Documentation quality of patient-directed discharge and early warning interactions in an adult inpatient service.

Abstract

Documentation quality of patient-physician discussion, assessment, and intervention at the time of patient directed discharges (elopement and 'against medical advice' discharges) is found to be poor in available studies, and importantly, may be a proxy for quality of care delivered. Less is known about the patient-physician interactions and documentation at the time a patient vocalizes the desire to leave early ('early warning interaction') prior to a patient directed discharge. This was a cohort study comprising a retrospective chart review of patients leaving 'against medical advice' from an inpatient internal medicine - infectious disease service at a tertiary medical center from 07/01/2020 to 09/24/2021. Documentation quality was assessed using 11 extractable factors detailing patient-physician conversation elements from the AIMED framework, plus related interventions pertinent to patient safety and care optimization. Descriptive statistics were mainly utilized with inferential statistics and regression models as appropriate. 52 patients left against medical advice and 49 eloped; 11% had an early warning interaction. Aggregate documentation quality scores at early warning interaction (13%), 'against medical advice' discharge (42%), and at elopement (31%) were low. Half of suggested documentation elements were recorded in no patients. Documentation quality overall was poor, suggesting the need for further training and interventions to facilitate more thorough documentation.