Against Medical Advice: A Survey of ED Clinicians’ Rationale for Use

Why Do Patients Leave against Medical Advice? Reasons, Consequences, Prevention, and Interventions

“…Collaboration with nurses to design new interventions that aim to reduce DAMA is needed. A team-based approach with a shared goal of early recognition and efficient intervention can address the trigger to leave, and find the solution to achieving lower rates of patients leaving against medical advice [20,21].…”

Against Medical Advice Discharges

“…Although there are little empirical data to inform how and why physicians choose to designate a discharge as AMA when patients decline recommended care, the existing evidence suggests that fears of legal liability are strongly driving the practice 4 . Physicians may believe that they must discharge patients AMA in order to fulfill their legal and ethical responsibilities, or to demonstrate in writing the physician's concern and the significant risk of leaving 5,6 . Clinicians may have been acculturated during training to believe that an AMA discharge may also be seen as a way of formally distancing themselves from the patient's request for a nonstandard or unsafe discharge plan, thus deflecting any potential blame for worse patient outcomes.…”

“…4 Physicians may believe that they must discharge patients AMA in order to fulfill their legal and ethical responsibilities, or to demonstrate in writing the physician's concern and the significant risk of leaving. 5,6 Clinicians may have been acculturated during training to believe that an AMA discharge may also be seen as a way of formally distancing themselves from the patient's request for a nonstandard or unsafe discharge plan, thus deflecting any potential blame for worse patient outcomes.…”

Improving Quality in Against Medical Advice Discharges—More Empirical Evidence, Enhanced Professional Education, and Directed Systems Changes

“…Moreover, research that expands the object of study beyond the physician-patient relationship could significantly improve outcomes in this vulnerable population of patients. Recent studies have begun to elucidate the deficiencies that may underlie communication failures with patients before they choose to leave AMA, 15 how providers decide to designate a discharge as AMA, 16 and how changing the structure and environment of care for patients who use injection drugs can reduce AMA discharges and improve health outcomes. 17 AMA discharges are a persistent, complicated healthcare quality problem that defies an easy solution.…”