MEDICOLEGAL
Accidental death Accident cases Injuries
Poisoning
Unnatural
events under
suspicious
circumstances
Violence
Bullet injury Drowning

33. MEDICOLEGAL ISSUE DURING
ADMISSION OF THE PATIENT
Assault
• Intentional act
that cause
another
person to fear
that he/she is
about to suffer
physical harm.
Injuries
• Damage to
any part of the
body caused
by violence.
Disclosure of
the information
• Disclose
information
about
patient’s
condition, the
methods of
treatment and
alternative for
the treatment.
Medical
negligence
• Improper or
unskilled
treatment of a
patient by a
medical
practitioner

34. ROLE OF NURSE IN ADMISSION OF
MEDICOLEGAL CASES

35. ROLE OF
NURSE IN
THE
ADMISSION
OF THE
PATIENT
PREPARATION OF UNIT OR
ROOM
Role of nurse is to prepare the unit.
Keep the bed ready. Linens and blanket
should be clean. Position the bed.
ENTRY OF THE PATIENT Enter the patient’s information in
admission register as well as computer
system.
AVAILABILITY OF THE
EQUIPMENT
Ensure that all the articles and
equipment are available and functioning
properly.
ORIENTATION OF THE PATIENT Orient the patient to the surroundings
and hospital policies and protocols.
MEETING NEEDS OF THE
PATIENT
Recognizing and meeting the various
needs of the patient.
CARE OF PATIENT’S
VALUABLES AND CLOTHES
Handover the patient’s valuables to the
family members at the time of
admission.
TREATMENT Carry out the instructions as prescribed
by the physician.

36. DISCHARGE OF THE PATIENT
Definition:
Discharge of a patient means
departure of a patient from
the hospital. It is also known
as dismissal of patient from
the hospital.

37. PURPOSES
OF
DISCHARGE
Purposes
of
discharge
To ensure continuity of care.
For a safe and effective
return of all the patient’s
clothing and valuables.
Help the patient to adjust
effectively with the change
of environment.
To make sure that the patient
has information about his/her
condition.

38. TYPES OF DISCHARGE

39. PLANNED DISCHARGE
The decision of discharge is taken by the attending doctor or
physician when the patient has completed the initial and actual
management of the disease in the hospital and now patient
does not need the direct supervision.

40. LEAVE AGAINST MEDICAL REQUEST
(LAMA)
Also known as Discharge Against Medical Advice (DAMA), in this it is
clearly explained by the doctor that taking the patient from the hospital
may impose risk to the life of the patient, but still patient or patient’s
family want to take the patient to some other hospital or to the home
after signing a declaration form saying that the risks and consequences
of taking the patient from the hospital were informed to the patient or
family.

41. PAROLE
It is used in psychiatric hospital and patient is sent to home for
2 to 4 days by the approval of psychiatrist in charge.

42. REFERRAL
Shifting the patient to other units or to the hospital for further
management.

43. DISCHARGE ON REQUEST
Treatment is not complete but there is no immediate danger to
the life of the patient in taking the patient out of the hospital.

44. PNEUMONIC –
DISCHARGE
PLANNING
PNEUMONIC – DISCHARGE PLANNING
The pneumonic that is used to describe the discharge
planning is IDEAL.

45. DISCHARGE
PLANNING
Include : Include the patient and the family members in
the process of discharge planning.
Discuss : Five main areas like life at home, medications,
warning signs, test results and follow up visits need to be
discussed with patient and the family.
Educate : Educate the patient and the family members
regarding the condition, diet, exercise and medications.
Assess : Assess how well doctors and nurses has explained
the diagnosis, condition, and the steps in the patient’s care
to the patient and the family members.
Listen : Listen to the patient and his/her families goals,
preferences, observations, and concerns.

46. PROCEDURE
OF
DISCHARGE
• Review the doctor’s order for discharge in written
form.
• Prepare the cumulative hospital charges and return
the extra medication to the pharmacy.
• Send the final cumulative billing sheet to the cashier
and process the final bill.
• Patient settles the bill and receives payment paid
slip.
• Patient or family members goes to the ward to
collect the discharge summary and physician or staff
explains about the medication and follow – up –
date.

47. PROCEDURE
OF
DISCHARGE
• Remove the lines, tubing, cut off the identity
bracelet and ask the patient to change the
hospital dress.
• Transfer the patient to hospital lobby and
document the return process of the patient in
progress notes.
• Inform the housekeeping to clean the room.
• Check all the documents of the patient with
medical record, change the status of the
inpatient room and make the room ready for
the next patient arrival.

48. ROLE OF
NURSE IN
DISCHARGE
Role of the nurse in an MLC during discharge:
• Inform the police on duty in the hospital and to the
Chief Medical Officer (CMO).
• Discharge only after the clearance.
• If patient absconds, inform the nursing supervisor,
CMO and the treating doctor.
• No MLC patient can leave the hospital with LAMA.
• The care given to the patient should be documented
timely, accurate and duly sign the nurses’ notes.
• Records related to the treatment of the patient has to be
stored safely and should be handed over to the
authorized person as designated by the hospital
authority.
• In case of death, the body is not to be handed over to
the relatives. Label the body properly and sent to the
mortuary and inform CMO and police officer.

49. ROLE OF NURSE IN DISCHARGE

50. CARE OF THE UNIT AFTER
PATIENT DISCHARGE
• When the patient is discharged, inform the housekeeping
staff to clean the room and make it ready for the next
patient arrival.
• Instruct the housekeeping staff to clean the furniture and
windows and send the linens and blanket for the laundry.
• The articles which are used by the patient should be sent to
the utility room for cleaning, sterilization and disinfection.
• Discard the unwanted objects or materials and disinfect
the mattresses.
• In case the room is used by the patient suffering from
communicable diseases then it should be fumigated.
• Prepare the unit for next patient as per hospital policy.

51. CHAPTER
FOCUS
POINTS
• Admission is the process of allowing the patient to
stay in the hospital for a diagnostics or therapeutic
purposes. It can be emergency admission or routine
admission.
• Nurse should be skillful to receive the patient in ICU
or in the emergency because every second is
important for the patient and should be more careful
while receiving the medicolegal case.
• Discharge of the patient means departure of the
patient from hospital environment to another
environment. Do not discharge the patient without
doctor’s written order.

52. “Textbook of Foundation of
Nursing" by Jyoti Kathwal