A Toolkit for At-Risk Patients Expressing Desire for Discharge
Acquired brain injuries (ABI) can be associated with cognitive, behavioral, physical, and psychosocial difficulties that endure far beyond medical-surgical stabilization in acute care hospital. The goals of post-acute ABI inpatient rehabilitation are to provide intensive, specialized, and coordinated interdisciplinary assessment and treatment, and to facilitate safe community re-integration. There is a lack of guidance for clinicians in Ontario when “at-risk” patients – for example, with individuals with subacute cognitive or behavioral difficulties — seek premature discharge before their inpatient treatment is complete and necessary community supports are in place, particularly in post-acute hospital settings, where patients cannot be detained under the Mental Health Act. Clinicians must carefully consider the legal and ethical options for treatment. A tool to facilitate in-the-moment decision making when a patient is demonstrating a desire to be discharged was developed.