Claire Dawson
In the UK, patients have the right to discharge themselves from hospital at any time during their stay. However, there are several factors to consider before doing so. Hospital staff will assess patients before agreeing to a self-discharge, and if they have concerns, they must arrange a further assessment. The patient's medical history and records will be taken into account, and the patient's mental capacity to make the decision will be evaluated, with the applicable legislation varying between the nations of the UK. If patients choose to discharge themselves against medical advice, they may be asked to sign a form acknowledging the risks of leaving and taking responsibility for any consequences. While patients can return to the hospital for treatment after self-discharging, they should ensure they understand the risks and alternatives associated with their decision.
| Characteristics | Values |
|---|---|
| Patient's right | Patients have the right to self-discharge from the hospital. |
| Hospital's assessment | Hospital staff will assess the patient before agreeing to a self-discharge. |
| Patient's capacity | The patient's mental capacity to make the decision is assessed. |
| Risk of harm | The risk of harm to the patient if allowed to leave is considered. |
| Patient's decision | The patient should be able to make an informed decision, understanding the risks, benefits, and alternatives. |
| Documentation | The discussion with the patient and the assessment are documented. |
| Discharge form | The patient may be asked to sign a discharge AMA (against medical advice) form or self-discharge form. |
| Follow-up | Follow-up plans and options for reassessment are explained to the patient. |
| Re-admission | No hospital in the UK will refuse to re-admit a patient on the grounds of previous self-discharge. |
| Medication | The patient should arrange a repeat prescription from their GP before their hospital supply runs out. |
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What You'll Learn
Patients have the right to self-discharge
When considering self-discharge, it is crucial to assess the risks associated with leaving the hospital against medical advice. Patients need to make informed decisions, ensuring they fully understand the risks, benefits, and alternatives. Seeking advice from PALS or PASS can be beneficial in resolving any questions or concerns. Patients should also be aware that their mental capacity to make the decision to self-discharge may be assessed, particularly in England and Scotland, where the Mental Capacity Act 2005 and the Adults with Incapacity Act 2000, respectively, provide guidance.
Hospital staff will typically assess a patient's request for self-discharge and may arrange further assessments if concerns arise. If patients choose to self-discharge against medical advice, they may be required to sign a discharge Against Medical Advice (AMA) form or a self-discharge form. These forms vary across NHS trusts, and by signing, patients acknowledge the risks and consequences of leaving the hospital prematurely. It is important to note that even after signing these forms, patients can still return to the hospital or A&E and receive treatment if needed.
Before leaving the hospital, patients should ensure they have necessary arrangements in place, such as repeat prescriptions, understanding how to use any medical devices provided, and organising transportation home. While self-discharge is a patient's right, it is important to consider the potential risks and ensure a comprehensive understanding of the associated implications.
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Hospitals must assess patients before agreeing to self-discharge
Patients have the right to self-discharge from hospital in the UK, but hospital staff will assess patients before agreeing to a self-discharge. This is to ensure that the patient has the capacity to make an informed decision and is aware of the risks, benefits, and alternatives of leaving the hospital against medical advice. If the patient is deemed to have the capacity and chooses to self-discharge, they may be asked to sign a discharge Against Medical Advice (AMA) form or a self-discharge form. This document states that the patient is aware that self-discharging goes against medical advice.
The assessment process may involve gathering information about the patient's admission and medical history, both from a review of their records and discussions with nursing staff. The patient's mental capacity will be assessed in line with the Mental Capacity Act 2005 in England and the Adults with Incapacity Act 2000 in Scotland. If the patient is found to lack capacity, the hospital must demonstrate and document this.
In some cases, patients may become acutely confused or have underlying conditions that affect their capacity to make decisions. It is important for hospital staff to be aware of the relevant legal frameworks and seek advice or discuss the case with senior colleagues if there are any doubts about the patient's capacity. The patient's GP should also be informed of their discharge, especially if they need a repeat prescription or further care.
While patients have the right to self-discharge, it is important to consider the risks associated with leaving the hospital prematurely. Patients should ensure they have a full understanding of these risks and the potential consequences of their decision. Hospital staff may also arrange follow-up plans and provide options for reassessment in case the patient's condition deteriorates after self-discharge. Ultimately, the patient's health and recovery are the top priorities, and hospitals will not refuse to treat a patient who has previously self-discharged, even if it was against medical advice.
