SHM Converge Scientific Abstract ePoster Gallery-Improving the Self-Directed Discharge Process by Addressing Frontline Clinician Perspectives

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This study explored how hospitalists and nurses view self-directed discharges, also known as leaving “against medical advice” (AMA), which occur when patients leave the hospital before being medically ready. These discharges can worsen patient outcomes, create ethical challenges for clinicians, and increase readmissions.<br /><br />The researchers conducted ten semi-structured interviews and one focus group with 6 hospitalists and 11 nurses between August and November 2024. Using rapid qualitative analysis, they identified common themes in terminology, documentation, challenges, and ideas for improvement.<br /><br />A key finding was that nurses were more likely to use the term “AMA” and complete an AMA form, often seeing it as a way to protect staff and document the situation. Hospitalists more often preferred terms like “self-directed discharge” or “patient-directed discharge,” and were less likely to sign formal paperwork because they felt it could escalate conflict or was unnecessary when notes were sufficient. There was also uncertainty and variability in how hospital policy should guide documentation.<br /><br />Both groups agreed that self-directed discharges are stressful and difficult to manage. Common challenges included balancing patient autonomy with safety, handling emotionally charged conversations, and coordinating a safe discharge plan under time pressure.<br /><br />Participants suggested several improvements: better education about the legal and ethical aspects of self-directed discharges, stronger communication between physicians and nurses, more team-based rounding, faster physician-to-nurse updates when a patient wants to leave, and possibly dedicated staff or teams to help manage these cases.<br /><br />Overall, the study highlights the need for clearer, more standardized approaches to self-directed discharge documentation and stronger collaboration among frontline clinicians to improve safety, communication, and respect for patient and provider perspectives.

Asset Subtitle

Karishma Patel

Meta Tag

Author List Karishma Patel, Molly A. Kantor, Monisha Bhatia, Zainab H. Apalara

Category Research

Concept Self-directed Discharge

Concept Patient Outcome

Concept Readmission

Concept Medical Readiness

Concept Communication

Distinguished Non-Finalist

Presenter Organization Department of Medicine, University of California, San Francisco

Presenting Author Karishma Patel

Track Quality Improvement

Keywords

self-directed discharge

against medical advice

AMA

hospitalists

nurses

documentation

patient autonomy

hospital policy

clinical communication

patient safety

Self-directed Discharge

Patient Outcome

Readmission

Medical Readiness

Communication