In assessing a patient’s fitness for discharge, medical practitioners are expected to exercise clinical judgment, guided by applicable professional and regulatory guidelines.
The Australian and New Zealand College of Anesthetists Guideline for the perioperative care of patients selected for day stay procedures (PG15) (DSP Guideline) gives a solid roadmap for such procedures. It is very clear that a patient must only be discharged when a dependable adult is with them. They also recommend someone stay with the patient at least overnight.
The guidelines include-
- “Make discharge criteria and expectations clear well before the scheduled date of the procedure so patients can plan appropriately.
- Warn of the potential effects and risks of the procedure and any medication. Explain how sedation or medications may affect their ability to resume driving or other tasks and for how long.
- Provide written and verbal instructions about post-anaesthesia and post-procedural care. Include a contact number and location for emergency medical care if necessary.”
Once you’re satisfied a patient is well enough to be discharged, there is rarely a legal basis to detain them if they insist on leaving. A patient can only be detained in hospital against their will if they meet the requirements for involuntary admission under the relevant legislation.
Sometimes, despite best efforts at explaining discharge requirements, a patient does not have a responsible support person to take them home. In this case, healthcare practitioners should be concerned the risk involved if a patient is discharged alone and:
- injures themselves or someone else when traveling home, or
- experiences a post-procedure complication.
Just remember, once you’re satisfied a patient is well enough to be discharged, there is rarely a legal basis to detain them if they insist on leaving. A patient can only be detained in hospital against their will if they meet the requirements for involuntary admission under the relevant legislation.
Managing difficult situations
Medical practitioners often ask what to do if a patient insists on driving after sedation.
It is standard procedure for medical practitioners to advise patients not to drive until they have sufficiently recovered, physically and mentally, but do not generally have a duty to report to the licensing authority.
There are times when a patient gets angry and abusive when told they should not leave the facility until they are not feeling the effects of the anesthesia. When a patient disagrees with the recommended discharge approach – read our article about managing difficult patients.
Documentation is vital
Always document any materials, information, and advice you give a patient. If a patient insists on leaving, be sure they have signed a confirmation that they left against medical advice, and your personal advice.
As Australian medical indemnity insurance providers, we understand the intricacies and risks involved in patient-doctor relationships. We are experts in medical indemnity insurance, medical malpractice insurance, doctors indemnity insurance, GP medical indemnity insurance, medical practice insurance, and more. If you are a health practitioner with Tego, we offer 24/7 medico-legal advice and support in regards to what you need to know about the risks invoiced with receiving a gift from a patient.
This publication is general in nature and is not comprehensive or constitutes legal or medical advice. You should seek legal, medical or other professional advice before relying on any content, and practice proper clinical decision making with regard to individual circumstances. Persons implementing any recommendations contained in this publication must exercise their own independent skill or judgment or seek appropriate professional advice relevant to their own particular practice. Compliance with any recommendations will not in any way guarantee discharge of the duty of care owed to patients and others coming into contact with the health professional or practice. Tego Insurance Pty Ltd is not responsible to you or anyone else for any loss suffered in connection with the use of this information.
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