The role of patient-provider interactions: Using an accounts framework to explain hospital discharges against medical advice

Against Medical Advice Discharge: A Narrative Review and Recommendations for a Systematic Approach

“…In both studies top reasons for leaving AMA included substance abuse and/or insufficient pain management, other obligations (such as work and childcare), wait time, communication problems, and the teaching hospital setting with multiple evaluations. 7,8 Risks Associated with AMA Discharge…”

Against Medical Advice Discharges

“…3,11 Compared to patients discharged conventionally from an emergency department, 25% of patients discharged AMA reported not wanting to return for follow-up care. 8 This reluctance to return for care is in part mediated by provider-generated stigma and blame 9,12 and may be exacerbated when patients believe that their decision to leave AMA was based upon extenuating circumstance or competing necessity (eg, limited care options for their dependents, poor quality hospital care, etc. ).…”

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.…”