Q&A: Patients who leave against medical advice

Q. How can case managers work through cases where patients leave against medical advice?

A. Working with a patient who is leaving against medical advice (AMA) can be difficult. Although the physician responsible for the patient’s medical care is primarily involved in this situation, discharge planners frequently become involved when the patient has continuing-care needs. The rate of readmission or return to the emergency department is relatively high for AMA patients. Therefore, establishing a multi-professional protocol for managing these patients is wise.

If a patient is AMA and the patient’s physician determines a need for postacute care services, should a discharge planner make a referral for continuing care? Hospitals should implement a policy or procedure that addresses patients who voluntarily refuse medically recommended hospital treatment but who clearly need continuing or postacute care services. Hospitals should consult legal counsel, the medical staff office, nursing leadership, and the administrator who oversees the discharge planning process when implementing these policies and procedures. Clinicians who perform discharge planning, nurses, and social workers should also participate in developing these policies and procedures. This policy would be in addition to the hospital policy in which a patient signs a form indicating he or she has been informed of the risks of signing out AMA.

For more information, see Discharge Planning Guide: Tools for Compliance, Fourth Edition.

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