72 hour notice/AMA

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Hey everyone,

So in my state, if a voluntary psychiatric patient wishes to "sign out" of treatment, they can sign a "72 hour notice" that they would like to withdrawal from treatment, but the form states they can be held up to 72 hours in the hospital for further observation. At your facility ,if a patient who has signed a 72 hour notice gets discharged, do you have them also sign a separate "AMA" paper that states they understand they are leaving AMA and that this and the risks of doing do have been explained to them? Basically, are signing a 72 hour notice and signing out AMA the same thing? Or can a patient sign a 72 hour notice to withdrawal from treatment, and then the psychiatrist says ok, you can be discharged and lets them go without it being considered AMA?

There is confusion on this at my facility....practice has been that if a patient signs a 72 hour notice, the MD will specify whether they want the patient to also sign an AMA form. Other times, patients sign a 72 hour intent to withdrawal from treatment form and are NOT required to sign a separate AMA form. I was always under the impression from working at a previous facility that if a patient signs a 72 hour notice and then gets discharged, the discharge would be considered against medical advise, but that doesnt seem to be the thought where I am working now...

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i'm amazed you don't file the court continuance as soon as they hit the hospital. Most places do that and most doc's unless they know the patient let the court decided if they are sain enough to release.

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Specializes in Family Nurse Practitioner.

Many of my discharges have submitted a 72 but aren't considered to be leaving AMA. In most cases if a patient is not ready for discharge to the point of being unsafe they will meet the criteria for certification. I can only think of a few times someone wasn't certifiable and yet I felt they were worth documenting as an AMA discharge, usually substance abuse who could benefit from continued detox. Most times they are just putting in their notice of intent and I assess them as being able to be managed on an outpatient basis and off they go.

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Specializes in Leadership, Psych, HomeCare, Amb. Care.

In Illinois, it's 5 business days, and at the end of that time the DR can't file court papers if a risk to self or others.

usually, they withdraw the request, or are discharged at the end.

Signing an AMA is not required by the mental health code, and is rarely done.

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Specializes in Psych.

I would think that the patient would have to sign both. First for the intent (or request) to leave AMA, and second to confirm that they are still agreeing to leave after it's been approved by the doc?

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Specializes in hospice.
i'm amazed you don't file the court continuance as soon as they hit the hospital. Most places do that and most doc's unless they know the patient let the court decided if they are sain enough to release.

The OP was pretty clear that these are voluntarily admitted patients, not court-ordered.

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Specializes in Family Nurse Practitioner.
I would think that the patient would have to sign both. First for the intent (or request) to leave AMA, and second to confirm that they are still agreeing to leave after it's been approved by the doc?

But initially they aren't requesting to leave AMA they are simply asserting their intent to leave within 72 hours which requires an assessment to decide if they are safe to go or not.

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Specializes in Psych.
But initially they aren't requesting to leave AMA they are simply asserting their intent to leave within 72 hours which requires an assessment to decide if they are safe to go or not.

If they are "asserting their intent", that is a request to leave...especially since they fill out paperwork legally confirming this intent/request. The MD then has to evaluate if they are safe, yes. In my state, the doc has 24 hours to address this request. If they aren't deemed safe, they are placed on a 72 hour hold, since only voluntary patients are able to make this request...whether they were admitted voluntary, or were on a hold then signed in voluntary.

I've seen patients come in on a 72-hour hold, then sign in voluntary after it expires, want to leave days after signing in voluntary despite that they are actively suicidal with a plan, and get put on yet another hold due to still not being able to be safe.

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Specializes in Critical Care.

We use a form provided by the state which covers the documentation that they were a voluntary admit, they are requesting discharge within the 72 hour period, and includes language that covers the AMA aspects.

Once a voluntary admit requests to leave we can't legally hold them beyond the time it takes to do an "immediate review" of the patient's chart to determine if pursuing an involuntary admission is warranted. This can include informing the doctor so long as they are immediately available, otherwise the doctor needs to leave documentation to hold patient for review if they decide to leave voluntarily.

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The OP was pretty clear that these are voluntarily admitted patients, not court-ordered.

thanks for pointing that out...i see 72 hours...voluntary doesn't register.

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Specializes in Critical Care.
If they are "asserting their intent", that is a request to leave...especially since they fill out paperwork legally confirming this intent/request. The MD then has to evaluate if they are safe, yes. In my state, the doc has 24 hours to address this request. If they aren't deemed safe, they are placed on a 72 hour hold, since only voluntary patients are able to make this request...whether they were admitted voluntary, or were on a hold then signed in voluntary.

I've seen patients come in on a 72-hour hold, then sign in voluntary after it expires, want to leave days after signing in voluntary despite that they are actively suicidal with a plan, and get put on yet another hold due to still not being able to be safe.

If the patient was voluntary, what's the legal basis for holding them for 24 hours despite their stated wish to leave? That sounds like an illegal hold.

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Specializes in Psych.
If the patient was voluntary, what's the legal basis for holding them for 24 hours despite their stated wish to leave? That sounds like an illegal hold.

Ethically, any discharge, including AMA, needs to be approved by a doctor. The doc needs to conduct another evaluation to determine if the patient is safe enough to discharge. If you think about it, if we discharge any patient that isn't safe and they go home and kill themselves or someone else, ultimately we are liable for letting them walk out that door. Destroys the sole purpose of any inpatient stay (I.e. higher level of care). 24 hours is allotted for us because docs are not always on site to do this evaluation...so if I get an AMA request at 2330, which I have, they unfortunately will have to wait until morning for the doc to come in. All of our AMAs are pretty understanding about this.

Normally a client with this severe of an intent is put on a 72hr hold initially to prevent circumstances like wanting to leave AMA from happening...but I have seen cases where a client comes in voluntary and an intent develops during hospitalization to hurt oneself or another person.

Also, leaving AMA means insurance won't cover their hospitalization, which can change people's minds sometimes.

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