Access and Continuity of Care

ACC
1. Patients Initial Screening Prior to Treatment
• Patients who may be admitted to Elaraby Hospital or who seek outpatient
services are screened to identify if their healthcare needs match the
hospital’s mission and resources.

• Patient will be accepted only if the Hospital can provide the necessary
services and the appropriate outpatient or inpatient setting for care.

• So, If The Patient Healthcare Needs is not matching our scope of service or
Resources
• Patients will be Stabilized and transferred to appropriate Healthcare Facility matching
their Health
2. Emergency Department Triage Process
• As ED is struggling to cope with overcrowding, there is a critical need for
triage system to sort these incoming patients more rapidly and more
accurately.

• Emergent or urgent Patients are given priority for assessment and treatment.
• Emergent: patient’s condition is life-threatening and requires immediate intervention.
• Urgent: patient’s condition is potentially life-threatening and requires timely
assessment and possible intervention.
2. Emergency Department Triage Process
• Elaraby hospital uses an evidence-based Australasian Triage Scale to
prioritize patients.
• Patients are triaged to five Categories.
• Level One for the most severe cases that need immediate intervention.
• Level five for the cold cases.

• 2 forms used in ED of our hospital,

• Emergency Department Triage and Assessment Form
• ED Patients Follow up Instructions Form
ED nurse completes these 2 pages
ED physician completes the remaining pages
3. Observation of Patients in Emergency Department

• In Elaraby Hospital, there is no Observation of Patients in ED.

• So, the hospital shall:

• Admit the patient, if there is available bed.
• Transfer the patient to another hospital, if there is no available bed.
• Discharge the patient, if the patient is hemodynamically stable.
• Hold the patient in ED holding area for continuous monitoring, until a bed is vacated.
4. Managing Patient flow in Emergency Department (Holding
patient in ED)

• In case bed is not available or there is a delay of patient admission

for any reason,
• The patient will be held in ED Holding area (2 beds in observation room 1).
• The patient will be under direct observation and clinical management of
the relevant clinical/nursing staff.
• Patient will be kept there up to maximum 6 hours’ time frame.
• During this time, patient care will be similar to the inpatient and
management plan with same frequency of vital signs.
5. Admission & Discharge criteria for ICU

• Admission Criteria Checklist for ICU

• Admission Criteria Checklist for Surgical ICU

• Discharge Criteria Checklist for ICU

• Admission Criteria Checklist for Pediatric Patients in ICU

• Discharge Criteria Checklist for Pediatric Patients in ICU
6. Admission & Discharge criteria for NICU

• Admission Criteria Checklist for NICU

• Discharge Criteria Checklist for NICU

7. Continuity of Patient Care

• Continuity of care: The degree to which the care of individuals is

coordinated among practitioners, among organizations, and over time.

• The patient’s medical record is an essential communication tool and a

primary source of information on the care process and the patient’s
progress, thus medical record facilitate continuity of care and coordination
among healthcare practitioners.

• All healthcare teams shall keep the patient’s medical record up to date to
ensure communication of the latest information.
7. Continuity of Patient Care

• Continuity and coordination are evident throughout all phases of patient care,
as follow:
1. The Physician shall document patient's care, course of treatment and
discharge.
2. The Nurse shall
• Assure continuity of care with the care plan.
• Assure that a care plan is implemented with input from the patient/family and other
appropriate healthcare team members.
• Exchange of information between nursing staff during each shift, and during transfers
between units.
3. Nutritionist, dietitian, physical therapists, and other ancillary personnel shall
contribute to the care plan through consultation for patients as required.
7. Continuity of Patient Care

• During all phases of inpatient care, there is a qualified primary physician

identified as responsible for the patient care.
• The primary physician will be documented in the admission consent of the patient.

• Continuity and coordination of care processes are supported by the use of

tools, such as care plans, guidelines or clinical pathways.
8. Consultation
• Consultation: refers to a request for another physician’s expert advice,
whenever a patient’s condition requires expertise that falls outside the
primary physician’s privileges.

