ADMISSION,

TRANSFER,
DISCHARGE AND
CARE OF DECEASED
PATIENT
Module

Prepared:2011
Reviewed: 2014
1
By the end of the session learners will be able to:

 Define the term admission and discharge

 Discuss the purpose and importance of hospitalization
 List the types of admissions and discharges
 Discuss the admission and discharge process in THI
 Review the THI policy about admission and discharge
process
 Review the categories of patients in accordance to their
health needs
 List reasons of patients transfer in and out and
inter departmental shifting

2
 Review THI policy of inter and intra hospital transfer
 List the roles and responsibilities of a nurse, health care
assistant, technicians and receptionist in admission,
discharge and transfer process
 Discuss care of deceased patient in accordance with policy at
THI
 List the roles and responsibilities of nurse, health care
assistant, technicians and receptionist in care of deceased
patient and their family.

3
4
 The formal acceptance by a
hospital or other inpatient
health care facility of a patient
who is to be provided with
room, board, and continuous
nursing service.
(Mosby’s Dental Dictionary,
2004 )

5
 Patients are admitted to the
hospital for a variety of
reasons including:
Scheduled tests
Procedures
 Surgery
Emergency medical
treatment
Administration of
medication
6
 Emergency
admission

Elective
admission

Day care admission

Direct admission 7
 An emergency hospital admission is
defined as one that is not planned and
which results from trauma (injury) or
acute illness which cannot be treated
on an outpatient basis.
(Admission and Discharge guidelines, 2003)
Examples: Sudden heart attack, RTA
(road traffic accident, sudden loss of
consciousness etc.

8
 A booked admission on a date usually
more than seven days after a specialist
decision to admit or a patient who was
placed on a waiting list without a specific
date being given.
(Admission and Discharge guidelines, 2003)
Examples: For diagnostic procedures such
as endoscopy, angiography, chemotherapy
administration (long hour infusions),
blood transfusions etc.
9
A patient who attends a hospital same day
program with pre- and post-
interventional protocols for a scheduled
elective surgical, diagnostic and/or
therapeutic procedure under sedation or a
local, regional or general anesthesia.
(Concept: Day Surgery Identification, 2007)
Also it includes chemotherapy
administration (short hour
infusions), blood transfusions.
10
Direct Admission from clinic and need
urgent admission due to health issue
as per physician assessment. If
delayed in admission, morbidity will
rise.

11
12
 Admission, Discharge & Transfer
(ADT) system
Special Need: Special care, intensive
care or isolation

Communication with nursing office

Inform assign nurse and health

care assistant
Preparation of area as per patient
need
Receptionists notified before
sending patient to the unit
13
 Patient received from emergency, electively or directly

Nursing staff introduced themselves and verify name and

MR number from identification band and admission form.

Receptionists will inform concerned on call resident.

Orientation of patient and attendant to unit and routine.

Provision of admission pack if required.

Nursing staff will perform initial assessment of patient

within same shift and notify on call resident
regarding abnormal findings. 14
 Leave the patient comfortable.

Make sure to take all safety precautions and teach attendant as

well before you leave.

Keep call bell and required items in easy reach to patient.

Review history and check physician orders ongoing basis.

Initiates the nursing care plan as per policy.

Receptionist will inform Nutrition & Food Service department

about patient's admission and dietary requirements and enter the
same in Nutrition Care Management System.(NCMS)
15
Complete initial assessment
form.

Write nurses notes following

A to G method of
documentation.

Make sure to write full

signature and designation.
16
Performance phase will
last till discharge of
patient from hospital.

17
18
 Release from a
hospital or other
course of care.
Dorland's Medical Dictionary for Health
Consumers. 2007

19
 Discharge planning
Discharge planning should ensure that
is the development patients are
of an discharged from
individualized hospital at an
discharge plan for appropriate time in
the patient prior to their care and that,
leaving hospital, with adequate
with the aim of notice, the provision
constraining costs of other services
and improving will be organized.
patient outcomes.
20
Discharge planning should commence
pre-admission.
On admission, the patient’s co-morbid and
functional status information is
documented in order to plan discharge and
to identify patients at risk when returning
home.
In this way, referrals to inter-hospital
and community services are initiated in
a timely manner.
21
 Patient

Support
System
Health
Patient Care
Team

22
 Transfer out due to other reason
(TROR)
Transfer out due to unavailability of
ventilator (TRV) [only through
Aman Foundation].

