Involuntary Patient Discharge

Involuntary Discharges by Attending Physicians

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[PDF, 79.3 KB] 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 [PDF, 82.1KB]. 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.

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.

Network Participates in Involuntary Patient Discharge Survey

The involuntarily discharge of patients is a growing concern that has received increased national attention. To assess its prevalence twelve of the ESRD networks participated in an Involuntary Patient Discharge Survey.

The objectives of the survey were to: (1) determine the number of patients that have been involuntarily discharged within a network; (2) gain an understanding of the reasons patients are being discharged from the dialysis clinic setting; (3) gain a better understanding of the characteristics (age, race, gender, ethnicity, principle of diagnosis, duration, modality, setting) of the discharged patient population; and (4) identify the placement outcome for the discharged patient.

In December 2002 each of the participating networks asked all of their facilities to complete the Involuntary Discharged Patient Survey form.

Completed forms were to be returned during January 2003. All information was strictly confidential.

A total of 3,149 surveys were sent out by participating networks with 2,960 surveys returned constituting a 94% return rate overall.

The Renal Network sent out a total of 497 surveys (328 in Network 9; 169 in Network 10). Overall, 399 or 80% of our facilities responded to the survey. Network 9 realized a 78% response rate with 255 returns and Network 10 achieved an 85% response rate with 144 returns.

Only 50 or 12.5% of Network facilities responding reported having involuntarily discharged a patient (35 in Network 9; 15 in Network 10). A total of 70 patients received involuntary discharges (49 in Network 9; 21 in Network 10).



















The Renal Network
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Patient Line:
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Email: [email protected]

Last updated on: September 19, 2014