• Referring physician: refers to a physician who initiates/ asks the expertise

of another physician.

• Consulting physician: refers to a physician who is asked by the referring

physician to give his expertise.
8. Consultation
• Very Urgent Consultation: is for which within 30 minutes medical/surgical
consultation is needed.

• Urgent Consultation: is for which there is medical/ surgical need for

consultation within three hours of the request.

• Routine consultation: is for which the patient’s condition permits 24 hours

for the consultation to be done.
8. Consultation
• The referring physician shall

• Do a full medical history and detailed physical examination to the patient

before determining the need for consultation.

• Initiate a request for consultation to the consulting physician on

consultation form.

• Determine the urgency of consultation; Very Urgent, Urgent and Routine.

• Very urgent and urgent consultations require direct contact between the
referring and the consulting physician.
8. Consultation

• The consulting physician shall

• Respond to request appropriately, review available data (history, physical

examination, investigation) and evaluate the patient.

• Communicate briefly, directly to the referring physician in urgent and very

urgent cases.

• Document specific recommendation (investigation, suggested plan) in the

consultation form.
8. Consultation

• The referring physician shall

• Review and carry out the recommendations made be by the consulting

physician.

• Document this review in the doctors order form.

8. Consultation

• In case of transfer of patient responsibility between the

consulting and referring physician,

• Both physicians shall agree and document this transfer by using

internal transfer form and keep this form as an evident in the
patient medical record

• Internal transfer must be approved by Medical director or his

deputy.
9. Outpatients with Complex Care

• Complex Care Patients:

• Patients who had 10 outpatient visits or more in the last

3 months.

• Patient Diagnosed as Cancer, Diabetes Mellitus, and

Hypertension.
9. Outpatients with Complex Care
• IT Department is responsible for generating online
Electronic summary for Complex Care Patients, named
Complex Care Patients Report.

• This summary Contains data of:

• History and physical examination findings.
• All known significant diagnoses.
• All allergies.
• Current medications.
• Any past surgical procedures and hospitalizations (Admissions
with its Diagnosis).
10. Discharge Planning
• Discharge Planning:
• A multidisciplinary, collaborative process across the continuum of care
involving the patient, patient’s family and concerned team members
during a specific episode of illness.

• Specifying the providers and services that the patient will receive upon
discharge.

• Begins early in the care process, prior to admission (i.e. elective surgical
cases) or at the time of admission if possible (within 8 hours).
11. Patient Discharge
• Discharge: The point at which patient’s active involvement with hospital is
terminated and the hospital no longer maintains active responsibility for the
care of patient.

• Discharge Summary: A section of a patient record that summarizes the

reasons for admission, the significant findings, the procedures performed,
the treatment rendered, the patient’s condition on discharge, and any
specific instructions given to the patient or family (for example, follow-up,
medications)

• Medically Advised Discharge: Is when the physician considers that the

patient no longer requires inpatient care and document this in the patient's
medical record.
11. Patient Discharge
• The physician shall:

• Order specific tests and perform clinical examination to confirm patient’s

readiness for discharge.

• Document discharge order in doctor order form in the patient medical

record.

• Document and complete discharge summary in patient medical record.

11. Patient Discharge
• Staff Nurse shall:

• Check completeness of discharge summary written by Physicians.

• Arrange for follow-up appointments (OPD and support services e.g.,

Physiotherapy etc.) and prescribed medications in coordination with
pharmacy.
11. Patient Discharge
• The physician and staff nurse shall educate patients and their families, in a
form and language the patient can understand, about:

• The safe and effective use of all medications, potential side effects of medications,
and prevention of potential interactions with over-the-counter medications and/or
food.

• Safe and effective use of medical technology.

• Proper diet and nutrition.

• Pain management.

• Rehabilitation techniques.
11. Patient Discharge

• Staff Nurse shall

• Provide the patient/guardian with a copy of discharge summary and any

necessary documents.

