The hospital admission to discharge process

The patients are looked after by a healthcare team specially trained to treat urgent medical conditions like that one that caused them to visit the Hospital Clínic’s Accident and Emergency Department.

Admission

The Hospital Clínic de Barcelona’s Accident and Emergency Department has two admission points, which are open 24 hours a day. The admission points are located on floor 0 and the first floor (Accident and Emergency Department reception).

What documentation is required during the admission process?

The following documentation is required for the correct registration and clear, unambiguous identification that guarantee the patient’s security:

• Personal identity document (ID card, NIE, passport, etc.)
• Valid individual health card (TSI, TSE, etc.)

If the patient is registered with another healthcare authority, they must present authorization for their stay in hospital before they are discharged. 

If the patient does not have the abovementioned documentation, any administrative staff member in the Accident and Emergency Department can inform them about their options and the steps to take.

Triage

After the reception, the triage assessment is carried out, in order to classify and prioritize patients rationally, so that they are seen in accordance with the severity of their condition and irrespective of the order in which they arrive.  This ensures that the patients with the most serious conditions are prioritized. This process is carried out by the nursing staff using a computer program that assesses the patient’s symptoms via a series of basic questions.

A five-level triage system is established:

• Level 1. Situations that require resuscitation, are life-threatening and need immediate attention. These patients are generally taken to the immediate attention area.
• Level 2. Emergency or very urgent situations that could become life-threatening, and their resolution depends on time.
• Level 3. Urgent situations that are potentially life-threatening.
• Level 4. Less urgent situations, potentially complex but not potentially life-threatening.
• Level 5. Non-urgent situations, which allow for a delay in treatment or can be programmed without any risk to the patient.

Initial attention

Once the patient has been admitted, they are given an identity wristband, which they must wear throughout their stay in the Accident and Emergency Department. Later, they are called by name and visited in an observation bed in the area that corresponds to their level of urgency.  A nurse (and/or nursing auxiliary) helps the patient settle in and carries out an initial assessment, which includes monitoring their vital signs. Next, the patient has a medical visit, after which the attending doctor decides whether to request any diagnostic tests (blood test, X-rays, etc.). The treatment then begins, if necessary, and the presumptive diagnosis is made.  Once the results of any diagnostic tests come back, and the response to the initial treatment is assessed, the doctor responsible for the patient's care makes a diagnosis and explains their final destination, which may be:

Discharged home

A discharge report is provided with the diagnosis, the treatment recommendations and the general measures that should be followed at home, as well as the warning signs that the patient must look out for.  Observation in the Accident and Emergency Department. For a maximum of 24 hours. Hospital admission. Depending on the availability of hospital beds and the severity and / or complexity of the patient’s condition, they are admitted to the Hospital Clínic or to one of the healthcare units such as the: the Hospital Plató, Hospital Sagrat Cor, Clínica Sant Antoni, Parc Sanitari Pere Virgili, Hospital Sant Joan de Déu de Barcelona, Numància Salut Mental, hospital at home.

Observation in the Accident and Emergency Department

On the instructions of the attending doctor, the patient is transferred to the observation area, in the Helios Building, where they either remain in observation in the Level 2 area or in a resuscitation bed.

In the Helios Building:

• The patient’s response to the treatment administered is assessed for several hours in order to decide whether they can be discharged and sent home or need to be admitted as an inpatient.
• The doctors will carry out additional diagnostic tests on the patient outside the Accident and Emergency Department (ultrasound scan, computerized tomography scan, etc.).
• Area in which the patient has to wait until an on-call specialist (not an A&E specialist) visits them.
• Area in which to wait until the doctor and the service that admitted the patient have a hospital bed available for their transfer.

In Level 2 and the resuscitation bed, the previous actions are also carried out, but during their stay in hospital the patient continues to be monitored.

During observation in any of the areas, the patient is assigned an A&E doctor, who will keep them updated regularly, in accordance with the medical visiting times or, in Level 2 / resuscitation bed patients, whenever there is a change in the patient’s condition. 

Likewise, the patient is allocated a nurse and / or a nursing auxiliary who care(s) for them and look(s) after their well-being.   It is important for there to be no more staff changes than strictly necessary, since changes in healthcare staff can lead to mistakes and compromise the patient’s safety.

Reminder. The Accident and Emergency Department is an area that is open 24 hours a day and, therefore, decisions can be made about the patient’s destination (discharge or admission) at any time. 

Hospital admission

When hospital beds become available in the Hospital Clínic, the patient is transferred to the inpatient wards, which may correspond to their admission service or may be pre-admission wards. 

If they are admitted to a location other than the Hospital Clínic, they are transferred by ambulance, where the patient can be accompanied by a friend or family member. 

General information on the stay in the Accident and Emergency Department

• Space. Space is limited in the observation units, so it is important to ensure there is no more than one companion with the patient. 
• Food. Permission must be asked of medical staff before the patient eats anything. If the patient is allowed to eat, the companion can go out and get food for them, since the Accident and Emergency Department only has juice and yoghurts. If the patient stays in the Accident and Emergency Department for over 12 hours, they will be given hospital meals.
• Medication. During their stay in the Accident and Emergency Department, the patient is not allowed to take any kind of medication. The patient's team of doctors and nurses must be consulted. 
• WiFi connection. WiFi access is offered in all areas of the Accident and Emergency Department.
• Personal items. The patient and any companion must look after their own personal and valuable items, since the hospital cannot be held responsible for their loss.