Review AMA forms, follow-up procedures
Review AMA forms, follow-up procedures
Most hospitals already have against-medical-advice (AMA) forms they use when the patient gives the staff a chance, but Helenemarie Blake, JD, a shareholder with the law firm of Fowler White Burnett in Miami, says risk managers should remember that merely having an AMA form and procedure does not guarantee they will be used correctly.
"We've seen cases in which the staff forget to have the patient sign the AMA form, and we've seen instances in which the form was not clear that the patient has made a decision which is clearly against medical advice to walk out the door," she says. "Risk managers may need to revisit these forms, some of which may have been used for years, and maybe revamp them to ensure that it makes clear this is the patient's choice and that the medical staff of the hospital have told them that leaving may cause harm to their health."
Details are always better, Blake says. A form that simply states the patient is leaving against medical advice, with a signature, is not nearly as good as one that details the circumstances and what information was conveyed to the patient. The form must adequately document two primary points: The first is that the patient has made an affirmative decision to leave against advice, and that the patient has been informed of the potential consequences.
Follow-up calls to the patient, whether the person left AMA or eloped, also are a crucial part of the medical record, Blake says. The chart should show clearly that the health care provider did not just forget about the patient but called soon to follow up or at least made a diligent effort to do so.
"This is one of the times when you want to be as detailed as possible in your charting," she says. "The chart should indicate that on the follow-up call, you urged the patient to return to the ED if needed, or to seek care elsewhere. This can be an appropriate time to remind the patient of any test findings or other results of the examination that warrant concern, and your reminder also should be well documented."
However, Blake cautions that the health care provider should not dispense advice over the phone on the follow-up call.
"At that point, you don't have the ability to examine the patient physically, to run tests, to actually provide the needed care," she says. "So, you should not dispense advice other than to 'seek medical care' and urge the patient to return to the ED. The emphasis must be on urging the patient to come back for medical care."
Most hospitals already have against-medical-advice (AMA) forms they use when the patient gives the staff a chance, but Helenemarie Blake, JD, a shareholder with the law firm of Fowler White Burnett in Miami, says risk managers should remember that merely having an AMA form and procedure does not guarantee they will be used correctly.Subscribe Now for Access
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