• Attach a copy of discharge summary to patient medical record.

• Remove ID band and assist the patient leave the Hospital safely.
12. Against Medical Advise (AMA)

• Leaving Against Medical Advice (LAMA): Is when the patient/ guardian

decide to discontinue treatment and leave the hospital although medically
unfit for discharge.
12. Against Medical Advise (AMA)
A. If patient / guardian notify staff that he/she want leaving against
medical advice:

• The physician shall

• Encourage the patient to wait in the hospital and continue the care plan.
• Inform the patient / guardian about their rights to refuse or to discontinue
treatment.
• Identify the reasons for patient leaving against medical advice and
document it.
• Inform patient / guardian of medical risks of inadequate treatment and
leaving against medical advice.
• Explain of the alternative treatment.
12. Against Medical Advise (AMA)

• If the patient / guardian insist on Leaving against medical advice,

then he/she shall sign Against Medical Advice (AMA) form.

• If the patient/ guardian refuse to sign AMA form, then physician

and nurse shall document this in AMA form and they sign the form,
with another member of medical team or nurse sign as a second
witness.
12. Against Medical Advise (AMA)
B. If patient leave the hospital against medical advice without notifying
hospital staff:

• Staff nurse shall document this in nursing progress notes and inform
the physician.

• The physician shall document this circumstances in doctor progress

note.

• Physician and nurse shall document this in AMA form and they sign the
form, with another member of medical team or nurse sign as a second
witness.
13. Out on Pass

• Out on Pass: the process for patient being permitted to leave the
hospital during the planned course of treatment on an approved
pass for a defined period of time.

• In Elaraby hospital, Out on Pass process is not applicable.

14. Patient External Transfer
• Referral: The sending of an individual, from one clinician to another clinician
or specialist, or from one setting or service to another or other resource,
either for consultation or care that the referring source is not prepared or
qualified to provide.

• Transfer: The formal shifting of responsibility for the care of a patient from
one care unit to another, one clinical service to another, one qualified
practitioner to another, or one organization to another.
14. Patient External Transfer

• Transfer or referral of patients are based on criteria to address

patients’ needs for continuing care. These criteria are:

• Patient`s need for specialized care not available in Elaraby Hospital.

• Non availability of hospital beds in Elaraby Hospital.

• Patient Health Care needs not Matching Elaraby Hospital Scope of

Service.

• Preference of the patient.

14. Patient External Transfer
• The physician authorizing the transfer:
A. Determine the appropriateness of the patient transfer as follow:
• The patient’s medical condition is stable. Patient must be stabilized before a transfer/
referral is made.
• The patient is transferred after assessing the transportation needs of the patient.

B. Determine that the receiving facility can meet the needs of the patient to be
transferred by contact the receiving physician to ensure that the receiving
facility
• Accept patient before the transfer.
• Has an available bed for patient.
• Has the appropriate resources to provide continuing care to the patient.
14. Patient External Transfer
• The physician authorizing the transfer:
C. Ensure that the patient/ family are informed and educated on the need to
transfer and they approve of it.

D. Document in the patient’s medical record as follow:

• External Transfer Form.
• Ambulance Request Form.

E. If patient transfer is not possible, continue the treatment to stabilize the

patient’s condition until proper and safe transfer arrangements can be
made.
14. Patient External Transfer
A. Before transportation, Elaraby hospital assess of transportation that
appropriate to the needs and condition of the patient as follow:

• Appropriate ambulance with the necessary equipment and medications.

• The staff type and qualifications required for the type of patient being transferred.

B. Mode of Transportation: Do not further harm is the most important principle

when choosing the mode of patient transportation.
14. Patient External Transfer
C. During Transportation:

• Management:
• Monitoring vital signs
• Continued support of cardiorespiratory system.
• Use of appropriate medications as ordered by a physician

• Documentation in Ambulance Monitoring Form.