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.

The crisis standard of care: Considerations for risk management.

Many writers and organizations have postulated that health care facilities and providers may need to implement a "crisis standard of care" to deal with the exigent circumstances associated with the massive influx of patients infected with the novel coronavirus and suffering from COVID-19. There is a relative scarcity of critical resources, such as intensive care unit beds, emergency department beds, ventilators, personal protective equipment, and medications. Facilities can become overwhelmed. A crisis standard of care can act as a guidepost for rationing supplies and care, should that become necessary. However, that is not without danger. Health care facilities and providers should plan carefully and then act with due deliberation in implementing a crisis standard of care to mitigate or prevent future liability.