Expiry (E)

Leaving against medical advice

(LAMA)

Discharge on recovery (Sent Home)

[SH].
23
All discharge and potential discharge patients
should, wherever possible, be identified, 24
hours in advance.

Nursing staff on the unit must be informed of

all potential discharges 24 hours in advance.

All discharge orders should preferably be

written before 1200 hours on the day of
discharge.

Patients, whose discharge orders are written

by doctors before 1200 hrs, should vacate their
beds by1600 hrs on the day of discharge.
24
 Prior to discharge, PBSD will provide the patient / relative
with the final bill. The patient/relative will settle the bill in
PBSD and will return to the unit. Discharge slip will be
sent online to the unit receptionist by PBSD.

Nursing staff will remove patient’s ID band and electrodes

(if applicable) before patient’s discharge.

Patient will be given discharge summary, follow up visit

appointment and take home medications by RN.

Nursing staff will contact Home Health Care (HHC) nursing

in case patient require/requests for services from HHC.

25
 Nursing staff will ask for the wheel
chair or any other assistance at the time
of discharge.

Nursing staff will formally say

goodbye to the patient / family before
they leave nursing unit

Receptionist will check and prepare

patient’s file for transfer to Health
Information Management Services
(HIMS) next day after reviewing by
Head Nurse or her delegate.
26
Nursing staff will conduct discharge teaching on following and
document the same:
Take home medications. (by RN
only)
Wound site care / observation (for
post operative patients).

Diet.

Follow up appointment.

Rehabilitation.

Teaching for NG feeding, catheter

care (if applicable).
When / how to contact in case of
emergency (ED contact 27
Patient discharge may get delayed, due to the following reasons:

Absence of attendant

Delay in financial
settlement

Non-availability of
nursing care at home

28
29
Diagnostic
procedure(CT scan)
Therapeutic
procedure(dialysis)

Alternate
accommodation

High acuity level to low

acuity level
Low acuity level to high 30
 Limited bed availability

Limited resources
available(ventilator)

Financial constraints

Palliative care or long

term
illness

Unsatisfactory services 31
Category Category Category Category
A B C D
ward (O2 ward
(without
Intensive Special and
O2 and
care Care infusions) infusions)

32
33
34
 Patients at AKUH are mostly transferred out due to
unavailability of services and high dependency beds (e.g.
ventilated beds, beds in Special Care Unit etc.) or
/family
patient and financial reasons.
 In case of a possible Transfer Out, the concerned team
shall brief the patient/attendants’ about the patient’s
condition as well as the reason(s) for which the
patient needs to be transferred out.
 Once patient/family agrees to transfer the patient to
other healthcare facility, Nurse In-Charge/Patient
Care Coordinator will contact Aman Health Care
Services (EMS) to arrange the ambulance and explain
the patient/family regarding ambulance charges.

35
 In situation where patients/families refuse transfer, the
On-call Faculty /physician supervisor shall explain all
anticipated risks and retain the patient in the available
facility.

 In case of patients / family’s refusal for transfer out,

Manager Emergency Department (ED) along with Patient
Care Coordinator (PCC) will have a meeting with the
family and will explain the situation. If the family refuses
transfer out, the Manager ED will get Stay against Medical
Advice Form (SAMA) signed by family / attendant.

36
 When transferring out a patient, the concerned
physician/ PCC / Nursing Office and Administrator On
call will be responsible in identifying an appropriate bed
in a pre identified hospital with space for such patients.

 Once the bed is identified, the concerned attending

physician or his/her designee shall write the detail patient
medical summary/ referral letter while the concerned area
nurse/physician shall fill out the Transfer Out form.

37
38
39
 Patients will be transferred through Aman Health
Care Services (EMS).

 In case attending team/physician decides to transfer

the patient through AKUH ambulance based on
patient’s clinical need, a competent transfer out team
will be constituted (e.g. Medical Resident/ Registered
Nurse/Technician) to deliver care and monitor
patient during transfer.

