What must be completed if a patient initiates a refusal of transport?

• A. A properly executed refusal process, including capacity assessment and informed consent.
• B. A brief note in the chart.
• C. Verbal confirmation from family member only.
• D. Immediate transport against the patient’s wishes.

Answer: (A)

When a patient refuses transport, the key is to ensure the patient’s autonomy is respected while confirming they are capable of making that decision. The best approach requires a properly executed refusal process that centers on capacity and informed consent. You assess whether the patient understands their condition and the risks of not being transported, the benefits of alternatives, and the potential consequences of refusing care. If capacity is present and the decision is voluntary, you document the discussion thoroughly and obtain a written (or signed) refusal form or equivalent documentation, often with a witness, and you clearly outline what the patient was told and their decision. It’s important to inform the patient that they can call back if their condition changes and to offer appropriate alternatives or follow-up if applicable. A simple chart note or just a verbal confirmation from a family member does not establish the patient’s informed, voluntary decision. Transport against the patient’s wishes is not appropriate when the patient has decision-making capacity; only if capacity is lacking or other protocols demand action would different steps be taken.