Involuntary Discharges

MEDICAL REVIEW BOARD STATEMENT
REPORTING OF INVOLUNTARY PATIENT DISCHARGES (PDF)

Purpose
As the quality management body representing ESRD Network 18, the Medical Review Board (MRB) would like to accurately monitor and track the incidence of Involuntary Patient Discharges (IVD) and clarify the responsibility of the ESRD providers.

Statement
The issue of under-reporting involuntarily discharged patients in Network 18 is a concern to the Network staff, Medical Review Board, and Board of Directors (BOD). Network 18 is committed to assisting with conflict and patient discharge situations, but can only do so when made aware of the concerns in advance.

As the CMS business rule on the Patient Activity Report (PAR) for the Networks related to Involuntary Discharge-Transfer out-Category C reads “Patient has been discharged from the facility against his/her will”. A patient is considered involuntarily discharged if they have received written or verbal notice that they will no longer be allowed to receive dialysis at your center. If the patient transfers to another facility without interruption to service, it is still to be reported as an involuntary patient discharge.

In the event that the decision to involuntarily discharge a patient is made, the MRB is asking ESRD providers to carry out the following reporting guidelines:

1. Notify the Network 18 Patient Services Director (PSD) of the decision to involuntarily discharge a patient prior to the actual discharge. In the case of immediate discharge due to violence or threats of violence contact PSD as soon as possible.
2. Be prepared to answer questions related to the events leading to the decision to involuntarily discharge the patient and interventions used to address the issue(s) prior to the discharge. If necessary, a request for documentation may be made.
3. Report the involuntary discharge on the monthly Patient Activity Report (PAR) under event “6C” (Transfer Out-Category C) in the losses column and indicate the reason for the discharge in the last column of the PAR.

Network 18 is committed to assisting you with conflict and patient discharge situations, but can only do so when we are made aware of the concerns in advance. Please feel free to contact the Network 18 office with questions or comments.

Report of the ESRD Networks Collaborative Project: 2002 Involuntary Patient Discharge Survey
Includes: Background, Purpose & Goals, Project Description and Methods and Results

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