Re: Informed refusal of ambulance transfer

[Guest guest]

Good questions. A one sized fits all just isn't right. I have patients who

refuse a test or treatment, but not everything. In those cases, it is best to

do what you can and have them understand that the test or treatment is really

important by having a special informed refusal for that.

In my 20+ years, I have also found that often we treat AMAs as a do what I say

or get the hell out situation. Oh yes, and don't come back or call back. That

is WRONG! we must take the time to explain why everything is important (if it

is) and document they do understand that, have mental capacity to understand and

make the decision, and give them MANY chances to change their minds.

I do understand not wanting another form, in hospital or pre-hospital, but have

you looked at yours and your partners' documentation of these? I have looked at

lots, and we don't do them well, at all!

>

> > We have had a few instances lately where our ED physicians have recommended

> > transfer by ambulance and the patient/parent has refused and will go by POV

> > instead. We have a refusal form for tests/treatment (this is not a leaving

AMA

> > form but just refusing specific care items) but our CNO wants something

specific

> > for these instances. Do you know of any hospitals with such a form/policy?

> >

> > I would imagine something such as:

> > I refuse transfer to ________ hospital by ___ground ambulance _____Air

> > ambulance. I will instead go by privately owned conveyance (my own car).

> >

> > I understand that my provider has prescribed EMS transfer for the following

> > reasons: speed, patient monitoring, medications, oxygen, safety, bypassing

the

> > triage process at the receiving hospital, ___________.

> > I understand and accept all potential risks and/or complications, including,

but

> > not limited to: death, disability, pain, worsening of condition, shortness

of

> > breath, ________________.

> > I understand and acknowledge that if I go by my own transport that I am

> > accepting responsibility to carry and deliver the required paperwork to

complete

> > the transfer. I understand that at the receiving facility I may be delayed

in

> > accomplishing triage and ultimate definitive care and this may be

detrimental to

> > mine, or my loved one's care, comfort and final outcome.

> >

> > I understand and acknowledge that the staff of XYZ hospital have explained

this

> > to me, feel that I have understood all items and have the mental

capabilities to

> > understand all risks and complications, and have offered to answer any and

all

> > questions.

> >

> > I understand and acknowledge that if I change my mind I may tell staff right

> > now! I also understand and acknowledge that if circumstances arise while

> > driving to the receiving facility that I should immediately stop and call

911.

> > If I do call 911, I may not be taken to the designated receiving hospital if

in

> > the judgement of the responding agency it would be detrimental to the health

of

> > me or my loved one to continue that transport.

> >

> > Thoughts? If anyone has such a form, I'd love to see it.

> >

> > Don

> >

> >

> >