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Discussion

legit discharge?

a voluntary patient came in to the psych unit and was suicidal and also using alcohol. They were detoxed off the alcohol, started on antidepressants, and was no linger suicidal at discharge. The pt wanted to go to a specific rehab at discharge but the rehab wouldn't accept him. So, the pt decided he didn't want us to schedule him any follow up. The Dr. said he was discharging him home then. My question is, was this ok? Was it ok to discharge this patient with no aftercare? The Dr. the patient was no longer suicidal so they could be discharged regularly, AMA wasnt necessary. They got a 30 day supply of meds but with no aftercare, they will have to find a provider on their ownwho will continue to prescribe the meds...

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    If the patient is AO4 and not holdable, it's legit. Not ideal, and not the preferred practice by most places, but legit. You can't force a patient into follow-up care that they don't want. Just be sure you document the patient's refusal for follow-up care.

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    Without knowing much much more about this particular case, an answer to this question in this vacuum is impossible, but this is really two separate questions. Being awake, alert, oriented, and denying suicidality is completely irrelevant to the question of this patients ability to be discharged safely. What's more important is a thorough suicide risk assessment taking into account their chronic/acute risk factors for suicide and having a psychiatrist make a decision as to whether or not they are too dangerous to leave the hospital. The second question about the follow up is a little easier. Generally, if a patient is safe enough to leave they generally have the right to not have follow, though this is not optimal. If a patient doesn't want to follow up, they probably won't regardless of whether you have scheduled follow up for them. Medicolegally (and cynically), it is probably better for you for a patient to commit suicide before his scheduled follow up than to do the same without a discharge plan

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