Discharging a Pregnant Patient

Q. One of the most common risk management questions involves discharging a disruptive or non-compliant patient. Recently, we received a call from an OB/GYN regarding a non-compliant patient entering the 27th week of a pregnancy. The pregnancy is slightly complicated, and the patient has failed to show up for multiple office visits and other scheduled appointments. The practice is both concerned and frustrated and they would like to discharge the patient. Should the practice discharge the patient this late in the pregnancy?

A. No, it is not advisable to discharge the patient this late in the pregnancy. This patient is experiencing complications and heading into the third trimester of her pregnancy. Generally, after 24 weeks of pregnancy, it is often too difficult to find an obstetric provider before delivery.

The provider needs to accurately document any recommendations that were made and not followed by the patient, and that includes any missed appointments and all notes from any telephone conversations between the physician (including staff) and the patient. Further, the OB/GYN should also have strict guidelines and procedures in place to address the non-compliant behavior (missed appointments) such as what is occurring in the above.

Finally, The patient should be made aware of the importance and/or consequences of the missed appointments, and offered the prompt opportunity to be seen.