A McCabe, J Goodliffe, H Dee, A Radford, K Jones.

1. Patients Who Discharge Against Medical Advice: Using High Fidelity Simulation to Improve Patient Safety A McCabe, J Goodliffe, H Dee, A Radford, K Jones. A McCabe, Clinical Education Fellow, Swindon Academy, University of Bristol • Background • -50% of patients who self discharged were under the influence of drugs or alcohol1 • 63% refused advised hospital admission1 • 59% attended at night (8pm-8am)1 • 53% of patients who returned with ongoing symptoms were later found to have significant clinical findings.2 • Patient Safety Concerns • Studies report only a minority of patients are reviewed by a doctor prior to self discharge and that documentation of mental capacity assessment is often absent.1 • Final year students in this study reported an average confidence of 5.6/10 in managing self discharge although this is a problem commonly encountered by F1 doctors. • Objectives • -To raise awareness of the risks to patient safety in self discharge • -To develop practical skills to address these risks such as assessing mental capacity • -To encourage a patient centred approach to support patients in informed decision making . • -To demonstrate legal and professional guidelines around protecting patients from harm. Patient Safety Intervention: Using High Fidelity Simulation Students were asked to complete a full consultation with a simulated patient who wanted to discharge against medical advice including discussion of risks, mental capacity assessment and completion of necessary documentation. • The session was recorded and used as a basis for group discussion and reflection on the legal and professional requirements surrounding self discharge. Course Outcomes: Students (n=15) reported an average increase in confidence of 2.8 (1-10 Likert scale) in managing self discharge following this session (p< 0.0001). Previous studies demonstrate that increased awareness of safety procedures lead to improvements in patient care1. Simulation extends this further by also providing students with the necessary skills and attitudes to confidently manage this potentially difficult situation. Qualitative Analysis “I feel more prepared for difficult situations in future” Conclusion: Value to the NHS This study demonstrates that simulation training can successfully be used to equip staff with the skills to minimise the risks associated with self discharge. Potential applications of this study include extending the use of simulation to train staff to manage a broad range of patient safety issues in the future. “Learning from a textbook is completely different to learning from real-time situations” • References: (1)Henson, V, Vickery, D (2005) Patient self discharge from the emergency department: who is at risk? Emergency Med Journal;22:499-501 • (2) Jerrard, D, Charms, R, (2009) Patients leaving against medical advice from the emergency department- disease prevalence and willingness to return., The Journal of Emergency Medicine 41(4) 412-417