In our previous PODT we started a discussion regarding how to handle patients that refuse discharge. We will continue our tips on the management of these situations.
Tip 2:
Call on others
Speak to the patient’s family/ household members/ friends to get more collateral and history. Ask them if the patient looks more sick than usual
Get case management/ social work involved if you feel like there is an underlying social issue at play that’s causing the patient to resist discharge
Discussing the case with another colleague can be very helpful. It never hurts to have a fresh set of eyes evaluate a case without any prior bias
Tip 3:
Document
So you’ve come to the point where there is very little more you can offer the patient in terms of diagnostic workup in the ED. Do one more chart review starting with your EMS and nursing notes and make sure you can make sense of any abnormal vital signs.
If you’ve gotten to this point, now is the time to document your conversations. Make sure you explain your MDM well and document your conversation with the patient extensively. Document any collateral you obtained and any consult recommendations including case management recommendations. Document the plan and outpatient follow-up plan and any conversations you may have had with the PMD.
Summary
Remember the primary purpose of the ED is not a shelter. Sometimes you will have situations where it will get to the point where you have to call security to escort a patient out of the ED. Be extra careful with those patients who still say that they feel sick and have a low threshold to broaden your workup. Make sure to involve others, including family, case management, and colleagues who may be able to shed more light on the care. Phoning a friend for a second option never hurts. Document well. Bad outcomes unfortunately sometimes do happen in this segment of the patients so be carful not to blindly dismiss someone's complaint. EM is a game of balance and with time, diligence, and practice we will perfect our skills.
Stay well,
TR Adam