2. PAGE OF CONTENTS
• A. PURPOSE
• B. SCOPE
• C. RESPONSIBILITY
• D. PROCESS
• 1. Discharge Decision
• 2. Preparation of Discharge Summary
• 3. Billing for payment and credit category patients
• 4. Patient Counseling
• 5. Leave Against Medical Advice
• 6. Patient Expiry
• 7. Records Generated
3. A. PURPOSE
• The purpose of this policy is to set out the process requirements and
staff responsibilities to support well-organised, safe and timely
discharge for all patients.
• It aims to fully involve patients and their carers/relatives in the
discharge process and ensure that patients receive appropriate
assessment, planning and information about their discharge and after
care.
4. B. SCOPE
• Patient discharge must be seen as an interdisciplinary and/or disciplinary
issue. Therefore, this policy applies including doctors, allied health
professionals, medico social workers and administrative staff. It call the
patients who are admitted and getting discharge from the SVIMS hospital
including following categories:
• a Patient cured of disease
• Patient with treated disease to take further treatment in OP basis
• Patient not fully treated But getting discharge for other reason
(social,financial, family, personal)
• Terminally ill patients getting discharge
• LAMA
• Expired patient
5. C. RESPONSIBILITY:
Treating doctor/ ln charge of unit is the responsible person
• D. PROCESS:
• 1. Discharge Decision:
• Decision regarding discharging the patients rests with the treating doctor / In charge of the patient who
make such decision during his evening rounds on the previous day prior to the discharge of patient and the
same is communicated to the patient & relatives ,the concerned ward nursing staff / duty Medical Officer.
However the final decision regarding discharge is made on the basis of the condition of the patient during
the morning rounds of the treating consultant on the scheduled day of discharge.
• On the scheduled day of discharge the treating doctor/ In charge during his morning rounds examines the
condition of the patient to ascertain whether the patient can be discharged or not. After confirming the
patient fit to be discharged on that day the same is communicated to ward nurse, secretary and the medical
officer on duty.
6. 2. Preparation of Discharge Summary
After final decision to discharge the patient is taken, the treating consultant / duty Resident/ Medical officer
prepares the discharge summary of the patient which contains the following information:
a. Patient demographic data, UHID , IP number
b. Reasons for Admission
c. Investigations performed and summarized information about the results of the Investigation
d. Diagnosis
e. Record of any procedures (operation, etc) performed
f. Condition of the patient at the time of discharge
g. Medication instructions
7. h. Follow up Advice
i. Emergency contact number of the hospital, when and how to contact
One copy of the Discharge Summary will be handed over to the patient/relatives and
the other copy is attached to the patient’s case sheet.
As per the medication advised by the treating consultant in the Discharge Summary, Ward
nurse will collect the medicine from the pharmacy for credit patients and handover to
patient relatives. In case of paying patients, patient relatives are advised by the ward nurse
to collect the medicine from the pharmacy.
3. Inpatient Billing:
In case of discharge of paying patients admitted in the hospital, ward nurse forwards the
Patient case sheet along with the Discharge summary to the inpatient billing for clearance.
.
8. • In case of various credit patients admitted in the hospital, ward nurse forwards the patient case sheet
along with discharge summary to the concerned credit department for the bill settlement. (DR
YSRA & EHS Cell, credit cell). Inpatient billing section prepares the final bill of the patient
adjusting the advance paid by the patient/relatives at the time of admission. In case any refund has
to be made the same is done or the balance amount if any will be collected from the patient /
relatives at the billing section. Final settlement of payment is done, cash receipt prepared and handed
over to the patient/relatives and a copy of the same is forwarded to the ward nurse who enters the
same in the discharge register maintained in the ward. The whole discharge process should be
completed in 3- 4 hours.
4. Patient Counseling
• Prior to discharge of patient from the hospital the ward nurse counsels the patient regarding the
diet, medications , follow-up etc., as mentioned in the discharge summary. Patient follow up visit
dates are clearly informed. Patients discharge records are entered in the Ward Admission
/Discharge register.
• In case of old patients, bedridden patients, and recently delivered patients etc they are taken to
the hospital exit area in wheel chairs / stretcher by the ward attendants.
9. 5. Left against Medical Advance (LAMA)
• In case patient/relatives want to get discharged against medical advice, the same is indicated in the patients
case sheet record by the treating doctor /medical officer and the same is entered in patient case sheet and a
written consent is taken from the patient/relatives.
• Discharge Summary is prepared and the above mentioned steps are followed.
6. Patient Expiry
• In case of expiry of the patient the treating doctor /medical officers/nursing staff informs the patient
relatives.
• Ward nurse makes necessary preparation for cleaning the body. Body is cleaned by designated staff and
wrapped in clean sheet. The on duty medical officer prepares three copies of the Death Summary. Body
handed over to the patient relatives or kept in the mortuary within an hour of death. Body handed over to
the relatives along with one copy of Death Summary and the second copy is attached to the patient case
sheet and the third copy will be forwarded to municipal office/ updated in the births & deaths website (for
issue of birth and death certificates by municipal authorities).
• In case of medico legal cases at the time of admission police intimation given by security officer to local
police station and in case of death of MLC case the body will be handed over to local police for further
process.
10. Treating consultant informs ward nurse about discharging the patient (an evening
before the scheduled day of discharge)
Patient’s relative informed by the ward nurse
Final decision on discharge taken by the treating doctor ( on the scheduled day of
discharge )
Paying category patients
Patient/relatives pays the bill
amount in billing section
DR YSRA & EHS cell &
CREDIT cell
Credit category patients.
Patient/relatives counseled by ward nurse and
discharge
Discharge Process:
11. 7. Records Generated:
• 1. Patients Case sheet
• 2. Discharge Summary / Death summary
• 3. Death commentary
• 4. LAMA consent
• 5. Admission& Discharge Register
• 6. Final Bill
