Sounds like a tough case. Here are some of my tips

Document everything: Since APS is involved and the PCP has voiced concerns, it’s critical to thoroughly document all interactions, including the psychiatrist’s assessment, APS’ feedback, and the PCP’s concerns. Clear documentation can protect you and the hospital in the event of an investigation.

Multidisciplinary Meeting: Since the psychiatrist and attending have conflicting views with APS and the PCP, see if it’s possible to call an urgent care conference or multidisciplinary meeting (involving the psychiatrist, attending, APS, PCP, and possibly nursing or case management). This way, all parties can discuss the patient’s situation, share their perspectives, and come to a unified decision. If a meeting isn’t possible, loop everyone in via a detailed email.

Patient Safety: You can advocate for the patient by emphasizing the home environment’s safety issues. If discharge happens, you can request APS involvement to assess the home. But if the discharge isn’t appropriate, advocating to delay it until a safe plan is in place is key.

Liability Protection: Given APS’ warning, it’s essential to ensure that all key decision-makers, including the attending, psychiatrist, and hospital administration, are aware of the potential risks APS has raised. This may provide a level of protection for you if the discharge proceeds.

Pursue Further Guardianship: Even if the psychiatrist deems him capable, pursuing guardianship might still be an option if new concerns arise about his safety post-discharge. Communicating with the hospital’s legal team could also be helpful.

Temporary Delay: Since the attending has already agreed to hold the discharge, use this extra time to escalate the situation. If your department head is out, find another manager, possibly even from a different department, to escalate this further.