Signing out AMA

OKAY here's the question....a patient signed out AMA 2 days ago...all well documented that we told her she wasn't ready to go and was at risk....she left anyway. She is now back in the ER wanting to come back. I said NO. I've never worked in a place that took someone back after signing out against medical advice. My administrator wants to take her to make nice with the docs. I am outraged and know I will be over ruled (another story altogether)..what do all y'all think.?

Whenever we had someone sign out AMA, we had the Admin behind us. We always made sure we had them involved from the start. As far as taking them back, we have, but not under many circumstances. .....they usually went back to hospital or another SNF.

Best to you!!!

~ear

Our hospital allows them to come back. There's more liability with turning them away.

I did not think hospitals could turn pts away even if they do sign out AMA then come back.

In our ER when we have a pt leave AMA we generally mention to them that signing out AMA does not mean they are not welcome back and we encourage them to return should they change their mind.

i did not think hospitals could turn pts away even if they do sign out ama then come back.

baring a court order, hospitals can't.

ltc facilities, however, are a different story.

i'd think it would depend on why the patient left ama, and how the whole situation went.

doesn't sound like it went well. does your facility have a policy? if not, it is probably up to the admin to decide.

I'm sure that LTC is different, but in my experience with hospitals, it's like Jabra posted - the patient is encouraged to come back if he feels that he needs/wants to...

=^..^=

Is payment an issue? I thought that if a Medicare or insurance patient signed himself out AMA that payment would be denied to the facility.

If the patient is self-pay or covered by Medicaid that may not be an issue, though.

OKAY here's the question....a patient signed out AMA 2 days ago...all well documented that we told her she wasn't ready to go and was at risk....she left anyway. She is now back in the ER wanting to come back. I said NO. I've never worked in a place that took someone back after signing out against medical advice. My administrator wants to take her to make nice with the docs. I am outraged and know I will be over ruled (another story altogether)..what do all y'all think.?

here in nj refusing care to ANYONE who seeks it is an emtala(sp?) violation.

amas have to start right back at triage and wait all over again though.

I agree capecod... admin will take them back. Happens all to frequently.. anything to fill a bed.

capecod - why did she leave in the first place? Do you think she'll do it againn? You might point out to your admin. that no matter how well you advised her, it's not going to look too good if this gal keeps checking in and out.

OKAY here's the question....a patient signed out AMA 2 days ago...all well documented that we told her she wasn't ready to go and was at risk....she left anyway. She is now back in the ER wanting to come back. I said NO. I've never worked in a place that took someone back after signing out against medical advice. My administrator wants to take her to make nice with the docs. I am outraged and know I will be over ruled (another story altogether)..what do all y'all think.?

EMTALA protects patients rights. it doesn't matter how many times she signs out and comes back, she is entitled to have a medical screening for anything considered an emergency. too much liability and not worth the hassle.

Since the original poster posted this in the geriatric and ltc forum, I am pretty sure she is talking about a nursing home in which case EMTALA or other hospital regulations do not apply. I have known a few nursing homes to not accept pts back after signing out AMA. It really depends on the facility policy.

It also should depend on the circumstance, the one big question mark I have is also the insurance. I am pretty sure in my state she would have to be authorized again if she was on Medicaid which can take a few days to a week or longer. Was she there for acute rehab or long term placement?

I agree with the other posters that most administrators are just going to want to fill the bed. Why did she sign out AMA? It would have to be horrible to be in a nursing home (or hospital) for Christmas, so I can understand leaving.