Involuntary Discharge: Alternative Strategies to Address Behaviors

Abstract

The author is the Community Services Coordinator at FMQAI: The Florida ESRD Network. She is also a member of D&T’s Editorial Advisory Board. G uest Edtorial The number of patients involun­ tarily discharged from facilities is a concern throughout the coun­ try. Many of these individuals become displaced, with no facility willing to accept them. These patients are forced to go to hospital emergency rooms for treatment, thus contributing to an already over-burdened system, and receive little or no continuity or coordination of care. Any end-stage renal disease (ESRD) patient without access to regular chronic dialysis and the necessary support services is at increased risk for morbidity and mortality. The new ESRD Conditions for Coverage mandate that facilities inform patients of their right to file a grievance without reprisal or denial of services. Further, patients must be informed of the facility’s policies for transfer, routine or involuntary discharge, and discontinua­ tion of services. Patients must receive a 30-day written notice of an involuntary dis­ charge, and the facility must follow specifi c involuntary discharge procedures. A patient being involuntarily discharged must have an order for discharge signed by the facility’s medical director and the patient’s attend­ ing physician. An abbreviated discharge procedure is allowed only in the case of immediate severe threats to the health and safety of others. The medical director has specific responsibilities and accountability to the governing body for patient care and outcomes and is responsible for ensuring that the interdisciplinary team adheres to discharge and transfer policies. With these new regulations in place, the challenge for providers is to fi nd creative solutions to work more effectively with diffi cult and special needs patients.