Delays in Medicating New Admissions Leading to Discharge Against Medical Advice Essay

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Introduction


Factors related to hospitals and the patient population influence incidents of discharge Against Medical Advice, also known as AMA (Karimi et al., 2014). There is a high rate of discharges against the doctor’s advice after admission into emergency units. There is a need to probe the reasons behind such a trend (Shirani et al., 2010). It should be noted with concern that AMA is a healthcare institutions’ problem across the world because, in cases where children are discharged in such a manner, the blame cannot fall on these children. Children do not contribute to such decisions (Mohseni et al., 2013). Figures show that out of every 65 to 120 discharges from general hospitals across the world, one is a case of AMA. Such action is prone to dire consequences including litigation (Devitt et al., 2000). The scenario is a challenge to physicians across the globe (Taqueti, 2007). It is difficult to honour a patient’s wishes when such a move will jeopardize their health (Caresse, 2006). It has been observed that a psychiatrist will always have a case or cases that leave hospital care against medical advice. In fact, 35% of patients admitted to psychiatrist care are discharged against medical advice (Tavallaei et al., 2005). The abbreviations AMA and DAMA are used alternately in hospital. They refer to situations where patients leave hospital despite being advised against it by their physician (Alfandre, 2009; Karimi et al., 2014).



Explain the process you have illustrated above

If the parents of the child insist on taking their child home despite the medical expert’s view against it, do the following:



1. Get in touch with the Neonatologist so that they assess the treatments and observations required for the infant. They will also discuss such measures with the SW and the parents.

2. Liaise with the social worker so that they assess and establish contact with the Department of Child Protection during office hours or, otherwise, Crisis Care on weekends, or if the case is noted after official work hours.

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3. Find ways of avoiding physical confrontation. If it is appropriate, call security to assist. You have no mandate to physically prevent such parents from leaving with their child. It is the Department of Child protection and Crisis Care that have the legal authority to recover the child from their parents and return them to a healthcare facility.

4. Make sure that you explain to the child’s parents the consequences of their leaving with their child

5. Inform the parents of the role of the DCP and Crisis Care and let them know that they will be notified.

6. Alert the DCP or SW. The DCP happen to be involved in cases where the threat to remove a child from hospital against medical care is real. DCP are empowered by the Children and Community Services act of 2004.

7. If the parents want to proceed with actions that are in conflict with the DCP plan, and the child does not need to be kept at the healthcare facility on medical grounds, inform the DCP or their after-working-hours partners, Crisis Care to decide what to do next.



Who does this step? (It can be several people.)

· Social worker

· Doctor and medical practitioner related to the disease of patient, in this case a Neonatologist

· Nurse and assistant to the doctor

· Receptionist

· DCP officer

· Executive officer at the hospital



What technology is used?

· Telephone to communicate between members of the staff of the hospital

· Computer to document the process

· Printer for printing discharge….....

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References

Neonatal Coordinating Group. (2006). Discharge Against Medical Advice. Women and New-born Health Service. King Edward Memorial Hospital

Alfandre DJ. “I’m going home”: discharges against medical advice. Mayo Clin Proc Elsevier. 2009:255–260.

Carrese JA. Refusal of care: patients’ well-being and physicians’ ethical obligations: “but doctor, I want to go home” JAMA. 2006;296(6):691–695.

Devitt PJ, Devitt AC, Dewan M. Does identifying a discharge as “against medical advice” confer legal protection? The Journal of Family Practice. 2000;49(3):224–227.

Karimi SAP, Saravi BM, Abokheily MA. Studying the Rate and Causes of Discharge Against Medical Advice in Hospitals Affiliated to Mazandaran University of Medical Sciences. Mater Sociomed. 2014 Jun; 26(3): 203–207

Mohseni Saravi B, Reza Zadeh E, Siamian H, Yahghoobian M. Discharge Against Medical Advice in the Pediatric Wards in Boo-ali Sina Hospital, Sari, Iran 2010. Acta Inform Med. 2013;21(4):253–256.

Shirani F, Jalili M, Asl-e-Soleimani H. Discharge against medical advice from emergency department: results from a tertiary care hospital in Tehran, Iran. European Journal of emergency medicine. 2010;17(6):318–321.

Taqueti V. Leaving against medical advice. N Engl J Med. 2007;357(3):213–215.

Tavallaei SA, Asarii S, Habibi M, KHodami HR, Siavoshi Y, Nouhi S, et al. Discharge Against Medical Active from Psychiatric Ward. Journal of Military Medicine. 2005;8(1):24–30.

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