Makindo Medical Notes

Patients who discharge against advice are still entitled to medications, discharge summaries, and proper instructions. Notify the GP promptly, and if necessary, escalate to a senior consultant.

About: Escalate to Senior Registrar or Consultant if Unsure

• Right to Refuse: Patients have the right to refuse treatment provided they have the mental capacity to make informed decisions. Occasionally, patients may refuse due to receiving unclear or suboptimal advice, and it’s crucial to respect their autonomy.
• Duty of Care: If a patient refuses one aspect of management, such as extended observation, it does not negate their right to other forms of support or information.

When a Patient Discharges Against Advice

• Document Thoroughly: Fully document your conversations with the patient, including explanations of potential risks, available options, and follow-up recommendations.
• Offer Alternatives: For example, if a patient with chest pain declines continued observation, try negotiating for them to stay for a specific test, like a 3-hour troponin check.
• Advise on Symptoms: Explain symptoms that would warrant immediate return, like chest pain recurrence, and advise prompt re-attendance if symptoms change.

Follow-up Actions

• Provide Medications and Documentation: Ensure the patient receives any necessary medications and a discharge letter. If the discharge summary cannot be produced quickly, arrange for collection at a later time.
• Inform GP: For urgent or pressing concerns, notify the GP through fax, email, or a direct call to facilitate follow-up, particularly if an outpatient cardiology or other specialist follow-up is advised.
• Respect the Patient’s Decision: Avoid any punitive response to their decision to leave. Offer reasonable support such as transport or other standard discharge services to all AMA patients as you would any other patient.

High-Risk Scenarios: Suicide or Self-Harm

• Involve Psychiatry: For patients at risk of self-harm or suicide, notify the duty psychiatrist or psychiatric team. Delay the discharge if possible and obtain advice on managing the patient’s mental health needs.
• Take All Steps Reasonably Possible: Inform family members, police, psychiatric teams, and senior staff if the patient insists on leaving, as appropriate. The safety of the patient and public must be the primary concern.
• Legal Considerations: Documentation of every action is crucial in high-risk cases, as healthcare providers may need to account for their decisions in legal settings, such as a coroner’s court.

Always strive to balance patient autonomy with duty of care, and remember that clear, thorough documentation of all interactions is essential.