Objectives: To identify the number of patients who take their own discharge, to review how their competence1,2 to make the decision to refuse treatment was being assessed and managed, and to quantify the medical risk to these patients.
Methods: A retrospective review of all case notes coded as “self discharge” for a three month period. A second cohort was reviewed following the introduction of a new self discharge proforma.
Results: Patients who self discharge represented 0.5% of the total number of attendances, and those who “did not wait” represented a further 11%. Fifty percent were under the influence of drugs or alcohol. Sixty three percent refused admission, 24% refused treatment, and 13% refused medical assessment. In the first audit, assessment of capacity was documented in 0%, 58% signed a self discharge form, 25% were reviewed by a doctor prior to leaving, and 31% left the department without the staff’s knowledge. In the second audit, capacity was documented in 80%, 80% signed the new self discharge form, 41% were reviewed by a doctor prior to leaving, and 0% left the department without being reviewed.
Discussion: Self discharge may be a significant risk to both the patient and the hospital trust. Departments should review their own systems for assessing and managing this patient group. Further work looking at the consequences of self discharge is required.
- risk management
- self discharge
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.
Competing interests: none declared