40
 Concerned area’s receptionist shall arrange
AKUH ambulance for transfer out.
 AKUH ambulance driver (under supervision of Nursing
Technician/Nursing Staff) is responsible for checking of
equipment for working condition and cleaning of
ambulance for infection control practices.
 The patient will be transferred with a standardized kit of
medication and equipment. The Head Nurse /Team Leader
will arrange for equipment and drugs required as per
patient’s condition.
 After the patient has been transferred, the duly filled
Transferred Out Form will be added to patient’s medical
records by the concerned nurse for future reference.

41
 Medical and nursing team would be responsible to
coordinate the movement of patients between
departments to avoid delays and to ensure patient
’s safety during transfer process.
 All elective diagnostic of inpatients should be performed
during day time, preferably between 0800 – 1800 hours and
transfer of inpatients from one unit to another should be
done before 1800 hours.
 Decision of patient’s transfer to low/high acuity level will be
made by primary team based on patient’s clinical status.
Transfer orders would be written in patient’s file and family
would be communicated about the plan by primary team.
 Booking would be entered into ADT system by primary
team and receptionist for ICU/SCU and general
ward respectively.
42
 Upon availability of bed, assigned nurse would inform the
receiving unit nursing staff about patient clinical condition,
special equipment or isolation required.

 All stat and due medications would be administered

before transfer.

 Assigned nurse would notify family members the unit and

bed # where patient is to be transferred. If attendants are
not available, unit receptionist would inform the family
upon their arrival about transfer or about valuables.

43
 Primary team and assigned nurse/ team leader/ CNI/HN
would perform patient’s assessment prior to transfer.
Assessment before transfer, safety checks and personal
accompanying patient during transfer would be
determined by acuity level of patients.

 All patients who are high risk for fall should be

transferred on bed only.

 In case of sudden life threatening emergency

on the way,
patient should be rushed back to nearest clinical
facility.
44
 All valuables would be sent to the patient or the family
at the time of transfer.
 Transferring nurse would give following information to
the receiving nurse during hands off process to ensure
continuity of care.
 Brief clinical history, medical or surgical problems,
related interventions performed and plan of care
 Transfer orders
 Medication orders
 Diet
 Activity level
 Nursing kardex

45
 For transfer in and out of a patient, nursing staff will
ensure to carry emergency/transfer kit equipped with the
appropriate medications and supplies mentioned in the
transfer In and Out checklist

 Medical record including folder, confidential, bed side

folder, hospital ID card, medications and personal
belongings would be handed over to the receiving nurse.

 In case of transfer to high acuity, all medications would

be reentered as per medication policy

46
 Following details would be documented in the notes
by transferring nurse
 Time of transfer
 Unit of transfer
 Mode of transportation
 Condition of patient
 Any special instructions if applicable

47
 Reassessment would be performed by receiving nurse and
following information would be documented in
assessment reassessment sheet or nursing notes.
 Date and time patient received, condition of patient

 Patient’s location would be changed in the ADT system and

diet office and physiotherapy department would be notified
about change in location.
 Receptionist/assigned nurse/incharge nurse would be
responsible to ensure terminal disinfection of the
area after patient is transferred.

48
49
 Death of some one close is an event of great significance
and long lasting impact on an individual or a family.
 Grief may bring great sadness, anger
among family members.
 Nursing / Medical staff with experience and training will
be able to help those who are grieving.
 Nursing / Medical staff will ensure religious and
cultural beliefs are respected without violating
hospital policies for e.g. any spiritual or other
leader of the community can be brought by the
family into the decision making process or to
practices any spiritual beliefs.
50
 Nursing / M.edical staff will allow the family to stay
the dead person as long as they wish to touch or hold
their loved ones etc.
 Nursing / Medical staff will be careful in using the
words which can provoke the individual emotions such
as “its good that deceased suffering is over” etc.
 Nursing / Medical staff will ensure not to suppress the
crying. Crying helps to provide relief from feeling of acute
pain and stress. Remain with the person until he/she is
comfortable. The presence of the Nursing / Medical staff
communicates caring to the patient and family. Identify a
family member who can look after the grieved individual

51
 The patient will be pronounced dead by a Physician and
he/she will communicate the information to next of kin of
patient.

 Three copies of the death certificate will be completed

by the attending doctor.

 The Unit Receptionist will check the certificate

for completeness and clarity.

