Start of Care/Admission Process Ideas

[tbroz1229]

Looking for ideas on how to improve the start of care process for new hospice admissions. Currently, the start of care process we are using is a three day process in which the patient's case manager/primary nurse is responsible for completing. I was wondering if other services offer admission nurses, how long it takes, why it is done that way, and who completes the admissions. Thank you.....trying to help this process a long with making new patients feel comfortable without disconnecting with current patients.

[hospiRN]

I wish we had an admissions nurse! We, the case managers, take turns taking admissions unless someone asks for us by name. We do our admissions within 24 hours. What is involved in a three day process??

[curiousauntie]

Our goal is to have the nurse there within 4 hours of receiving a referral/md order. No admission nurse, but if possible the case manager who will have the patient will do the admission, or the on-call (me;)) will do it in the evening or weekend. I do the initial assessment, get the legals signed and fill out 3 hours of paper...then there is the follow-up in 24-48 hours. The nurse doing the admission also calls medications into Hospice Pharmacia, gets durable medical equipment delivered and calls the hospice physician and the attending physician to verify orders. Seems like each one takes 3 days, but can actually all be done in about a 5 hour period, with the exception of the follow-up visit.

[Mommy&RN, BSN, RN]

We have usually 2 admission nurses. Many times the social worker or Chaplin meets the family & pt first to sign legals. Then the admit RN will assess the pt and family needs. The admit RN calls MD for decision on medication payment and she will order emergent meds if needed. The secretaries order DME. The CM will see the pt the following day or Monday if Friday night or weekend admit. They open the care plans. Friday night - Monday am the on call nurse does the admissions. Each admission nurse can usually do 2 a day. I would rather gnaw my arm off than do an admit. It took me upwards of 6+ hours to complete. I'm prn, so I don't do many. Our census is around 180.

I forgot to add... A CM is assigned to back up admissions each week day.

We also try to have some discipline see the pt & family every weekday of their first week on service.

[Kabin]

I'm not involved with admissions so take this with a grain of salt.

Admit process needs to begin before the service starts. Whenever possible initial contact is made in the hospital, rehab center, etc. The trick is to not be in such a hurry that you admit inappropriate patients and then upset everyone with added cost and effort of discharge/revoke. Some physicians are very liberal with referrals even giving them when families are no longer able to care for loved ones in the home.