Reception, Admission, Referral and Discharge Procedures

Ward Reception and Patient Orientation

Receiving a patient properly sets the tone for their entire hospital stay. When a client arrives at the ward, the nurse must greet them warmly, verify their identity, and settle them into their designated bed. Anxiety is common during this period, so a calm and professional demeanor helps build immediate trust.

• Physical Orientation: Show the patient how to use the nurse call bell, operate the adjustable bed, and locate the bathroom facilities.
• Ward Routine: Explain meal times, visiting hours, and the names of the doctors and nurses managing the shift.
• Safety Measures: Inform them about fall prevention protocols, such as keeping side rails up and wearing non-slip footwear.

Types and Procedures of Hospital Admission

Hospital admission is the official acceptance of a patient into a healthcare facility for inpatient care, diagnosis, and treatment. Admissions generally fall into two broad categories based on urgency.

• Routine Admission: Planned in advance for elective surgeries, specialized investigations, or chronic disease management. The patient arrives with a scheduled date and pre-admission clearance.
• Emergency Admission: Unplanned entry resulting from acute trauma, sudden severe illness, or critical medical crises coming through the accident and emergency department.

The admission procedure requires verifying clinical orders, assigning a bed based on clinical acuity, conducting a baseline physical assessment, and securing personal valuables according to hospital policy.

Admission Documentation and Record Keeping

Accurate documentation during admission creates the legal and clinical baseline for the patient's hospital journey. Nurses must complete the admission data sheet, nursing care plan, and baseline vital signs chart promptly.

Failure to document known allergies or existing pressure ulcers upon admission can lead to severe clinical errors and legal liability.

Patient Referral Principles and Procedures

Referral is the formal process of sending a patient from one level of care to another, ensuring continuous treatment when local facilities lack the necessary expertise or equipment. Effective referrals rely on clear communication between the referring and receiving facilities.

1. Clinical Assessment: Stabilize the patient and identify the specific reason for transfer.
2. Communication: Contact the receiving physician or facility to confirm bed availability and acceptance.
3. Documentation: Prepare a comprehensive referral letter detailing history, treatments administered, and current condition.
4. Transport: Arrange appropriate transport personnel, equipment, and medications needed en route.

Intra-Facility and Inter-Facility Transfers

Transfers move a patient from one care area to another. Intra-facility transfers occur within the same hospital, such as moving a client from the intensive care unit to a general surgical ward as they improve. Inter-facility transfers move patients between entirely separate health institutions.

Safe transfer requires a complete verbal handover alongside written notes. The transferring nurse must ensure that equipment such as oxygen tanks, IV pumps, or drainage bags remain secure and functional throughout the physical movement.

Discharge Planning and Preparation

Discharge planning is a coordinated, multi-disciplinary process designed to ensure that a patient has a smooth transition from hospital to home or another care facility. Planning begins on the day of admission, not the day of departure.

The nurse assesses the home environment, family support systems, and any required medical equipment. Education covers wound care, medication schedules, dietary restrictions, and warning signs that require emergency medical attention. Collaboration with physiotherapists, social workers, and pharmacists ensures comprehensive support.

Types of Discharge and Nursing Responsibilities

The manner in which a patient leaves the hospital dictates specific legal and clinical actions by the nursing team.

• Routine Discharge: Planned departure when clinical goals are met. The nurse provides final medications, checks follow-up appointments, and ensures belongings are returned.
• Discharge Against Medical Advice (DAMA): Occurs when a competent patient chooses to leave before the physician recommends. The nurse must inform the doctor, explain the risks of leaving early, and have the patient sign a liability waiver.
• Absconding: Unplanned and unauthorized departure. Nurses must notify hospital security and the attending physician immediately.
• Transfer/Death: Formal processing of body handover to the mortuary or transfer to another institution.