52
 The Unit Receptionist will enter patients death information
in the ADT system and will notify to the followings:

 PBSD
 Dietary Department
 Morgue (if necessary)
 Nursing / Medical staff will ensure that the request for
permission from family for autopsy (if required) will
be obtained by the attending Physician.

53
 If death occurred in the absence of family, the
family will be informed by telephone about the
critical condition of the patient.
 If the contact with family is not possible on the
telephone. A written note will be sent by messenger
about the critical condition of the patient.
 Physician will write a note and will send it to
the family with a driver.
 Upon arrival of relative to the hospital the concern
physician will inform the family about the death
of patient.
54
 Nursing / Medical staff (Receptionist) will gently
remind the family about settling any outstanding
account from PBSD before taking the body home.
 Timely arrangement of an ambulance (AKUH
or outside) to prevent the delays.
 Attendants are given required information which
includes dead body packing, bathing of dead
body, sealing in coffin box.
 Attendants are given assistance in arranging the flight
if the body is to be taken outside the city or country.

55
 A Body Storage Form is to be filled and kept in the morgue. This
information should be document in the logbook by the person transferring
the body to morgue.
 The attendants are explained about the body releasing process by
receptionist.
 Transfer of body to morgue should be done within half an hour. After
placing the identification tag, shift the body on the morgue trolley.
 Cover the trolley completely before moving it from bedside. Place the
body on the refrigerator plate and place it properly in the morgue.
 Apply one identification tag over the refrigerator door.
 During off-hours, enter information in morgue register. (During working
hours 0800-1700 hrs., assigned staff in the morgue will be responsible
for this)

NOTE: During the evening and night shifts, the Security Supervisor will be
contacted for access to the morgue.

 Infected bodies (meningitis, hepatitis etc.) will be handled according

to Infection Control protocol.
 Any valuables of the deceased will be returned to the family in
accordance with the hospital policy. 56
 The death of the patient will be recorded in the unit’s logbook.

 Physician will complete comprehensive death note i.e. cause of

death, Cardio Pulmonary Resuscitation cycle if given and exact
time of expiry should be recorded in the nurses notes and on
death certification by physician.

NURSES NOTES:

 Date and time of patients death and name of physician

who pronounced death of the patient.
 Last offices performed.
 Release of the body (transferred to morgue or handed
to family)
 Presence or absence of family
57
58
59
 Shepperd, S., Mc Claran, J., Phillips, C., Lannin, N., Clemson,
L., Mc Cluskey, A., Cameron, I. (2010). Discharge planning from
hospital to home. Cochrane Database of Systematic Reviews,
(1). doi: 10.1002/14651858.CD000313.pub3
 Admission and discharge guidelines, Health strategy
implementation project (2003). Retrieved from
http://lenus.ie/hse/bitstream/10147/43554/1/3494.pd
f
 For Providers:Hospital Discharge Planning –First Steps with
Family Caregivers.(2011). Retrieved from
http://www.nextstepincare.org./next_step_in_care_guides/63/Provi

der_Hospital_Discharge_Planning
 Mosby's Dental Dictionary. (2nd Ed.,) (2008) Elsevier Retrieved
from http://medical-dictionary.thefreedictionary.com/Admission
 Dorland's Medical Dictionary for Health Consumers.
(2007) by Elsevier Retrieved from http://medical-
dictionary.thefreedictionary.com/discharge
60
CONT…

 Responsibility of Nursing / Medical Staff at the Time of Grieving

and Patients Death Last Offices / Care of Deceased Patient.
(2012). Administrative Policy. Retrieved from
http://intranet/nursing/pdf/M-dis%20Pol%20A%20R-010.pdf
 Admission of a Patient. (2012). Administrative Protocol
Retrieved from http://intranet/nursing/pdf/M- dis
%20Prot%20A%20A-010.pdf
 Discharge of a Patient.(2011) Administrative Protocol
Retrieved from http://intranet/nursing/pdf/M- dis
%20Pro%20A%20D-010.pdf
 Transfer of a Patient : Intra and Inter Unit, For Diagnostic
Procedure. (2012) Clinical Protocol. Retrieved from
http://intranet/nursing/pdf/M-dis%20Prot%20C%20T-020.pdf

61