HAIK PRIMARY

HOSPITAL
Admission and Discharge
Protocol

Senie 2016 EC
Updated on Hamlie 2017 EC
Contents
1. INTRODUCTION...............................................................................................................................3
2. IPD PATIENT ADMISSION AND DISCHARGE...........................................................................7
2.1. Patient admission at IPD.......................................................................................................7
2.1.1. Patient admission from emergeny department.......................................................7
2.1.2. Patient admission from OPD........................................................................................8
2.1.3. Elective admission..........................................................................................................9
2.2. Patient discharge at IPD........................................................................................................9
3. ED PATIENT ADMISSION AND DISCHARGE..........................................................................11
3.1. Patient admission at emergency.......................................................................................11
3.2. Patient discharge at emergency........................................................................................12
4. NICU PATIENT ADMISSION AND DISCHARGE......................................................................15
4.1. Patient admission at NICU..................................................................................................15
4.2. Patient discharge at NICU...................................................................................................15
5. MCH PATIENT ADMISSION AND DISCHARGE......................................................................15
5.1. Patient admission at MCH...................................................................................................15
5.2. Patient discharge at MCH...................................................................................................15
6. Annex 1: Expected length of stay.............................................................................................16
7. Annex 2: HPH discharge summary..........................................................................................17
8. Referrences....................................................................................................................................18

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 1. INTRODUCTION
The inpatient department (IPD) is where patients who require prolonged overnight stays
(≥2 days) for medical care are accommodated. These patients are typically admitted for
more serious conditions or procedures needing continuous monitoring and treatment.
The IPD provides a dedicated space for patients to receive care, including specialized
wards and services tailored to their specific needs. IPD provides a higher level of care
and monitoring compared to outpatient settings, often involving complex treatments and
procedures.

Patients are admitted to the IPD based on a physicians’ recommendation, usually after
an initial assessment or visit to the OPD or emergency department.

Haik primary hospital IPD has different wards with in it. These include pediatrics ward,
adult male ward, adult female ward and surgical wards. The IPD is staffed with doctors,
IESOs, nurses, pharmacists and other professionals necessary for multidirectional
patient care.

Princilpes of patient admission

The principles of patient admission revolve around ensuring patient safety, comfort, and
a smooth transition into the hospital environment. Key aspects include verifying patient
identity and medical condition, providing clear information and orientation, and
establishing a foundation for ongoing care.

 Patient Identification and Assessment:

 Accurate Identification: Confirming the patient's identity is crucial for preventing

errors and ensuring the right care is provided to the right person.

 Medical Condition Evaluation: Assessing the patient's medical condition helps

determine the appropriate level of care and resources needed.

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 Ensuring Patient Safety:

 Allergy and Medication Review: Identifying and documenting allergies and

current medications is essential to avoid adverse reactions.

 Infection Control: Implementing appropriate infection control measures is vital to

prevent the spread of infections within the hospital.

 Promoting Patient Comfort and Well-being:

 Creating a Welcoming Environment: Greeting the patient warmly and making

them feel comfortable can reduce anxiety and promote a positive experience.

 Orientation to the Environment: Providing information about the hospital layout,

routines, and available resources helps patients adjust to their new surroundings.

 Respecting Patient Privacy and Dignity: Maintaining patient confidentiality and

respecting their personal space are essential for fostering trust and comfort.

 Establishing a Foundation for Ongoing Care:

 Gathering Relevant Information: Collecting demographic, clinical, and social

information provides a comprehensive picture of the patient's needs.

 Informing Patients About Procedures: Providing clear explanations about

upcoming procedures, treatments, and potential risks.

 Documenting Initial Assessments: Recording vital signs, lab results, and other
relevant information establishes a baseline for monitoring the patient's progress.

 Effective Communication and Coordination:

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  Interprofessional Collaboration: Admission procedures involve communication
and coordination among various healthcare professionals to ensure seamless
care.

 Continuity of Care: Planning for discharge and follow-up care begins at the time
of admission, ensuring a smooth transition back to the community.

