VA Nebraska-Western Iowa Health Care System
Admission and Discharge Procedures
Emergency medical care will be rendered immediately to anyone, veteran or not, when such care is required.
Patients who are entitled to care at the VA Nebraska – Western Iowa Health Care System are either receiving treatment for an injury or a disability incurred or aggravated while in active military service (service-connected) or are receiving treatment for non-service-connected conditions provided they are unable to defray the costs of private care. With the exception of care for service-connected disorders, all patients are screened for what is termed “legal and financial entitlement” before being provided care. This entitlement is established by law and the screening is performed by non-medical personnel.
If legal eligibility exists, medical care is rendered on the basis of need for medical care in service-connected conditions and on the basis of need for hospitalization for non-service-connected disorders. Determination of need for medical care and hospitalization is made by a physician. During regular working hours, an admitting physician makes these determinations; after hours, the medical officer of the day makes the determination. If it is determined that a patient meets both the legal and medical qualifications for care, the patient is scheduled to receive such care on a priority basis. Both service-connected and non-service-connected veterans receive treatment on an outpatient basis without prior hospitalization through the Ambulatory Care Program. For the latter, the outpatient care is on a resource-available basis. Patients are admitted to the clinical service which is most appropriate for the admission diagnosis. Medical patients are admitted in rotation to clinical teams staffed by faculty and house officers of Creighton University or the University of Nebraska.
All admissions are subject to post-admission utilization review. The hospital uses InterQual criteria for post-admission review. The utilization reviewers provide the work teams with the diagnostic-related group (DRG) average length of stay (ALOS) for each patient’s admission diagnosis. Ward teams are expected to provide appropriate inpatient care within the ALOS guidelines. Ward teams and their staff attendings are expected to participate in multidisciplinary rounds daily on their patients. These rounds facilitate communication between physicians, nurses, and other support staff and improve patient flow.
Upon completion of necessary inpatient care, patients may be discharged and returned to their personal physician or to non-VA clinics of their choice. In the latter circumstance, no further Veterans Affairs care is offered and Veterans Affairs services are terminated.
Patients may also be discharged to a VA-based ambulatory status for either service-connected or non-service-connected conditions. Service-connected patients should be discharged to the Outpatient Clinic. For non-service-connected conditions, the patients are discharged to Outpatient Treatment/Non-Service Connected (OPT/NSC) status. This status is intended to provide outpatient follow-up care and adjustment of treatments following hospitalization. Upon stabilization of the patient’s condition, the patient may be discharged and returned to the care of a private physician
Irregular discharge, such as against medical advice (AMA) or absent without leave (AWOL), are also employed. Patients who refuse to cooperate or who wish to leave before the physician feels that the course of treatment has been completed are discharged AMA. Patients leaving under these circumstances should be asked to sign a document stating that they are leaving in spite of the fact that they have been advised it would be against their best interest to do so. An AMA template is available in CPRS for use in these instances. A patient leaving the Medical Center without official status (such as without a pass or fails to return from pass at the scheduled time) is considered absent without leave (AWOL) and is so discharged. The following is a tabulation of types of discharge which may be used in dismissing a patient from the Medical Center:
- Outpatient treatment/non-service-connected (OPT/NSC)
- Outpatient treatment/service-connected (OPT/SC)
- Irregular (AMA, AWOL, etc.)