The emergency department physician reviews your chart, tells you nothing serious was found, and sends you home with instructions to follow up with your regular doctor. You leave feeling reassured. Twelve hours later you're back—sicker, sometimes critically so—because something serious was actually happening and the ER missed it.
Discharge errors are among the most dangerous mistakes emergency departments make. Sending patients home with undiagnosed serious conditions, or releasing them too soon, or failing to provide adequate instructions and follow-up arrangements, can turn survivable emergencies into tragedies.
The Premature Discharge Problem
Emergency departments face constant pressure to move patients through. Waiting rooms fill up. Admitted patients board in hallways. Performance metrics track "door-to-discharge" times. This pressure creates incentives to discharge patients quickly—sometimes too quickly.
Premature discharge happens when patients are released before their conditions have been adequately evaluated or stabilized. The chest pain patient sent home after a single negative troponin, without the serial testing that might have caught a developing heart attack. The abdominal pain patient given a diagnosis of "gastritis" without imaging that would have revealed appendicitis. The child with fever sent home with instructions to give Tylenol, whose bacterial meningitis wasn't diagnosed until hours later when she started seizing.
These patients were discharged because they looked stable at a moment in time, not because their conditions had been thoroughly evaluated. The illusion of stability masked underlying problems that would have been apparent with more complete workup or observation.
Inadequate Discharge Instructions
Even when the decision to discharge is appropriate, how patients are discharged matters. Discharge instructions should tell patients what warning signs to watch for, what symptoms should prompt immediate return to the ER, what follow-up appointments are needed, and what activities or medications to avoid or continue.
Too often, discharge instructions are generic, illegible, or never actually explained to patients. A sheet of paper handed to a patient on the way out the door, written in medical jargon, doesn't meet the standard. Patients should understand what they need to do and what symptoms should concern them. When instructions fail to communicate this effectively—and patients suffer because they didn't know to come back—the discharge process was deficient.
Failure to Arrange Follow-Up
Some conditions can't be fully evaluated or treated in an emergency department but require prompt outpatient follow-up. The ED identifies a concerning finding, determines the patient is stable enough to leave, and expects them to get further workup with a specialist.
But patients without regular doctors, without insurance, or without understanding of how urgent the follow-up is may not complete it. The ED found something that needs attention, told the patient to "see your doctor," and then lost track of whether that ever happened. If the hospital knows certain patients face barriers to follow-up, doing nothing to address those barriers may fall below the standard of care.
The "Bounce-Back" Problem
Patients who return to the emergency department shortly after discharge—"bounce-backs"—are at elevated risk. Their return suggests something was missed or is progressing. Yet bounce-backs sometimes face the same cognitive biases that led to the original discharge: "We already worked this up," the thinking goes, "and nothing was wrong." Fresh evaluation may be less thorough because prior (incorrect) conclusions anchor current thinking.
Hospitals track bounce-back rates as quality metrics precisely because returns signal potential problems with initial care. When bounce-back patients suffer harm that should have been prevented, both the original discharge decision and the response to the return visit may be implicated.
High-Risk Discharge Scenarios
Certain clinical situations carry elevated discharge risk. Chest pain discharges are notoriously dangerous—the patient sent home with "non-cardiac chest pain" who dies of a heart attack is a common malpractice scenario. Abdominal pain with incomplete workup, headache without consideration of serious causes, and weakness or dizziness attributed to benign causes are similarly risky.
Patient populations matter too. Elderly patients may present atypically, with serious conditions manifesting as vague complaints that are easy to dismiss. Psychiatric patients may have physical symptoms attributed to their mental health conditions. Patients with complex medical histories may have new problems obscured by their baseline complexity. Discharge decisions for these patients require particular care.
Proving Discharge Errors
Medical records document what evaluation was performed before discharge, what diagnoses were considered and ruled out, what instructions were given, and what follow-up was arranged. Comparing this documentation to what the standard of care required—and to what actually happened after discharge—reveals whether errors occurred.
Expert testimony establishes whether the discharge decision was appropriate given the clinical presentation, whether workup before discharge was adequate, and whether different discharge practices would have prevented the ultimate harm. The causation question is central: you must show that proper handling would have led to diagnosis and treatment that prevented your injury.
What Discharge Should Look Like
Appropriate discharge requires confidence that dangerous conditions have been adequately ruled out or that the patient is stable enough to complete evaluation as an outpatient. It requires clear communication of instructions the patient actually understands. It requires follow-up arrangements appropriate to the clinical situation. When any of these elements is missing and harm results, the discharge was deficient.