NABH 6th Edition AAC Chapter: Access, Assessment and Continuity of Care Explained

What the AAC chapter is about

AAC is the chapter that follows the patient. NABH describes it as covering how patients are accepted, assessed and reassessed, how laboratory and imaging services are delivered safely, and how care stays continuous through transfer, discharge and beyond. If your hospital gets AAC right, the clinical chapters that follow have a sound base.

Core elements are checked at every assessment, Commitment elements at the final assessment, Achievement at surveillance and Excellence at re-accreditation. Our 6th Edition overview explains how they are scored.

The 13 standards at a glance

Services, registration and admission (AAC.1–AAC.2)

AAC.1 asks the hospital to define its clinical services in line with community needs, give each service the diagnostic and treatment support and qualified people it needs, define each department's scope, and display the services prominently.

AAC.2 covers written guidance for registering and admitting patients. Its Core element is simple and absolute: a unique identification number is generated at the end of registration. The hospital accepts patients only if it can provide the service they need, plans for times when beds are not available, and prioritises access by clinical need.

Evidence that works: a scope-of-services document by department; services displayed at entrances and on the website; a registration and admission policy with a bed-unavailability procedure; a working UHID system; triage or prioritisation criteria.

Transfer and referral (AAC.3)

The hospital needs a defined mechanism for transferring patients in and out and for referring them, so a patient moves with the right information, escort and transport.

Evidence that works: a transfer and referral policy; a transfer summary format; records of the patient's condition, the receiving facility and the accompanying staff; ambulance arrangements.

Initial assessment and reassessment (AAC.4–AAC.5)

AAC.4 requires a standardised initial assessment for out-patients, day-care patients, in-patients and emergency patients, done by qualified staff within a time frame based on the patient's needs. NABH does not fix the time frame; the hospital defines it and must then meet it. Day-care and in-patients also need a nursing assessment at admission, and the in-patient assessment must produce a documented care plan, countersigned by the clinician in charge within 24 hours, that identifies special needs for care after discharge.

AAC.5 requires regular, documented reassessment, so the care plan keeps pace with the patient's condition.

Evidence that works: assessment formats for each patient type; a policy stating who assesses and within what time; nursing admission assessments; countersigned care plans; reassessment frequency defined by unit and acuity, and followed in the notes.

Laboratory and imaging (AAC.6–AAC.9)

Four standards cover diagnostics. AAC.6 and AAC.8 require laboratory and imaging services to be provided as per the hospital's defined scope of services. AAC.7 and AAC.9 require established quality-assurance and safety programmes for each.

Evidence that works: scope and turnaround times for tests; critical-value reporting with records; internal quality control and external quality assessment for the laboratory; sample collection, transport and rejection criteria; lab safety training; for imaging, radiation safety and AERB compliance, equipment quality checks and reporting standards. If any tests or scans are sent outside, keep the agreement and evidence that you monitor the provider's quality.

Continuity, prevention and discharge (AAC.10–AAC.13)

AAC.10 expects care to be continuous and multidisciplinary: handovers between shifts and teams, joint care planning and clear responsibility at every point. AAC.11 brings preventive and promotive health services, such as screening and health education, into the chapter and asks that they be safe, collaborative and consistent.

AAC.12 requires an established discharge process, and AAC.13 requires the hospital to define what the discharge summary contains. In practice a good summary records the reason for admission, significant findings, investigations, diagnosis, procedures and treatment, the patient's condition at discharge, medicines and follow-up advice, including when and how to get urgent care. Check the full list of elements in the standard before finalising your format.

Evidence that works: handover tools and records; a discharge policy, including discharge against medical advice; a discharge summary template matched to the standard; audit of completed summaries.

How assessors test AAC

Assessors rarely ask for the AAC policy first. They pick a patient, often one admitted through emergency, and trace the journey: registration, assessment, care plan, investigations, transfer and discharge, checking each step against your written guidance and the records. Where the policy says one thing and the ward does another, the score drops.

Typical gaps are assessment time frames that were never defined or not met, care plans without the clinician's countersignature, reassessment that exists on paper but not in the notes, and discharge summaries missing required items.

Getting AAC ready

1. Map all 87 elements, marking the 6 Core elements first.
2. Write or revise the policies, with the time frames and responsibilities your hospital can actually meet.
3. Train registration, nursing, medical, laboratory and imaging staff on their part.
4. Audit 20 to 30 patient files a month and fix what the audit finds.
5. Run a mock tracer before the assessment.

Our NABH documents checklist lists the policies by chapter, and we run 6th Edition gap analyses scored the way assessors score. Smaller hospitals follow the equivalent chapter in the SHCO standards.

All ten NABH 6th Edition chapter guides: AAC · COP · MOM · PRE · IPC · PSQ · ROM · FMS · HRM · IMS