Admission of patient is one of the main process followed in any hospital. It is the first step in providing healthcare to a patient as an in-patient. By admitting a patient, hospital undertakes a high level of responsibility for the care and well-being of the patient and hence it is essential to have relevant policy and procedure for admission in place to avoid any problems later on. It also ensures that the patients are admitted uniformly irrespective of their ethnicity, religion, caste, gender, financial class etc. This post describes relevant points that should be considered while formulating a policy and procedure of admission. (Also read - Registration of patient - Policy and Procedure)
Admission Policy
Right to admit a patient – Only those doctors (full time or on contract) who have been given privileges of admitting the patient in the hospital can recommend patient for admission. This is also applicable in case of patients from emergency. In case of patient being transferred from another facility the admission shall be ordered by a doctor having admission privileges. An updated list of such doctors shall be maintained at the admission department. Request for admission by any other doctor or from directly from patient or family members or by any other staff of the hospital shall not be considered.
Responsibility of care – The doctor who orders for admission shall be considered as the primary doctor of the patient and he/she will be responsible for the medical care of the patient till the discharge or transfer of patient to any other doctor. Hospital shall be responsible for providing all facility and services necessary for patient’s stay and provision of medical care.
Information to patient – Every patient shall be provided with all the necessary information before admission for him/her to make an appropriate decision. These information include following
· Patients’ rights and responsibilities (A copy of patients’ rights shall be given)
· Type of accommodation available along-with its amenities and charges for the same
· Doctors round timing and how to contact doctors when required
· Provision of food, timing and whether or not food from outside is allowed
· Number of attendant who will be allowed to stay with the patient and arrangement for the attendant
· Visitors timings and rules related to visiting patients
· Keeping of valuables in the hospital
· Payment timings and mode of payments (In case of insurance patient details related to insurance payments)
· Code of conduct during stay
Cost estimate – Each patient at the time of admission shall be provided with an estimate of total cost of treatment, based on hospital's pricing policy. This shall be estimated with the help of the admitting doctor and by referring to the schedule of charges. The cost estimate shall be given to the patient in written. A disclaimer shall be made that the estimate may vary by certain percentage and may change significantly in case there is a change in treatment plan. In such cases a revised estimate will be given to the patient.
General consent – A written general consent shall be obtained from each patient upon admission. This shall be as per the general consent policy. Standard general consent form shall be used for obtaining the consent.
Non-availability of beds – In case the bed is not available in the category chosen by the patient the policy on ‘managing during non-availability of beds’ shall be followed
Identification of patient - Appropriate Idnetification mechanism of the patient shall be created as per patient identification policy In case of an un-identified patient (for eg. Patient is sub-conscious or mentally unstable) admission shall be done by generating a temporary identification details. This shall be corrected as soon as identity gets established.
Behaviour with patient – During the entire admission process the admitting staff shall be courteous, helpful and maintain good behaviour towards the patient. Patient shall be given sufficient opportunity to ask questions and clarify doubts. Rude behaviour or neglect of patient shall not be tolerated and can lead to penal action.
Privacy and confidentiality – The communication between patient and admitting staff shall be carried out with sufficient privacy. All information collected from patient shall be kept confidential.
Non-discrimination – The admission policy and process shall be uniformly applied to all patient seeking admission. No discrimination shall be done on the basis of patient’s ethnicity, religion, caste, gender, financial class and any other background of the patient.
Admission Procedure
· Admission process of a patient shall be carried out at the admission desk/admission chamber. The process starts as soon as the patient arrives to the desk with the admission order from the doctor.
· Check the written admission order brought by the patient and ensure that it is from a doctor who has the admission privileges granted by the hospital. In case, patient do not have the appropriate written order, admission shall not be done and patient shall be appropriately guided.
· Obtain necessary details of the patient. This can be done through the Unique ID number of the patient which was generated during registration. Additional details shall be obtained by asking the patient to fill up the admission form. In case of unidentified patient a temporary identification shall be provided for the purpose of completing admission.
· Allocation of bed/room – Inform the patient about various categories of accommodation available, its features and cost. Help the patient in selecting an appropriate accommodation of his/her choice. In case the chosen category is not available, follow the policy and procedure of ‘Managing during non-availability of beds’
· Information provision – Provide all information to the patient as described in the policy above. Patient information booklet that contains all necessary information, along with patients’ rights shall be handed over to the patient
· Cost estimate provision – The admission staff in consultation to the doctor should work out an estimate of the total cost that would be incurred to the patient, as per hospital's pricing policy. This cost estimate shall be given to the patient in written. A copy of this estimate, duly signed by the patient shall be retained as an evidence.
· Taking general consent – General consent shall be taken from the patient after provision of information and cost estimate and after final confirmation of admission. This should be done as per general consent policy and in the standardized format
· Registering the admission– Patient’s admission shall be registered/recorded in the system as per the patient’s choice of accommodation and availability of beds.
· Generation of Patient identifier - Patient identifier shall be generated which includes Patient ID band and patient's identification labels (sheet of stickers with printed patient identification details) shall be generated. This shall be as per patient identification policy and procedure.
· Generation of medical record – A medical record shall be generated for the patient which should have patient details and basic formats within it. If the patient is an existing patient, who has been admitted in past, the previous medical record number shall be stated on the new medical record file created.
· Payment of advance – Patient/family member shall be asked to pay the required advance amount at the billing counter and submit the receipt back.
· Sending patient to ward - After successful payment, patient shall be directed towards the appropriate ward. An attendant should to escort the patient, if needed. The medical record and patient identifier (ID band and the identification labels) shall also be sent to the ward by the hands of attendant.
· Internal communication – Immediately after admission information shall be sent to the ward in-charge and to the accounts department
· In the ward – The ward in-charge upon receiving the information shall allocate a primary nurse for the patient. As soon as the patient arrives, primary nurse shall help the patient to get into the room/bed. She should then make an entry in the ward’s admission/discharge register and sends an information of new admission to the medical officer on duty and the admitting doctor.
· In case of any unforeseen event the Hospital Administrator shall be contacted who will take appropriate decision as per situation.
