But what if the patient's dressed and ready for discharge and there's
no one in the waiting room to take her home — and there's no one
she can call to come get her? (Even if a loved one is waiting at home,
someone still needs to accompany the patient on the ride from the
facility.)
The short answer: document, document, document. Have the
patient sign an against medical advice (AMA) form, write up an inci-
dent report in the patient's medical record and notify the surgeon.
While documentation is an essential factor of risk mitigation, there's
no guarantee that documenting that the patient failed to comply with
your discharge policy will be a successful defense in a lawsuit.
Changing times
As Uber, Lyft and Uber Health — a means for healthcare organiza-
tions to offer transportation for patients — become more common-
place, it's increasingly clear that lawmakers will need to either modify
the rules or provide formal guidance for surgical facilities.
Under New Jersey law, for example, there is no definition as to
whether an Uber, Lyft or cab driver qualifies as an individual claiming
responsibility for a patient. If the facility lets a patient go home with a
for-hire driver and something happens to that patient, then you can
certainly make an argument that the center is responsible for any
injuries or death to the patient.
There are exceptions, such as patients who weren't sedated during
surgery or received only a minor regional block — but be sure the
physician who is responsible for the patient's care writes an order in
the chart exempting the patient. Otherwise, CMS and accreditation
agencies require that all patients who receive any kind of sedation be
released after surgery to "a responsible adult" who will go with the
patient after discharge.
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