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Bedside Management of Discharges Against Medical Advice

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Against‐Medical‐Advice Discharges from the Hospital

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Abstract

Physicians and other healthcare professionals have long struggled with discharges against medical advice (AMA), or when patients leave the hospital prior to a specified clinical end point over the recommendation of the physician. There is ample literature describing the risk factors associated with AMA discharge and the common reasons that patients choose to leave AMA. In this chapter, we review the best practice concepts of bedside management of an AMA discharge. We discuss components of a quality decisional capacity assessment and informed consent discussion as a prerequisite for a safe transition of care for AMA discharges. We also discuss cognitive and behavioral strategies that can form the basis for a practical approach to the professional, legal, and ethical obligations surrounding this type of discharge. Last, we discuss patient-centered strategies, shared decision-making models, and motivational interviewing and describe operational tools and processes to assist providers in negotiating a more productive health outcome for AMA discharges.

The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the U.S. Department of Veterans Affairs, the US Government, or the VA National Center for Ethics in Health Care.

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Author information

Authors and Affiliations

  1. Hospital Medicine, Raymond G. Murphy VA Medical Center, Albuquerque, NM, USA

    Holly Fleming

  2. University of New Mexico, Albuquerque, NM, USA

    Holly Fleming

  3. Department of Internal Medicine, Raymond G. Murphy VA Medical Center, Albuquerque, NM, USA

    David S. Olson Jr.

  4. VHA National Center for Ethics in Health Care, Department of Veterans Affairs, NYU School of Medicine, New York, NY, USA

    David Alfandre

  5. Department of Psychiatry and Director of Ethics Education, New Mexico Veterans Affairs Health Care System, Albuquerque, NM, USA

    Cynthia Geppert

Authors
  1. Holly Fleming
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  2. David S. Olson Jr.
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  3. David Alfandre
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  4. Cynthia Geppert
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Corresponding author

Correspondence to Holly Fleming .

Editor information

Editors and Affiliations

  1. VHA National Center for Ethics in Health Care, Department of Veterans Affairs, NYU School of Medicine, New York, New York, USA

    David Alfandre

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Fleming, H., Olson, D.S., Alfandre, D., Geppert, C. (2018). Bedside Management of Discharges Against Medical Advice. In: Alfandre, D. (eds) Against‐Medical‐Advice Discharges from the Hospital. Springer, Cham. https://doi.org/10.1007/978-3-319-75130-6_7

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  • DOI: https://doi.org/10.1007/978-3-319-75130-6_7

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-75129-0

  • Online ISBN: 978-3-319-75130-6

  • eBook Packages: MedicineMedicine (R0)

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