Admission & Discharge care

• Continuity of care


  • Communicate health information among different departments or facilities
  • The patient is able to receive safe transition with appropriate and uninterrupted care
  • The transition from one health environment to another
• Goals of continuity of care

  • Ensure a patient-focused care
  • Ensure an individualized continuum of healthcare
  • Ensure patient can attain maximum recovery and health
• Roles of nurses in continuity of care

  • Promote health and prevent illness
  • Teaching & Referral
  • Involve patient and family in a mutual planning process
  • Collaborate with other members of the healthcare team
• Types of admission

  • Emergency admission - admit through AED
  • Clinical admission - admit through doctor's referral
• Patient's will of admission

  • Voluntary admission
  • Involuntary admission
• Emergency admission

  • Through Accident and Emergency Department (AED)
  • The patient's condition may be less stable
  • Inform doctor upon receiving the patient from AED
  • Prepare necessary equipment
  • Resuscitation
  • Coordinate with other teams for patient care
  • Inform family if no family member accompany the patient
  • Arrange waiting area for family members
  • Keep family well informed about the patient's condition
  • Other admission procedure: same as clinical admission
• Pre-admission services

  • Pre-Anaesthetic Clinic
  • Pre-Admission Service
• Purpose of pre-admission services


  • To ensure clients have better psychologically and physically prepared
• Pre-admission services include

  • Doctor Consultation & Assessment
  • Referral to Specialists if required
  • Medication Arrangement
  • Introduction to Operation
  • Pre-operative Assessment
  • Admission Preparation (Basic Necessities, ID card & Property, Medication etc.)
  • Preoperative Assessment & Investigation
  • Notify operation cancellation or refusal
  • Post-Operative Advice
  • Registration Procedure
  • Postponement & Cancellation of Operation Appointment
• Psychological response about hospital admission

  • Anxiety
  • Loneliness
  • Fear
  • Loss of Privacy
  • Change of body image
  • Helplessness/ loss of control
  • Guilty feeling
• Principles for caring in-hospital patients

  • Understand their psychological status, provide appropriate information
  • Care for both patients and family members with professional attributes
  • Maintain patient's self-image and self-esteem
  • Ensure patient comfort and safety
  • Protect patient's rights and privacy
• Therapeutic relationship


  • When the relationship between the carer and the cared
  • Promoting or restoring the health and well-being of people within the relationship
• Information collected during admission

  • Full name
  • Date of birth
  • Gender
  • Identification number
  • Address
  • Nearest relative & contact number
  • Date and time of admission
  • Occupation
  • Religious preference
  • Financial status for healthcare payment (private hospitals)
• Patient admission

  • After the admission procedure, an identification wristband will be issued to the patient
  • Identification wristband includes important data
  • After completion of the admission procedure, the admission office will inform the ward about patient admission
  • Based on the patient's condition, he/she will be transferred to the ward by wheelchair or stretcher
  • Family members are usually allowed to accompany the patient
• Preparing the bed and equipment


  • Change an unoccupied bed to an occupied bed (admission bed)
  • Prepare necessary equipment that may be needed
• Receiving and orientating the patient


  • Welcome the patient and self-introduction
  • Put on identification wristband
  • Orientation of ward environment
  • Ask patient to get changed into a hospital gown
  • Inventory of personal belongings and valuables (if needed)
  • Provide patient with information such as "Patient's Charter", operating procedure/ post-operative care information
  • Provide psychological support as appropriate
  • Inform a doctor about admission
• Assessing the patient

  • Vital signs (BP, P, RR, T, SpO2)
  • Bodyweight, height
  • Routine urine analysis
  • Allergic history
  • Past medical history includes any operations
  • Current medication
  • Marital status, religious belief
  • Activity, fall risk, nutrition status and eating preference
• Information in the admission assessment form

  • General condition (e.g. Vital signs, mental state, emotional state, allergy history)
  • Patient's particular (e.g. Education level, dialect, religion, occupation)
  • Social status (e.g. Marital status, financial assistance)
  • Medications (e.g. Current medications, drug compliance/ administration)
  • Physical state (e.g. Pre-morbid state – functional level, fall risk, nutritional status, elimination, skin condition)
• Types of discharge

  • Regular discharge
  • Discharge Against Medical Advice (DAMA)
  • Discharge by death
  • Transfer
• Patient's responses to discharge

  • Excited - because able to get back to his/her original life
  • Worried - recurrence of disease, self-care ability, loss of job
  • Anxious about the unknown - unstable emotions
• Discharge planning


  • A process of preparing a patient to leave one level of care for another within or outside the current health care agency
  • Goal: To achieve continuity of care
• Nursing responsibilities in discharge planning

  • Anticipate and identify patient's needs after discharge from the hospital
  • Work with multidisciplinary team members
  • Involve patient and family to participate in the planning process and decision-making process
  • Deliver comprehensive patient and family education
• Effective discharge planning


  • May need to begin once the patient is admitted
  • Ongoing assessment to obtain comprehensive information about the patient's ongoing needs
  • Nursing care plan to ensure the patient's and caregiver's needs are met
  • Focus on ways to individualize care for the patient
  • Involves family, client & health care professional, provide an opportunity to plan carefully and set goals mutually
• Nurses need to assess when preparing patient to go home


  • Patients' personal and health data
  • Patients' cultural beliefs, medical history, prognosis
  • Ability to perform the activities of daily living
  • Physical, cognitive or other functional limitations
  • Caregivers' response and abilities
  • Financial resources
  • Community supports
  • Hazards or barriers within the home environment
  • Need for help care assistance at home
• Discharge planning includes

  • Medication
  • Environment
  • Treatment
  • Health teaching
  • Out-patient referral
  • Diet
• After discharge


  • Documentation - time and date of discharge, any information/ teaching provided
  • Handling all used equipment
  • Prepare the bed unit for a new admission