Creating a Best Practice for Discharges Against Medical Advice Background: Nationally, 1-2% of medical discharges from hospitals are against medical advice (AMA).  Patients that leave AMA are at higher risk for readmission and adverse health events.   At our facility, FY 2014 data revealed that 1% of discharges from the medical/surgical wards were AMA.  The 30 [...]

Creating a Best Practice for Discharges Against Medical Advice Background: Nationally, 1-2% of medical discharges from hospitals are against medical advice (AMA).  Patients that leave AMA are at higher risk for readmission and adverse health events.   At our facility, FY 2014 data revealed that 1% of discharges from the medical/surgical wards were AMA.  The 30 [...]

Background: Project Caring for Patients with Opioid Misuse through Evidence-Based Treatment (COMET) launched in 2019 to provide patients with opioid use disorders (OUD) individualized and evidence-based care at Duke University Hospital (DUH). Patients with OUD have higher rates of self-directed discharge (SDD) which is associated with higher healthcare utilization costs, hospital readmissions, and adverse health [...]

Background: Patients discharged against medical advice (AMA) have disproportionately high healthcare costs and increased morbidity, mortality, and hospital readmissions. While patient risk factors for discharge AMA are known, there is little data regarding providers’ practice patterns during AMA discharge, including provision of follow-up appointments. Similarly, the frequency of a documented discussion of the risks and [...]

Background: Inpatient addiction consultant services are an innovative and proliferating tool used to confront the opioid epidemic. As healthcare systems seek to address gaps in care for patients with substance use disorder (SUD), the inpatient setting is increasingly understood as a unique opportunity for counseling, referral for treatment, and initiation of medication assistance treatment (MAT) [...]

Background: Discharges against medical advice (AMA) account for 0.8-2.2% of all national discharges and represents an extreme in non-compliance. Patients who elect to leave AMA have increased rates of mortality, morbidity and readmission rates. Literature on this topic, to date, has focused on AMA in the context of specific admitting diagnoses or discharges from certain [...]

Background: Against medical advice (AMA) discharges are often emotionally charged for healthcare providers. Complicated capacity assessments, confusion regarding legal and ethical obligations to patients, and limited resources may strain providers. This cross-sectional survey study explored provider perceptions, experiences, and self-assessed competence with AMA discharges at a county hospital with a high AMA rate. Methods: Surveys, [...]

Background: The principle that patients have the right to make choices about their healthcare, including the decision to leave the hospital against the advice of the medical staff, is a foundation of medical ethics.  Consistently, studies have found disproportionately higher rates of readmission and mortality for patients who leave against medical advice (AMA) as compared to patients who are conventionally discharged. This mixed-methods study aimed to: [...]

Background: Self-directed discharge, also known as Against Medical Advice (AMA) discharges, comprise 1–2% of hospital discharges (1). The AMA process poses safety risks to patients and emotional strain on providers, potentially leading to implicit biases in documentation (2). While stigmatizing language in medical records has gained attention (3), its prevalence in AMA documentation remains underexplored. [...]

Background: Self-directed discharges, also referred to as discharge “against medical advice” (AMA), refer to when patients leave the hospital prior to medical readiness. These discharges lead to worse health outcomes for patients, ethical dilemmas for clinicians, and increased readmission rates affecting healthcare systems. Research on self-directed discharges has emphasized patient characteristics affecting discharge, with less [...]