A patient discharge protocol outlines the process for safely transitioning a patient from a
hospital setting back to their home or another care facility. It includes assessments,
planning, education, and coordination of services to ensure a smooth and successful
transition. A key aspect is ensuring the patient and their caregivers understand the
discharge instructions, medications, follow-up appointments, and potential
complications.

Principles of patient discharge

 Planning and Assessment:
 Early Planning: Discharge planning should ideally begin on or before admission
to the hospital.
 Multidisciplinary Approach: Involve various healthcare professionals (doctors,
nurses, social workers, etc.) in the planning process.
 Holistic Assessment: Evaluate the patient's medical, social, functional, and
psychological needs to identify potential challenges after discharge.
 Identify High-Risk Patients: Pay close attention to patients who may struggle with
self-care or require specialized support after discharge.
 Discharge Criteria: Establish clear criteria for when a patient is considered
medically stable and fit for discharge.
 Patient and Family Involvement: Actively involving the patient and their family
throughout the discharge process is essential for a successful transition.
 Education and Communication:
 Plain Language: Explain the patient's condition, treatment, and discharge
instructions in a way that is easy to understand.

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  Involve Patients and Families: Make sure patients and their caregivers are active
participants in the discharge planning process.
 Written Instructions: Provide clear, written instructions on medications, follow-up
appointments, potential complications, and self-care activities.
 Medication Reconciliation: Review all medications, including any changes made
during the hospital stay, and provide clear instructions on how to take them.
 Follow-up Appointments: Ensure the patient has scheduled follow-up
appointments with relevant healthcare providers.
 Emergency Plan: Explain what to do if symptoms worsen or complications arise
after discharge.
 Coordination of Care:
 Post-Hospital Care: Arrange for any necessary post-hospital services, such as
home healthcare, rehabilitation, or nearbay health center care.
 Transfer Arrangements: Coordinate transportation and any necessary equipment
for the patient's safe transfer.
 Monitoring:
 Post-Discharge Follow-up: Monitor the patient's progress after discharge, either
through phone calls or follow-up appointments, to ensure a smooth transition and
address any emerging needs.

Key Elements of Effective Discharge Planning:

 Early and ongoing communication: Keep the patient and family informed
throughout the process.
 Patient-centered approach: Tailor the plan to the individual patient's needs and
preferences.
 Multidisciplinary collaboration: Involve all relevant healthcare professionals.
 Thorough assessment: Evaluate the patient's physical, social, and psychological
needs.
 Clear and concise instructions: Provide written and verbal instructions that are
easy to understand.
 Post-discharge support: Arrange for necessary services and follow-up care.

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 2. IPD PATIENT ADMISSION AND DISCHARGE
2.1. Patient admission at IPD
Patient admission is a structured process in a healthcare facility where a patient is
formally accepted for care and treatment. This procedure involves several steps. But the
steps to be followed have some difference for patients admitted from emergency, OPD
and for elective admissions.

2.1.1. Patient admission from emergeny department

Once the patient arrive to emergency department he/she will be evaluated and received
treatment and care by emergency department staffs. Based on the patients’ disease
type and level of severity some of them will be sent home back after hours of
management at emergency, few of them might need higher level care and reffered to
DCSH, and the rest others will be admitted to IPD for further care and followup.

1. Indication for admission: patients who are known or expected to require days of
hospital based treatment and care must be admitted to IPD with in 24 hrs of
emergency presentation.
2. Dicission for admission: GPs are the first point of contact for patients seeking
medical care and can initiate the admission process. Although they can admit
pediatrics and medical patients with clear indication for admission by themselves,
they should consult a senior before admitting a patient, especially those with a
critical illness. IESOs, with or without consulting the surgeon, decide for admission of
surgical patients.
3. Admission paper and chart completeness: after decision for admission the chart
should be complete including physicians’ evaluation, order sheet, growth monitoring
and an admission paper, which has to be filled by nurses.
4. Liaison: A liaison ensure a smooth transition for emergency to IPD. They have to
check completeness of charts and categorize paitents wether they get CBHI or

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 payed service. They also check presence of free bed at IPD and finally sign for
admission.
5. Porter: The porter will bring the patient with his/her chart to the IPD.
6. Acceptance at IPD: The IPD nurse should welcome the patient warmly and register
him/her at the IPD admission registration book. The accepting nurse must also take
all the vital signs of the patient just after admission and document all the necessary
information on the nursing care plan, including expected length of stay.
7. Patient orientation: The process of familiarizing patients with their surroundings,
healthcare team, and the overall hospital environment. It's a crucial aspect of patient
care that aims to improve patient safety, comfort, and understanding during their
hospital stay.

