I was pulled to another unit the other day, and the nurses were discussing a particular patient that had left AMA and how they handled the patient. I said that I always go in to the room and attempt to find out why the patient wants to leave. I ask if there is anything that can be done to remedy the situation so that the patient will agree to remain for their test/treament/etc...If I don't take anything with me, then usually I'm able to de-escualate (sp?) the situation. If the patient hasn't agreed to stay before I leave the room, then by the time I get back with the AMA form they've had a chance to think about what we talked about, and will usually agree to stay. One nurse looked at me like I had lost my mind and stated that she always takes them the AMA form and removes their attachments. She said that she didn't have time to "argue" with the patient.
Some patient's relax and begin to talk to my just by being told, "That's your right. You can walk out right now." I have found that many of my patients do not want to stay because they are not allowed to smoke. Most of those will agree to a nicotine patch and "something for my nerves," and our MD's are very agreeable to this solution. Others agree to stay when they find out that their insurance will not pay if they go AMA. There was one patient that I couldn't get to talk to me. He had a defribulator placed that day. He walked out AMA, went to Wendy's for a burger. The supervisor called me when he returned to the ER to eat it, and then he returned to the room that he walked out of...that's the short version, anyway.
So, do you attempt to reason with your patients before they walk out? What kinds of reasons to you get from patients wanting to leave AMA?
My facility has a policy in place when dealing with patients who leave AMA or elope. We have to notify the MD, security, the nursing supervisor, Risk Management, and write up an incident report. With all that, I'd much rather see what I can do to rectify any problems they may be having and try to persuade them to complete their treatment.
We have the same policy, except we don't notify security. Most of our MD's basically acknowledge that we've told them and leave it at that. I've only had one cardiologist tell me that he was on his way to the floor and ask me to see if the patient would stay long enough to talk to him.
i don't think you can legally tell them that their insurance won't pay. it's a form of coercing and can be perceived as a threat.
Don't know about the legality, but would be interested to have a definite answer as our management requires us to explain this to the patient. I usually state, "I am required to make sure that you understand that if you leave AMA, your insurance may not pay for this hospital stay."
i don't think you can legally tell them that their insurance won't pay. it's a form of coercing and can be perceived as a threat.
As far as I know there are several that won't pay if they sign out. Wouldn't you rather be informed and spend a few extra hours in the ER instead of getting a $5000 bill you have to pay out of your own pocket.
I don't see how it could be in any way perceived as a threat.
i don't think you can legally tell them that their insurance won't pay. it's a form of coercing and can be perceived as a threat.
I think you are informing the patient of the possibility that their insurance may or may not cover the visit if they leave AMA. I think, personally, the patient has the right to know that information. That should be part of the standard here is what is going to happen or could happen if you sign out AMA speech.....
Most insurance companies don't require precert for an ER stay, only if someone is admitted over 23 hrs. It's up to the company, but most will pay..I think legally they have to, as a person has a right to be treated or not treated. If a person came in and was certified by insurance for 3 days, and they left on the 4rth AMA, their 3 days should still be certified.
I usually don't try and talk patients out of it, because we've generally been discussing the problem long before they decide. I do think it's often frustration w/ feeling like they don't have enough information, don't know what the plan is, haven't seen the doctor, etc.
I would have never believed that I would ever leave an ER AMA. But I did very recently. I am a student. I broke a glass and cut the skin on my hand all the way thru the skin and it was over a joint. I had to go to an ER because all the urgent care centers were closed. So I got there at 9 PM. I fully expected to wait for hours because I knew I certainly wasn't the sickest person there! In fact I felt embarrassed to be there, only needing a few stitches.
Anway, I was sent thru what's called fast track. I finally got my stitches at about 4 am. I certainly understand this is all about triage and I didn't say a peep to anyone about a wait. It's not their fault. So after I got my stitches the PA told me how to care for it, what to watch for, when to get the stitches out blah blah blah blah. So then I had to wait for the nursing discharge papers. Let's just say I was not impressed with my nurse because she touched my open wound with her bare hands and directly after touching a screaming infant with snot rolling down its face, without washing her hands. I also witnessed her talking with the other new grad nurses in the hall over the hours about 'the hot guy in surgery'. So when I waited 2.5 hours for the discharge instructions that I didn't need while listening to 'the hot guy' talk I decided that's it! I have a quiz in school in a few hours and I haven't gone to sleep all night. Enough! So I walked out. A woman tried to stop me, and I just told her, I can't wait anymore for nursing discharge instructions that I don't need, I've been waiting for hours. She gave me a mad look and that was it. I just left without signing AMA papers. I felt really strange about it, but ya know what? Ya gotta do what ya gotta do.
In the spirit of benevolence, we must attempt to reason and help the patient understand why they need to stay. If they ultimately refuse, they they can go.
On December 24, 2005 I signed out AMA, something I never thought I would do. I had been admitted the previous morning for an asthma attack and put on IV steroids. The covering doctor took me off and said he would discharge me at 5PM after my blood sugar came back. It came back 388 and he wanted me to stay until 9PM. Sorry but it was Xmas Eve, I knew it would continue to drop, which it did, 168 at midnight. Told him and the RN, if I had a problem I would come back to the ER. She told me Medicare would not cover my stay---they did.
I guess if you floated to that particular unit and this particular patient was a "frequent flyer" they might have had more insight into that patient.
I talk to my patients when they want to go AMA -the one that usually hits them most is that their insurance company probably won't pay for ANY of their hospitalizatin if they go AMA..........
i don't think you can legally tell them that their insurance won't pay. it's a form of coercing and can be perceived as a threat.
Maybe they will come back later and say "no one told me my insurance wouldn't pay for this" I tell them the truth-bluntly. It IS the truth that insurance companies won't pay when you go AMA almost 100% of the time.
veegeern, BSN, RN
179 Posts
We have the same policy, except we don't notify security. Most of our MD's basically acknowledge that we've told them and leave it at that. I've only had one cardiologist tell me that he was on his way to the floor and ask me to see if the patient would stay long enough to talk to him.