Question

You are a patient in a busy emergency department. You present with an asthma attack, which is a chronic condition for you, and is exacerbated by pollen season. While you are waiting for the doctor you have received 2-3 respiratory treatments and are feeling better. The doctor feels otherwise. He feels that you need to be admitted for steroid therapy and observation. The orders are to the staff to admit for this treatment for a few days of therapy. Knowing your symptoms, the progression of your disease process and how you respond to therapy. YOU decide you are not staying. In reading the article provided, "I'm Going Home"- Discharges Against Medical Advice by David Alfandre, MD, think of yourself now as the risk manager of this hospital. Why would it behoove the MD, staff and yourself to encourage this patient to stay? What risk to the hospital is there associated with the decision of the patient to sign out AMA? What risk to the MD is there associated with the decision of the patient to sign out AMA? What risk to the patient is there for this decision? Please use the below reference for the above question https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2664598/

Answer 1

1) ans)MD and staff encourage patient to stay in hospital because:

According to the article discharge against medical advice(AMA),in which a patient chooses to leave the hospital before treating the physician recommends discharge,is a problem for many physicians who treat hospitalized .

_this article reviews the prevalence,costs,predictors,and potential interventions for this clinical problem.

Against medical advice discharges continue to be a highly prevalent problem of the care quality.

_patient with asthma who were discharged AMA had a 4 times higher risk of readmissions to the emergency department within 30days (8.5%vs3.2%,).

_in a study of general medicine service,patient who left AMA were 7times more likely to be readmitted within 15 days.,almost always for the same diagnosis.

Risk to the hospital is there associated with the decision of patients to sign out AMA:

_against medical advice discharges continue to be a highly prevalent of health care quality,representing as many as 2%of all hospital discharge.

_patient discharge AMA ,taken as a whole,are an at risk group for both mortality and morbidity.

_ patient with asthma who were discharged AMA had a 4 times higher risk of readmissions to the emergency department within 30 days and almost a 3times higher risk of readmissions the hospital within 30 days.

Risk for patients decision:

_unnecessary health care cost of readmissions.

_follwing questions should be included in the evaluation of patients:

Does the patient understand and appreciate the admission diagnosis.its prognosis.

_is the patient aware of the alternative treatments in the hospital and risks and benefits associated with them?

_ can the patient make and communicate a choice?

Risk for MD for patients choice AMA:

_how the physician handles an evaluation for patients response.

Physicians who start with an accusatory attitude are likely to be met with unease at best and an AMA discharge and termination of care at worst.