[Link] admission from OPD

Admitting a patient from the Outpatient Department (OPD) to the Inpatient Department
(IPD) involves a process of transitioning a patient from receiving care without overnight
stay to requiring hospital admission.

1. Admission decision: a senior physician or a GP (with consultation to a senior)

decides the need to admit a patient.
2. Documentation: the indication for admission and subsequent plans must be clearly
documented. The GPs should document as “senior consulted and decided to admit
the patient”.
3. Liaison: A liaison ensure a smooth transition for OPD to IPD. They have to check the
documented decision for admission and categorize paitents weither they get CBHI or
payed service. They also check presence of free bed at IPD and finally sign for
admission.
4. Porter: The porter will bring the patient with his/her chart to the IPD.
5. Acceptance at IPD: The IPD nurse should welcome the patient warmly and register
him/her at the IPD admission registration book. The accepting nurse must also take
all the vital signs of the patient just after admission and document all the necessary
information on the admission paper and nursing care plan, including expected length
of stay.

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6. Patient orientation: The process of familiarizing patients with their surroundings,
healthcare team, and the overall hospital environment. It's a crucial aspect of patient
care that aims to improve patient safety, comfort, and understanding during their
hospital stay.

2.1.3. Elective admission

An elective admission refers to a planned hospital admission for a procedure or
treatment that is not an emergency. It implies that a reasonable delay in the admission
won't negatively impact the patient's health or outcome. At HPH elective admissions are
only for surgical procedures.

1. Decision for admission: The surgeon decides for elective admissions.

2. Liason: with documented admission note on their chart patients will go to liason
office. At liason office the patients receive appointmet dates for admission based on
the waiting list. On the date of their appointment the liason will should confirm their
admission.
3. Acceptance at IPD: The IPD nurse should welcome the patient warmly and register
him/her at the IPD admission registration book. The accepting nurse must also take
all the vital signs of the patient just after admission and document all the necessary
information on the admission paper and nursing care plan, including expected length
of stay.
4. Patient orientation: The process of familiarizing patients with their surroundings,
healthcare team, and the overall hospital environment. It's a crucial aspect of patient
care that aims to improve patient safety, comfort, and understanding during their
hospital stay.

2.2. Patient discharge at IPD

Patient discharge process

1. Discharge planning: begins at admission by telling the patient his/her expected

length of hospital stay and continues throught the patients’ hospital stay. See annex
1 for expected length of stay for different cases.

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2. Discharge decision: a physician or an IESO have to decide the date of patient
discharge from hospital. Clinical stability and functional ability are the major
indications to discharge a patient.
a. No fever for 24-48 hours.
b. Improvement in clinical status, including general well-being, appetite,
hemodynamic stability, and urine output.
c. No respiratory distress.
d. Stable vital signs (PR, BP, To, etc.) for atleast 24 hours.
e. Adequate fluid balance.
f. No active bleeding with stable hematocrit (HCT)
g. Adequate oral intake while off IV fluids.
h. Ability to perform basic self-care activities (eating, dressing, toileting) or the
ability to manage with appropriate support.
3. Discharge Summary: A comprehensive document summarizing the patient's
hospitalization, diagnosis, treatment, and post-discharge instructions must be
prepared by the discharging physician or IESO.
4. Medication Review: A review of the patient's medications is conducted by a nurse
to ensure they are appropriate for discharge, and any necessary changes are
communicated to the patient.
5. Education and Instructions: Patients and their caregivers must receive clear,
understandable instructions regarding medication management, wound care, dietary
needs, follow-up appointments, and potential warning signs or complications by the
discharging physician or IESO.
6. Follow-up Arrangements: Necessary follow-up appointments with specialists or
primary care physicians must be arranged before discharge. Write the appointment
date on a small notice card and check national calendar to know the exact dare of
referral clinics.
Tuesday: internist; Wedensday: sergeon; Thursday: pediatrician; Friday:
gynecologist
7. liason: after discharging the patient the portor have to take the chart to the liason
office where checkup for documentation completeness done.