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Patients may be asked to sign an AMA form
Patients who wish to discharge themselves from hospital may be asked to sign an AMA (against medical advice) form. This is because the patient is choosing to leave against the advice of a doctor or nurse. The patient must be fully informed of the potential consequences of leaving AMA, and the physician should assess and document the patient's competency to make such a decision. The patient should be made aware of the risks, benefits, and alternatives of their decision, and this should be documented. The patient's family can be involved in this process, and their presence may help convince the patient to stay.
The AMA form should be specific to the patient and their medical advice, and not a general form. The form should be signed by the patient, and witnessed by a family member and/or staff member. The form itself is not enough to protect a physician from litigation if the patient experiences health problems after leaving. The physician must also educate the patient about the risks of leaving AMA and document this education, as well as the patient's insight into their condition.
The AMA form is a release from responsibility for the hospital and its employees from any ill effects that may result from the patient's decision to discharge AMA. It is important to note that no hospital in the UK will refuse to treat a patient who has previously discharged themselves, even if it was against medical advice.
It is also important to note that mental capacity legislation varies between the different nations within the UK, and that Northern Ireland currently does not have specific legislation.
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Patients should be aware of the risks of self-discharge
Firstly, patients should be aware that self-discharging can negatively impact their health. It could lead to a deterioration in their health, requiring readmission to the hospital. The hospital staff will assess the patient's mental capacity to self-discharge and whether self-discharge could put the patient at risk. If the patient is assessed as lacking the capacity to make a decision, the hospital can refuse discharge if it is in the patient's best interest. Patients with acute mental disorders, where there is a risk of further deterioration or harm, will require a discussion with the mental health team and a possible Mental Health Act Assessment.
Secondly, patients should be aware that self-discharging can cause additional stress for hospital staff. While patients may see self-discharge as a way to reduce the workload of hospital staff, it can also add pressure, taking time away from patient care. It is important to discuss any concerns with the hospital staff and give them time for a detailed assessment.
Thirdly, patients should be aware that self-discharging may result in a lack of follow-up care. Before leaving, patients should ensure they receive any necessary treatment and have follow-up care arranged. Patients should also be aware that they may need to sign a discharge form, acknowledging the risks of leaving against medical advice and accepting responsibility for any consequences.
Finally, patients should be aware that self-discharging can impact their caregivers. Self-discharge can affect the way families care for their loved ones, which in turn can lead to further health deterioration. While patients have the right to self-discharge, it is important to consider these risks and discuss any concerns with the hospital staff before making an informed decision.
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Patients can complain about how a hospital discharge was handled
If a patient wishes to complain about the quality of care received during their hospital stay or discharge, they can contact their state's Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO). This includes complaints about receiving the wrong medication, undergoing incorrect surgery or treatment, or being discharged prematurely. Patients can also file a complaint with the Joint Commission if they develop an infection during their hospital stay or encounter problems with medication.
In the UK, if a patient has a complaint about a local authority or care provider, they should first raise it with the relevant party. If the issue remains unresolved or is not addressed within a reasonable timeframe, patients can escalate their complaint through the Local Government and Social Care Ombudsman. Additionally, individuals can provide information to local Healthwatch organisations and CQC, which may lead to further actions, including inspections.
When dealing with NHS bodies in the UK, patients can make complaints directly to the relevant body's complaints department or its Patient Advice and Liaison Service (PALS). PALS can provide information about the NHS complaints procedure and guide patients on obtaining independent help if needed. Patients can locate their nearest PALS office on the NHS website or by inquiring at their GP surgery or hospital. It is important to note that mental capacity legislation varies across different nations within the UK, and specific laws may apply to discharge assessments.
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Frequently asked questions
Yes, you have the right to discharge yourself from the hospital at any time during your stay. However, it is important to consider the risks associated with self-discharge and to make an informed decision.
If you discharge yourself from the hospital, you may be signing a form stating that you acknowledge the risks of leaving against medical advice and that any adverse outcomes resulting from your self-discharge are your responsibility. Additionally, you may not have a full understanding of your treatment plan, including any necessary follow-up care or medication requirements.
To self-discharge, you should first discuss your intention with hospital staff. They will assess you and address any concerns they may have about your decision. If you choose to proceed with self-discharge against medical advice, you may be asked to sign a discharge form acknowledging the risks.
Yes, hospital staff can refuse to allow you to self-discharge if they have concerns about your capacity to make the decision or if they believe there is a risk of harm to you upon leaving. Each hospital has its own discharge policy, and your specific circumstances will be evaluated before a decision is made.
Yes, you have the right to return to the hospital for treatment even if you previously self-discharged against medical advice. However, it is important to be aware of the potential consequences of interrupting your treatment plan.
