Does your hospital give DC instructions to AMA patients

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  1. Does your hospital policy call for DC instructions given to AMA patients?

    • 10
      Yes, we give them and we transport them out the door just as in any other discharge.
    • 4
      Yes, we give DC instructions but no W/C ride to the door.
    • 26
      No, we do not give DC instructions.
    • 2
      Other -- your comments welcome.

42 members have participated

Specializes in Utilization Management.

Just wondering what your hospital policy is. Does hospital policy assure that the patient leaving AMA (Against Medical Advice) gets discharge instructions of some kind or not?

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Very interesting question. I haven't had a patient leave AMA since I started traveling, but before that my hospital didn't provide any d/c instructions. The only requirement was that the doc explain the risks, then patient signed the AMA form and left. We (of course) had to file an incident report.

I wonder if it's a liability issue?

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Specializes in Med/Surg.

Ok I don't mean to sound stupid but why do you file an incident report? All we do is explain why it's not a good idea for them to leave, let them sign the AMA form and call the doctor. Most leave without a nursing escort.

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Our docs had to talk to the patient explaining the risks, then we had them sign the forms. No d/c instructions. Why would you since the patient is going against any medical advice, anyway?

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Ok I don't mean to sound stupid but why do you file an incident report?

Because it's outside the norm and risk management needs to be aware of the occurrence. Liability issues, I'm sure.

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Specializes in Palliative Care, NICU/NNP.

We would call the doc, explain the risks to the patient and have them sign the AMA form. Most of those leaving AMA were ETOH patients or those going back to the streets.

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Specializes in Med-Surg/Peds/O.R./Legal/cardiology.

Hey, Emmanuel! :lol2:

ebear

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Specializes in ER/EHR Trainer.

We have many leave that are on observation: Chestpain, abdominal, tia obs. Once results start coming back negative they get ancy...don't want to wait anymore. This is especially true of those in ER that have been there overnight!

Admitting and consulting physicians called, advised. Patient advised of potential problems, including possible death-asked to reconsider-Paperwork signed. Patient leaves.

AMA Against Medical Advice, says it all. Noting in chart everything above is more than enough! IMHO, If we gave discharge instructions it would almost be like agreeing that a patient was ready to leave and follow up as an outpatient. Many times that is not the case!

Maisy

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Specializes in Emergency/Trauma/Education.

It's always been my practice to give instructions. In my brain, explaining the risks, etc is giving instructions to the patient.

I've seen a doc write an antibiotic Rx for an ED patient refusing sutures (why they refused, I can't remember). Why wouldn't I discuss wound care with that patient? Care instructions for a wound left open to heal go hand-in-hand with explaining the risks of the decision & warnings of when to return.

Of course...and here's my disclaimer...the patient has to be willing to listen to said instructions! ;) I realize that in some AMA situations, the only thing the patient is interested in is getting out the door!

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Specializes in Emergency.

It kind of a double edged sword. AMA pts are a potential liability risk each and every time you deal with one. The more documentation on can have the better. This includes instruction or the lack there of. Even if it is as little as saying to return if their condition changes to in depth detailed ones. To just have them sign an AMA form and leave it up to the MD to document is leaving one self open to liability.

I work in the ED, with the most common patients to AMA being chest pain patients. That work up take minimum of 18-24 hours on a good day to get 3 negative enzymes and other tests.

People ask all the time even at triage how long is it going to take, I typically am brutally honest and tell them they are having chest pain, you are going to be admitted for observation at the very least, but along the same vein I tell them that if it is their heart and the leave they may end up very dead as well.

RJ

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Specializes in Neuro, Critical Care.

work in the ICU but yes, i have had some leave AMA. They leave with DC instructions and a nurse escort or PCT from our floor.

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We try to do d/c instructions on AMA pts, but not all are willing to stay that long. Some might leave as soon as they find out they are not going to get narcotics and refuse to wait for anything. Most just disagree with the course of action, like continued monitoring, further lab tests, or admisions. We take the approach that if the pt refuses the ideal course then try to find the next best thing the pt will agree to. Maybe a pt wont stay for cardiac monitor, but will take a holter monitor, wont get stitches but will take antibiotics and proper dressings. In most cases I always include in my d/c instructions that if they change there mind and things worsen to feel welcome to return.

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