Types of Hospital Admissions

Admission to an acute hospital can either be voluntary (elective) or mandatory (urgent/emergency). Elective admissions are those that arise as a result of a general practitioner's or medical consultant's referral to the hospital, a visit to the hospital's outpatient department, or a prearranged transfer from another hospital. Some patients, for example, patients requiring chemotherapy who are both urgent and planned, may confuse these concepts. The establishment of an efficient emergency and elective admissions and discharge planning function should be guided by many concepts. These are some of them: 

• The delivery of patient-centered services to the right people in the right place at the right time without jeopardizing safety, quality, or clinical standards to the general public. 
• Patients should be consulted and included in all healthcare choices. 
• The most recent evidence should be used to guide clinical practice and care. 
• Collaboration and clinical networking across hospitals and care groups are critical to improving outcomes, especially when dealing with complicated medical challenges. 
• A service that is based on sound clinical judgment (i.e., founded on continuous quality improvement, staff development, risk management, and audit) 
• Acute hospital services should be divided into three interdependent streams of care. They are divided into three categories: emergency, elective, and outpatient/daycare. 
• The importance of Primary Care Teams should be highlighted. 
• Healthcare staff should receive early introduction training by the principles outlined above. 

Proper management of hospital beds and associated resources is critical if the increasing demand for hospital resources is to be satisfied. The following are examples of known barriers to the patient "flow" in hospitals: 

• Access to inpatient beds is difficult to come by (i.e. insufficient bed capacity) 
• As a result, Emergency Departments are overburdened. 
• Patients should not be kept in hospital beds for long periods. 

Resources must be used efficiently and effectively to ensure that all patients admitted to the hospital receive the high quality and safe care to which they are entitled. Patients can transition effortlessly between emergency care and the best and most suitable inpatient care, primary care, and ongoing care, depending on their needs. All users of health services have the right to effective quality assurance and safe care. 

Emergency Admissions 

An unplanned emergency hospital admission occurs as a result of trauma (injury) or an acute illness that cannot be handled as an outpatient. The criteria listed below have been discovered as useful in enhancing admissions management and general patient flow in the Emergency Department to manage the balance between elective and emergency admissions. 

Managing emergency admissions: In the emergency department (ED), immediate care takes precedence over conventional admission processes. The patient is given a temporary identification bracelet, a physician's order sheet, and a record of care when they arrive at the nursing unit after ED treatment. To maintain continuity of treatment and obtain insight into the patient's condition and behavior, read this record and speak with the nurse who cared for the patient in the ED. Next, make a note of any ongoing treatments, such as an IV infusion. Take and record the patient's vital signs, and treat the patient according to the doctor's recommendations. If the patient has family members with them, ask them to wait in the lounge while you assess the situation and begin the treatment. After the patient has settled into their room, allow them to see them. Start with normal admission procedures as soon as the patient's condition allows. 

Elective Admissions 

Keeping the competing demands for hospital beds from elective and emergency cases of various complexity in check will undoubtedly remain a significant concern in the future. The following priorities have been highlighted to improve the experience of patients waiting for elective admission: 

• On the ratio of emergency admissions to planned elective surgeries, there is a local clinical consensus. 
• Criteria for hospital admission and periods of stay are being reviewed and monitored. 
• Greater emphasis on ensuring that when admitting elective patients, the length of time they have been waiting since the decision to admit was made – taking into account their clinical needs – is taken into account. 
• Greater consistency in waiting list administration, including regular monitoring of cancellations, suspensions, and removal from waiting lists without treatment. 
• The focus is on discharge planning from the first day of hospitalization. 
• The implementation of a holistic approach to bed management 
• The appointment of a management or clinician with enough authority and support to balance and monitor the opposing demands of emergency and elective pressures, ensuring that all bed and theater resources are fully utilized. 

Before a patient is admitted, their episode of care should be planned, taking into account the complete "journey" up to and including discharge from the hospital. Patients and their caregivers should participate in the planning process together. A Hospital Bed Manager should be in charge of bed management, with the power to implement the policy and coordinate the bed management team. The bed management service should be available continuously, i.e., 24 hours a day, 365 days a year.

A senior member of management reports to the bed manager. Continuous analysis and the giving of reports and projections would be part of their responsibilities. The responsibility for allocating beds to patients should be centralized, and the Hospital Bed Manager should have full control over all hospital beds. The bed designation ratio established by the Department of Health and Children should be understood. The Hospital Bed Manager should work within the notional allocation of beds to each specialty to ensure that patients are placed in the most appropriate bed available at the time of their admission and that patients are cared for by staff with the necessary skills. 

The following critical requirements have been identified to promote efficient optional admission methods: 

• Clinical consensus on the parameters for scheduling theater lists and centralized waiting list management 
• All elective admissions should have a pre-admission assessment as a regular requirement to ensure proper planning of the patient's complete trip. 
• For elective admissions, the anticipated length of stay (which should be stated as soon as possible to aid scheduling) should be indicated as soon as possible to facilitate scheduling. 
• Increased day surgery can also be aided by a pre-admission assessment to guarantee proper scheduling and reduce in-patient bed transfers.