What to Do When Your Patient Leaves the Hospital Against Medical Advice?
Learning Objectives and CME/Disclosure Information
This activity is intended for healthcare providers delivering care to women and their families.
After completing this activity, the participant should be better able to:
1. Restate that medical treatment requires patient consent 2. Summarize key elements that should be included when documenting refusal of care
Estimated time to complete activity: 0.25 hours
Susan J. Gross, MD, FRCSC, FACOG, FACMG
President and CEO, The ObG Project
Disclosure of Conflicts of Interest
Postgraduate Institute for Medicine (PIM) requires faculty, planners, and others in control of educational content to disclose all their financial relationships with ineligible companies. All identified conflicts of interest (COI) are thoroughly vetted and mitigated according to PIM policy. PIM is committed to providing its learners with high quality accredited continuing education activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of an ineligible company.
The PIM planners and others have nothing to disclose. The OBG Project planners and others have nothing to disclose.
Faculty: Susan J. Gross, MD, receives consulting fees from Cradle Genomics, and has financial interest in The ObG Project, Inc.
Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.
Method of Participation and Request for Credit
Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from Dec 31 2017 through Jan 25 2023, participants must read the learning objectives and faculty disclosures and study the educational activity.
If you wish to receive acknowledgment for completing this activity, please complete the post-test and evaluation. Upon registering and successfully completing the post-test with a score of 100% and the activity evaluation, your certificate will be made available immediately.
For Pharmacists: Upon successfully completing the post-test with a score of 100% and the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.
Joint Accreditation Statement
In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Physician Continuing Medical Education
Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Continuing Nursing Education
The maximum number of hours awarded for this Continuing Nursing Education activity is 0.2 contact hours.
It is a challenge to provide quality healthcare when patients do not adhere to their physicians’ recommendations for treatment. The patient who insists on leaving the hospital Against Medical Advice (AMA) is an extreme example of non-adherence, and this situation creates high potential for serious errors. Recognition of the reasons patients leave can help negotiate these encounters. They leave for a variety of reasons including personal and financial obligations, breakdown of communication between the patient and medical staff, dissatisfaction in care, and not understanding the need for further testing or treatment. Every effort should be made to determine what is driving the patient’s decision-making process. There may be times when the provider is at a loss to understand why a patient would walk out prior to receiving necessary care. Even in this circumstance, treatment without consent can be deemed as battery, as patients do have the right to refuse care.
Some courts have ruled that it is illegal for a hospital to require a patient to sign a waiver of liability as a “condition of their release” (Dedely V. Kings Highway Hospital Center, 617 NYS 2d 445 Supp (1994)). Therefore, the better approach consists of documenting the following eight criteria:
The patient’s ability to express a choice; ability to understand relevant information; ability to appreciate the significance of the information and its consequences; and, ability to manipulate information. A patient does not have to be free of mental illness or delusions
The signs and symptoms
The extent and limitation of the evaluation
The current treatment plan, risks, and benefits
The risks and benefits of forgoing treatment
The alternatives to suggested treatment
The exact statement made by the patient who left AMA, as well as the explicit documentation of what the patient was refusing
The follow-up care including discharge instructions
Practitioners should give the patient immediate attention so long as another patient is not compromised
Do not express your frustration and anger to the patient
Do not refuse to provide treatment – give the patient what she may be willing to accept, such as prescriptions or future appointments, even if not the entire nor ideal treatment plan
If unsure of capacity, call for help, which will usually entail a psychiatric consult
Use standard hospital and professional procedures if there is any threat the patient may harm herself or others
Focus on medical management and not insurance issues
Although providers will often help whenever possible, insurance coverage is ultimately the patient’s responsibility
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Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
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