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For patients who left against medical advice inadition to making the patient sign (or the
attendant if the patient is unable to do so) as left against all the other steps should be
followed including documented discharge summary and appointment.

3. ED PATIENT ADMISSION AND DISCHARGE

EOPD (Emergency Outpatient Department) refers to a unit where patients with acute conditions
are assessed, treated, and either discharged or admitted to inpatient services based on clinical
needs. At emergency atients typically stay less than 24 hours.

3.1. Patient admission at emergency

1. Triage Assessment
- Conducted by trained triage nurse.
- Determine acuity level based on vital signs, symptoms, and overall condition (e.g., using
ESI or CTAS scale).
- Assign triage priority (e.g., Red, Orange, Yellow, Green, and Blue).
2. Registration
- Patient identification and EOPD record creation.
- Assign case number or OPD number.
3. Initial Clinical Evaluation: Performed by EOPD physician.
- Collect: Presenting complaint; History of present illness; Past medical/surgical history;
Medication and allergy history; Conduct focused physical examination.
4. Preliminary Investigations (if indicated)
Labs (CBC, electrolytes, RBS, etc.)

ECG

Imaging (X-ray, ultrasound, etc.)

Urine/stool tests

Point-of-care tests (e.g., glucose, malaria)

5. Diagnosis and Provisional Plan

Based on history, exam, and initial findings decide on:

- Observation in EOPD
- Immediate treatment

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 - Transfer or admission to inpatient ward

6. Treatment Initiation
Administer emergency drugs, fluids, oxygen, etc. as needed.

Provide pain relief, antibiotics, antipyretics, or other relevant meds.

Monitor vitals during EOPD stay.

Common admitted cases at emergency:

Medical: asthma exacerbation, severe pneumonia, poisoning, DKA, sepsis (with or without
shock), stroke, meningitis, seizure, hypertensive crisis, dyspepsia

Pediatrics: sepsis (with or without shock), AGE, severe pneumonia, DKA, poisoning,
meningitis, seizure

Surgical: trauma, burn, acute appendicitis, foreign body

3.2. Patient discharge at emergency

1. Re-evaluation
- Assess response to treatment.
- Re-check vital signs and general status.
- Confirm patient is clinically stable for discharge.
2. Discharge Criteria
- Diagnosis confirmed or probable with no danger signs.
- Symptoms resolved or improved.
- No need for inpatient monitoring or procedures
- Patient/family understands home care instructions.
- Follow-up plan is clear.
3. Discharge Documentation
- Final diagnosis
- Treatment given in EOPD

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 - Medications prescribed on discharge
- Investigations done and pending (if any)
- Follow-up instructions
- Physician signature and date

4. Discharge Counseling: Educate patient/caregiver on:

- Disease condition
- Medication instructions (dose, timing, duration)
- Red flag symptoms requiring return
- Follow-up appointment details
- Use simple language or local dialect if needed.
5. Transfer to Inpatient Care (If Not Discharged)
If patient needs further observation or treatment:

- Admit to appropriate ward (medical, surgical, pediatrics, etc.)

- Arrange transport and handover if from another facility
- Complete admission note
6. Referral of patients
- For patients who need further investigations or better care refer to DCSH
- See patient referral protocol
7. Patient disappearance
- If the patient disappears from ED after they get out of hospital for investigation or any
other reason and never return back within 24 hours, write the notice “disappear” on the
chart and return the chart.
8. Left against
- For patients who wants to get out of hospital by themselves give proper counseling
about the benefit of getting care at hospital and the risks of leaving against medical
advice.
- After proper advice if they wants to leave against advice, make them leave the hospital;
 Prescribe oral medications if applicable
 Give them appointment cards if applicable
 Tell them they can return back at any time
 Make them sign for their leave against medical advice

