Documentation Requirements for Against Medical Advice (AMA) Discharge
Core Documentation Elements
- The American College of Cardiology recommends documenting specific risks of leaving with the current untreated or incompletely treated condition, including both immediate risks and longer-term consequences, for patients leaving against medical advice 1
- The risks of leaving against medical advice must be material and patient-specific, not generic warnings, as emphasized by medical guidelines 2
- Documenting the patient's verbalized understanding of the risks discussed is crucial, as it provides evidence that the patient was informed of the potential consequences of leaving against medical advice 1
- Providing and documenting discharge instructions, prescriptions, and urgent follow-up appointments is essential for patients leaving against medical advice, as it ensures continuity of care and reduces the risk of adverse outcomes 1
- The American Heart Association suggests that giving contact numbers for questions or if the patient changes their mind is an important aspect of follow-up care for patients leaving against medical advice 2
Quality Measure Implications
- The American College of Cardiology recommends documenting that the patient was informed they will be excluded from quality measure denominator populations due to AMA status, which applies to performance measures for conditions like myocardial infarction and heart failure 3, 4, 5, 6, 7, 1
Medication Provision for Patients Leaving Against Medical Advice
Quality Measure Implications
- Patients leaving against medical advice are excluded from all quality measure denominator populations, regardless of care provided before departure, according to the American College of Cardiology and American Heart Association guidelines 8, 9, 10
- This exclusion applies to dual antiplatelet therapy metrics, lipid-lowering therapy at discharge, ACE inhibitor/ARB prescribing, cardiac rehabilitation referrals, and all cardiovascular performance measures, as stated by the American College of Cardiology 8, 9, 10
Special Considerations for Cardiovascular Conditions
- The American College of Cardiology and American Heart Association guidelines emphasize the importance of continuing evidence-based therapies for cardiovascular conditions, even if the patient leaves against medical advice 8, 9, 11
- For patients with acute coronary syndrome, the American College of Cardiology recommends continuing aspirin, P2Y12 inhibitors, beta-blockers, and statins, as well as providing sublingual nitroglycerin with instructions for use and giving specific instructions about when to seek emergency care 8, 11