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Answers for Action:
Take these steps when patients leave the hospital against your advice
e-Reports, May 31, 2011
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ProAssurance offers risk management recommendations to help you with equipment, resources and discharge planning. Untitled document

Q: I’ve read there’s a rise in patients leaving the hospital early, against medical advice. What do I need to keep in mind?

A: You’re right. According to a recent report by the Agency for Healthcare Research and Quality, as reported in the New York Times, there was a 40 percent increase in patients leaving the hospital early in 2008 – to 370,000 patients, as opposed to 1997 where 264,000 discharged themselves early.

With health care reform on the books, it’s unsure how this trend will track in the future, but risk managers say it’s a good idea to brush up on the informed refusal process.

When patients leave the hospital early against medical advice, this tried-and-true tip still applies: document, document, document. Medical/legal experts suggest physicians discuss and document the proposed treatment and its benefits, as well as the risks of non-treatment or not following medical advice, if appropriate up to and including death.

Physicians also need to discuss signs and worsening symptoms with a patient and recommend a return to the emergency room, office or hospital if further care is needed.

Additionally, it’s a good idea to note:

  • The patient’s capacity to understand the information being provided or discussed
  • That treatment was offered and refused, and reasons a patient refuses treatment
  • Discharge and follow-up instructions

You should document a patient’s failure to follow advice, take medication, obtain requested diagnostic studies or other actions a patient fails to take that may contribute to an injury or delay of resolution of a medical problem.

Physicians insured by ProAssurance may contact our Risk Management department for prompt answers to liability questions by calling (800) 292-1036 or via email.

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