Response to “Self-discharge: intervention needed now?”: discharge documentation as a harm-reduction strategy

Dear Editor, We read with great interest an article by Price, Rischer, and Trimble published in the Postgraduate Medical Journal titled “Self-discharge: intervention needed now?”. The authors highlight a vulnerable patient population in patients discharged against medical advice (DAMA) who experience disproportionately worse outcomes. The authors rightly emphasize that these patients are often complex clinically and often have extenuating social factors. We agree that DAMA patients are often discharged with limited communication and are at risk for discontinuity of care especially with regard to follow-up arrangements and ongoing management [1, 2]. We would like to highlight discharge communication as an overlooked but actionable component of care for DAMA patients. Ensuring completion of discharge documentation may act as a mechanism to mitigate harm once the decision to discharge patients against medical advice has been made. This is especially true as it is a way to convey/arrange follow-up arrangements and actions required in the community. Discharge documentation is key as the bridge between primary and secondary care [3]. In our retrospective cohort review of discharge documentation in the Acute/General Medicine (AGM) Department, we observed substantially lower rates of discharge documentation among DAMA patients compared to those undergoing routine discharge.