Involuntary Discharge by Attending Physician
The Medical Review Board (MRB) recently discussed patients who are involuntarily discharged by their physicians. The MRB acknowledges that physicians can discharge patients without the consent of The Renal Network or the staff at the unit. However, the attending physician is required to follow the unit’s involuntary discharge process which should include the IVD process that is outlined in the Conditions for Coverage (494.180). The medical director is required to be involved in all discharges and the MRB recommends that medical directors reinforce V760 and V 763 of the State Guidance for the Conditions for Coverage. In addition, medical directors need to educate their attending physicians on the policies regarding involuntary discharges and to make them aware of the resources available from the staff that also can assist them with challenging situations to avoid discharging patients whenever possible.
The Attending Physician’s Responsibility
- Understands and adheres to the medical staff bylaws and policies and procedures regarding the involuntary discharge of patients;
- Discusses the potential discharge with the medical director;
- Involves the interdisciplinary team to prevent a facility discharge, when possible;
- Provides a signed, written physician’s order that also includes the signature of the medical director concurring with the patient’s discharge or transfer from the facility;
- Provides at least 30 days notice for a discharge unless there is a need for an immediate discharge as determined by the Conditions for Coverage.