What Is an Ethically Informed Approach to Managing Patient Safety Risk During Discharge Planning?

Hospital discharge planning for patients who might not be safe at home-particularly those leaving against medical advice-can require risk managers to navigate the complex intersection of tort law, federal and state regulations, and clinical ethics. An overarching duty is to ensure that a patient is as safe as possible in the environment to which the patient is being discharged, although it's not always possible to formulate a safe discharge plan. When patients have decision-making capacity, they can make a decision to be in an environment that's not safe. When patients do not have decision-making capacity, it is not always legally permissible to hold them against their wishes to keep them in a safe environment, so some kind of discharge plan must be made. This article considers the role of a risk manager in navigating this set of circumstances.