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9. Quality & Safety Measures
- Use checklists for admission and discharge
- Maintain infection control (hand hygiene, PPE)
- Ensure accurate patient identification
- Confirm medication reconciliation
- Use pain and vital sign reassessment tools

Cases who can be Cases who need Cases who need

managed and inpatient referral to DCSH
discharged from admission
ED

Asthma exacerbation Sepsis Stroke

Poisoning DKA MI

Minor traumas Severe pneumonia Head injury

Moderate to severe
Hypertensive urgency Meningitis
snake envenomation

Foreign body Burn Rabbis

Dyspepsia AGE Pediatric severe DKA

Seizure Appendicitis

Hypoglycemia

Liaison Officer: A person, often with a nursing or other health qualification whose main duties
are effecting referrals, bed management and coordinating admissions and discharges of patient
Non-Physician Clinician: Health professionals who are not physicians but can make clinical
decisions in the absence of a physician (e.g. health officer, midwives, emergency nurse
professional)
Patient Waiting Area: A patient waiting area is a place where patients can wait for either
admission or discharge. Similar to an airport, the patient waiting area is a ‘holding area’ for
patients who are either on their way into or out of the inpatient wards.
Pediatric Age Group: Those whose ages range from birth to 15 years

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Semi-elective: An intervention to preserve the patient’s life that does not need to be done
immediately
Social Services: Services and activities aimed at supporting or improving an individual’s well-
being. Often an organized public service department as in Ethiopia that can play an important
role before admission but even more so in helping to ensure that patients in hospital and being
discharged have their psychosocial needs assessed, planned for and addressed. In some
countries, social workers are also deployed within the hospitals.

4. NICU PATIENT ADMISSION AND DISCHARGE

4.1. Patient admission at NICU

4.2. Patient discharge at NICU

5. MCH PATIENT ADMISSION AND DISCHARGE

5.1. Patient admission at MCH

5.2. Patient discharge at MCH

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 6. Annex 1: Expected length of stay
Medical ward Pediatrics ward Surgical ward
Case Exp Case Exp Case (post op stay) Exp
ecte ecte ecte
d d d
LoS LoS LoS
in in in
day day day
s s s
CHF 7 CHF 7 Simple appendicitis 2
CLD with UGIB 3 Severe anemia 3 Complicated appendi. 7
CLD with HE 10 Severe pneumonia 5 Goiter 2
Severe anemia 3 HAD 3 BPH 7
Severe pneumonia 5 Croup 5 Cholelithiasis 2
Complicated PPE 14 AGE 3 SBO 7
Empyema 30 Meningitis 14 LBO 7
Tuberculosis 7 ATP 3 Wound dehiscence 7
Stroke 7 DKA 5 Varicose vein 1
DKA 3 Severe malaria 5 Hernia 1
AKI 7 SAM 14 Fistula 1
Meningitis 14 Hemorrhoid 1
Severe malaria 5 POP
Sepsis of GI focus 3 Fistula repair
Pyelonephritis 3 Myoma
DVT 7
NICU day Maternity Day
s s

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 7. Annex 2: HPH discharge summary
Name________________________ Age_____ Sex___ Ward__________ Bed No_____ MRN_________

Date of admission_____________________ Date of discharge______________________

Subjective summary_____________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Objective summary______________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Current subjective_______________________________________________________________

Current objective summary________________________________________________________

______________________________________________________________________________

Investigations__________________________________________________________________

______________________________________________________________________________

Management___________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Outcome: Cured Improved Same Reffered Left against

Final diagnosis_________________________________________________________________

_____________________________________________________________________________________

Discharge advice and medication____________________________________________

______________________________________________________________________________

______________________________________________________________________________

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Appointment___________________________________________________________________

Discharging physician name and signature____________________________________________

Nurses’ name and signature_______________________________________________________

Patients’/their attendants’ name and signature_________________________________________

8. Referrences
 DCSH admission and discharge protocol
 [Link]
 [Link]

Amending team members

1. Dr Andinet Azaje (Internist, CCO) Sign ____________

2. Dr Demoz Fikir (Pediatrician) Sign ____________
3. Seid Mohamed (IESO, quality officer) Sign ____________

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Amendment ------------------------------------------------------------every year

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