Access, Assessment and Continuity of Care (AAC)

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Access, Assessment & Continuity of Care (AAC) in NABH: Ensuring Seamless Patient Journeys

The Access, Assessment and Continuity of Care (AAC) chapter of NABH 6th Edition plays a foundational role in defining how hospitals initiate care, continue monitoring, and transition patients through various stages of treatment. This chapter ensures that patient care is timely, evidence-based, coordinated, and patient-centric from entry to discharge.

 

In this article, we explore the core components of the AAC chapter, its relevance in day-to-day hospital operations, and practical implementation tips for hospitals working toward NABH compliance.

🔹 AAC.1 – Scope of Services
Hospitals must define the scope of clinical and support services they offer. This should be clearly communicated to staff and patients and be aligned with available resources, specialties, and infrastructure.

Quick Win:

• Display the scope at the entrance and on the hospital website.
• Include specialty lists in your SOP manual and service directories.

🔹 AAC.2 – Patient Admission and Assessment
Upon entry, every patient must be assessed for clinical needs. Assessment should include history, vitals, provisional diagnosis, and risk assessment.

Key Elements:

• Initial assessment by a qualified healthcare provider.
• Time-bound assessments (e.g., within 1 hour of admission).
• Risk scoring tools like MEWS/NEWS for early deterioration detection.

Quick Win:

• Develop assessment templates for ER, OPD, IPD, ICU, and day-care.

🔹 AAC.3 – Transfer and Referral Mechanism
Safe transfer and referral (both internal and external) is critical. This includes documented summaries, handover protocols, and consent.

NABH Emphasis:

• Verbal and written communication during transfer.
• Use of a referral slip or discharge note.

Quick Win:

• Develop a standard checklist and handover form for all transfers.

🔹 AAC.4 – Reassessment
Patients must be reassessed during their stay based on clinical needs or condition changes.

Good Practices:

• Document reassessments in progress notes.
• Use early warning scoring tools at each nursing shift.

🔹 AAC.5 – Discharge Planning
Hospitals must plan discharges in consultation with the patient and family. It must include discharge summary, medication instructions, and follow-up advice.

Quick Win:

• Create a standard discharge summary template with all required fields including follow-up date and contact info.

🔹 AAC.6 – Laboratory Services
Lab services must follow strict quality and communication protocols:

• Panic/critical value reporting.
• Turnaround time (TAT) monitoring.
• External Quality Assurance Program (EQAS) participation. CMC Vellore and RML Lohia are two centers in India to refer  for EQUAS

Quick Win:

• Introduce a ‘read-back’ policy and document each critical value communication.

🔹 AAC.7 – Imaging Services
Imaging must be justified, documented, and follow safety protocols. Critical imaging findings must be reported promptly.

Quick Win:

• Ensure radiologists directly inform treating physicians and record the communication.

🔹 AAC.8 – Outsourced Services
Outsourced services like MRI/CT or specialized labs must be quality-assured. Partner only with vendors having NABL/NABH certifications where applicable.

Quick Win:

• Maintain a quality checklist for all outsourced services with periodic audits.

🔹 AAC.9 – Radiation Safety
Hospitals using radiological imaging must have a radiation safety plan compliant with AERB norms. A Radiation Safety Officer (RSO) must oversee operations.

Quick Win:

• Display ALARA posters and ensure radiation warning signage.

🔹 AAC.10 – Continuity of Care
Hospitals must ensure continuity between departments and during shift changes, through structured handovers, referrals, and care coordination.

Quick Win:

Use a ‘continuity of care’ sheet for every inpatient to track multidisciplinary inputs.

🔹 AAC.11 – Discharge Against Medical Advice (DAMA)
Proper consent, counseling, and documentation are required if a patient opts for DAMA.

Quick Win:

Create a bilingual DAMA form with risks explained clearly and caregiver signature.

🔹 AAC.12 – Death Summary
If a patient dies, a Death Summary must be issued promptly, mentioning the cause of death and care provided.

Quick Win:

Ensure 100% death summaries are reviewed and countersigned by a senior clinician.

Final Thoughts
The AAC chapter sets the tone for the patient-centric philosophy of NABH. From admission to discharge, hospitals are expected to deliver structured, safe, and collaborative care.

Hospitals aspiring for NABH Entry or Full Accreditation should prioritize building policies, staff awareness, and checklists around each AAC element. With the right systems, even small and mid-sized hospitals can efficiently meet these compliance requirements.

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