Patient-Directed Discharges / AMA

PDDs have a higher risk of hospital readmission and result in higher mortality rates. If paged from the bedside about a patient requesting to leave “AMA,” call nurse back and then go speak with the patient.

• Address patient concerns (i.e. pain control, substance withdrawal, fear/anxiety, financial strain, diet) to mitigate reversible causes for contention.
• Determine capacity to leave: review risks of leaving and medical reasoning to stay (see Medical Decision-Making Capacity under “Psychiatry”). This discussion should be witnessed by nurse or charge nurse if possible. Provider and patient will need to sign AMA discharge form, which nurse can obtain.
• Send new medications to pharmacy and request hospital follow-up visits if patient leaves
• Sign discharge order. In the “discharge to” section select “left against medical advice” (for more detailed discharge instructions, see appendices)
• Clearly document in discharge summary that patient was informed about the risks of leaving, had the capacity to make the decision to leave, and left prematurely based on your clinical judgement.
  • *Caveat: if patient at any point becomes threatening or you feel unsafe, allow them to leave or contact security