Summary

There are many different types of patient admissions to healthcare facilities. It is important to ensure the patient is admitted to the correct level of care. Acute care admissions are for patients who require inpatient monitoring and/or a professional level of care. Observational admissions are typically for one or two nights. Admissions to the hospital can be planned or unplanned. Some come from an ambulatory care setting, while others arrive from home or via EMS.

The admitting nurse must be organized and structured in their approach to admitting a patient. The admitting nurse must receive a complete and accurate report, ensure that their other patients are safe and their needs are met, and make their coworkers aware of an impending admission and their role, if necessary, to help with the admission. Maintaining patient safety in the hospital is very important. The nurse must be observant and thoughtful in preparing the room, tailoring it to their patient’s specific needs.

Developing a rapport with the patient is key to ensuring the patient makes the most informed decisions possible regarding their care. Orienting the patient to the hospital and the routines of care is also important in ensuring patient safety and comfort. Encourage patient participation in their care while in the hospital.

Patient transfers are an important transition point in care. They can be from one facility to another or within the same healthcare facility. There are many steps to a safe patient transfer that must be considered, and all members of the healthcare team should participate. Transfer to a higher level of care or within an acute care facility is very different from transfer to an extended care facility. All information is part of the patient’s history, but the nurse ensures that report is focused on the level of care the patient needs at the facility to which they are transferring. Emphasize the information the receiving unit requires and ensure the rest of the information is available in the chart. Transfer is one more step in the healthcare journey from entrance to exit, so it is important that all details are conveyed and accurately communicated.

Discharge planning begins the moment a patient is admitted to a facility. Ensuring goals are being developed in the beginning allows all team members to be involved in the patient’s care early on. Discharging patients from a healthcare facility is an important step in the healthcare process and requires education and collaboration to create a successful discharge plan that is tailored to the patient’s specific physical, medical, psychosocial, and educational needs. Care coordination among all interdisciplinary team members from start to finish ensures that quality, effective patient-centered care has been provided. Sometimes a patient may discharge themselves, leaving the hospital AMA; in cases like this, it is important to educate the patient about the ramifications of their actions, and if the patient still decides to leave, the nurse must document the discharge professionally and thoroughly. There are numerous reasons for a patient to choose to leave against medical advice (AMA), and many times it is not because they do not want to receive care. Sometimes, it is because they have no other choice; for example, a single parent needs to take care of their children, or the financial provider of the family cannot miss work. The process for discharge from a home health agency is similar to that from any other healthcare facility. The patients’ needs must have been met, goals have either been achieved or there has been major progression toward being achieved, and services have been deemed no longer necessary. Regardless of where discharge is occurring, the nurse needs to remember the importance of well-performed and documented patient education.