Admissions, transfers and discharges

Definitions & Key takeaways

Admissions, transfers, and discharges (ATD) are the three types of movement of patients within a hospital.

Admission is when a patient is first admitted to the hospital. This could be because they have been referred by their General Practitioner (GP), or they may have come to the hospital themselves through the Emergency Department.

A transfer is when a patient moves from one area of the hospital to another � for example, from A&E to a ward.

Discharge happens when a patient leaves the hospital � because they are transferring to another type of care such as going home or moving into a hospice.

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Admission refers to the official entry of a client into a healthcare facility, and a transfer is moving a person from one room to another, from one department to another, or from one healthcare facility to another.

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Discharge refers to the official departure of a person from a healthcare facility. These processes can be impactful and disruptive to a client's normal routine.

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The good news is that, as a nursing assistant, you can help the clients feel less overwhelmed as they check in and out of the healthcare facility.Alright, after the new client arrives in the healthcare facility, the admitting nurse fills out the client information on the admission sheet, including the client’s full name, the current address, and date of birth.

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The client is then given an identification number. As a nursing assistant, you will be asked to escort the client; this is a great opportunity to make a good first impression and help the client feel as comfortable as possible.

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Some clients may need to be transported in a wheelchair or on a stretcher depending on their health status. Remember, you’re the one who will take care of most of the clients’ basic needs.

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So, be sure to make them feel welcome and comfortable. First, greet every client by name and title, like Mr.

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or Mrs. You can find the client's name in their admission sheet or by asking the nurse.

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Then, introduce yourself and your title to the client and their family members or guardian if they are present. After the client gets into their assigned room, offer to help them with unpacking and getting changed into a gown or pajamas if needed.

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It’s also important to make a list of the client’s belongings to make sure that nothing gets lost. Make sure that the client feels respected and is treated with dignity.When the client is settled and relaxed, take their vital signs and measure height and weight.

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Usually, the nurse comes to make the admission assessment, which involves gathering the client’s information, including personal preferences, abilities, disabilities, and habits.

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It may be obtained from the client, the family members, or a guardian.Now, sometimes a client may need to be transferred.

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Basically, transfers occur when the client’s health status improves or deteriorates, and they will be better taken care of in another location.

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Transfers can be from one room to another, one department to another, or one facility to another. For example, a previously severely ill client in the intensive care unit, or the ICU, can improve and be transferred to a regular room.

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A transfer can also be from one healthcare facility to another, like when transferring a client with an acute illness from an assisted living facility to a hospital.

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As a nursing assistant, you’ll be helping with the client’s transfer and ensuring all their belongings are gathered and packed.

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If the client needs to be transported to another healthcare facility, the nurse will typically provide a client report to the receiving facility, usually to the nurse that will be caring for the client there.

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Because nursing assistants spend a lot of time with their clients, they can often contribute to this hand-off by sharing information like the client's personal preferences and habits.

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After the transfer is complete, document the time of the transfer, people who helped you in the process, where the client was taken, and by which means was the client transported: by wheelchair, stretcher, or in bed.

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If you are the team member that is physically transferring the client, you also have to document who received the client, whether the client tolerated the transfer, and any other important observations.Now, let’s say it's time to discharge the client from the healthcare facility.

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Preparations for the discharge process actually starts on the day the client is admitted into the facility because time is required to identify and address the needs a client might have after they’re discharged.

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For example, the client might require a regular wound dressing after the discharge. In such cases, the healthcare staff will use the time during the client's stay to teach the client’s family members or guardian how to change the wound dressing before the client is sent home.

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Normally, the client’s discharge is ordered by the healthcare provider. Sometimes, however, a mentally competent client may request and insist on leaving the healthcare facility, even if it may be against the healthcare provider’s advice.

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This is referred to as leaving AMA, or “Against Medical Advice.” When this happens, the nurse explains the facility’s protocol for AMA to the client and educates them about the potential consequences for leaving AMA.

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After ensuring that the client understands the teaching, the nurse asks the client to sign a document that confirms that they wish to leave AMA, they’ve been advised against leaving AMA, and that the facility can not be held legally liable for any consequence that results from said action.

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OK, as a nursing assistant, your responsibilities during the discharge process will be helping the clients gather and pack their belongings.

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First, ask the nurse for the estimated discharge time so that you may plan ahead and make sure the client is ready to leave on time.

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As the client is leaving the facility, you might need to help with transporting their belongings to the vehicle. Always notify the nurse when the client, family members, or guardian have questions related to the client’s medical condition, transfer, or discharge or when they have questions about what they have been told by a doctor or nurse.

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You should also notify the nurse when there are any signs of anxiety, such as crying, agitation, or any other unexplained behavior.

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Also, report any changes in the client’s vital signs or mental status or any mentions of the client’s desire to leave AMA.

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##SummaryAll right, as a quick recap... During the admission, transfer, and discharge processes, the responsibilities of nursing assistants consist of helping the client to easily adapt to the new environment and conditions and assisting the nurse in various activities.

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During the admission process, the nursing assistant can help escort the client to their room; help the client unpack and change their clothes; and record the client's vital signs, height, and weight.

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During the transfer and the discharge processes, the nursing assistant helps clients pack their belongings and assists them to the new location or to the vehicle that’ll transport them to another facility.

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The nursing assistant should notify the nurse in case the client, family members or guardian have questions related to the client’s medical condition, transfer, or discharge or when they have questions about the information they’ve been told by a doctor or nurse.

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The nursing assistant also notifies the nurse when the client talks about leaving AMA; any change in the vital signs; or the client has any signs of anxiety such as crying, agitation, or any other abnormal behavior.