What can the paliative care team do when the doctor in charge has signed the patients discharge orders but the family refuses to accept the order?

Answer 1

Extremely difficult problem, which clearly hinges on the reasons the family wish to oppose the discharge. If the family and/or the patient feels that problems still exist with this patient that the hospital hasn't addressed, I'd bring this up with the department head for that pathology. If the hospital discharges a patient against their will, and the patient turns out to be correct (which happens a LOT), and then the patient's pathology reasserts, the hospital can be legally liable, and the PR for that sort of thing is awful. Note also, the family can choose to readmit the patient through the ER under EMTALA rulings (depending on the pathology). To force a discharge on a patient that feels care is incomplete is dangerous. The hospital will need to really perform due dilligence, showing the discharge is absolutely medically justified. Ideally, the patient, doctor, team and family all agree on the discharge. If however, the patient is incompetant, or wishes to leave, but the family doesn't wish the responsibility, this needs to be passed to your Social Services group for placement. In either case, the paliative team isn't in much of a position to do anything -- you're reactive; not proactive. My advice would be to submit whatever reports are appropriate and take extra care to assure form as well as accuracy. I should also ask, does the paliative team feel the discharge is the appropriate action in this case?