“I'm Going Home”: Discharges Against Medical Advice

Abstract

Discharge against medical advice (AMA), in which a patient chooses to leave the hospital before the treating physician recommends discharge, continues to be a common and vexing problem. This article reviews the prevalence, costs, predictors, and potential interventions for this clinical problem. Between 1% and 2% of all medical admissions result in an AMA discharge. Predictors of AMA discharge, based primarily on retrospective cohort studies, tended to be younger age, Medicaid or no insurance, male sex, and current or a history of substance or alcohol abuse. Interventions to reduce the rate of AMA discharges have not been systematically studied. This article offers suggestions for interventions based on studies in other areas of clinical care as well as the psychiatric AMA discharge literature. Studies for this review were identified by searching the relevant MeSH heading (discharge) and key words (against medical advice, leave, elope, hospital, and self-discharge) in PubMed databases and selecting all English-language articles from 1970 through 2008 that included data on adult medical inpatients.

Reconsidering Against Medical Advice Discharges: Embracing Patient-Centeredness to Promote High Quality Care and a Renewed Research Agenda

“…The patient factors associated with AMA discharge have been reasonably consistent over time, and include lower socioeconomic class, male sex, younger age, Medicaid or no insurance, and a history of substance abuse. 1 Commonly reported patient reasons for leaving AMA include personal or financial obligations, feeling better or receipt of social assistance payments. 9,10 The stated aim of this research was to generate potential interventions that could mitigate the number of such discharges.…”

“…[1][2][3] Compared to patients discharged conventionally, 30-day readmission rates for patients discharged AMA are 20-40 % higher, 3,4 and their adjusted relative risk of 30-day mortality may be increased as much as 10 %. 2 Despite the excess morbidity, health care costs, and associated stigma, AMA discharges are relatively unexamined.…”

Discharges Against Medical Advice at a County Hospital: Provider Perceptions and Practice

“…6 In practice, however, AMA discharges are often emotionally charged for both patients and providers, and, in the high-stress setting of AMA discharge, providers may be confused about their roles. [7][8][9] The demographics of patients who leave AMA have been well described. Compared with conventionally discharged patients, AMA patients are younger, more likely to be male, and more likely a marginalized ethnic or racial minority.…”

Intentional Head Injury: Survivor Victim's Profile, Gender Differences and Role of Alcohol Use at Manipal Teaching Hospital, Pokhara, Nepal

“…Studies have suggested that pa ents with history of alcohol/drug abuse mistrust medical care givers, and also their addic ve behaviour -the desire to get more drug and [17][18] alcohol once discharged is high.…”