SHM Converge Scientific Abstract ePoster Gallery-"Let Me Go!": Are We Missing Key Elements in Capacity Evaluations for Patients Leaving Against Medical Advice?

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This document highlights problems with documenting decision-making capacity in patients who leave against medical advice (AMA). Because AMA discharges are linked to higher 30-day readmission and increased short-term mortality, accurate capacity assessment is important for patient safety and risk reduction.<br /><br />The main finding is that capacity documentation is often poor: decision-making capacity was properly documented in only about 10% of cases. The document also notes that advanced practice providers (APPs) and residents reported limited confidence and insufficient training in how to document these assessments.<br /><br />It emphasizes that capacity evaluations should follow the four Appelbaum criteria:<br />- Choice<br />- Understanding<br />- Appreciation<br />- Reasoning<br /><br />To address these gaps, the authors examined current documentation practices and surveyed clinicians about their comfort level, training, and interest in using an electronic medical record (EMR)-based support tool. The results suggest strong value in an EMR-based capacity evaluation template, which could help standardize documentation and supplement educational efforts.<br /><br />Overall, the document argues that better training and structured EMR tools could improve the quality of capacity assessments in AMA discharges and enhance patient safety.

Asset Subtitle

Vishmayaa Saravanan

Meta Tag

Author List Cleo Fleming, Emily Rivadeneira Cabezas, Emma Garry, Evelyn Elias, Irina Zaretsky, Shantheri Shenoy MD, Vishmayaa Saravanan, Zhuoran Yang

Category Research

Concept Decision-Making Capacity

Concept Against Medical Advice Discharge

Concept Capacity Assessment

Concept Appelbaum Criteria

Concept Documentation Practices

Distinguished Non-Finalist

Presenter Organization Icahn School of Medicine at Mount Sinai Morningside/West

Presenting Author Vishmayaa Saravanan

Track Quality Improvement

Keywords

decision-making capacity

AMA discharge

capacity documentation

patient safety

30-day readmission

short-term mortality

Appelbaum criteria

EMR template

clinical training

capacity assessment

Decision-Making Capacity

Against Medical Advice Discharge

Capacity Assessment

Appelbaum Criteria

Documentation Practices