Patients Leaving Against Medical Advice (AMA) from the Emergency Department-Disease Prevalence and Willingness to Return

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

“…In some cases, as described below, it may cause harm by stigmatizing the patient and reducing the patient's likelihood of following up. 7,8 There is also no professional consensus on what constitutes a discharge as AMA. This promotes greater variability in the clinical use of the term, and provides less meaningful and generalizable data for research.…”

“…Jerrard et al examined the perceptions of patients discharged AMA from an ER, and found that 25 % did not return for care because they felt they had angered the staff in their decision to leave, and that they "anticipated derision" if they returned. 7 Although it is not possible to conclude whether patients' perceptions were due to staff behavior or other unstudied variables, perceptions that potentially lead to worse access to care after AMA discharge are noteworthy.…”

Characteristics of patients with acute traumatic brain injury discharged against medical advice in a Level 1 urban trauma centre

“…However, a proportion of these admissions have ended by discharges against medical advice (AMA), whereby the patient decides to leave the hospital before discharge has been authorised by the patient's physician [3]. Leaving the hospital against the physician's recommendation raises the cost of long-term treatment by exposing the patient to the risk of an inadequately treated medical problem which is associated with increased risk for complications, re-admission and mortality [4][5][6].…”

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

“…Specifically, the use of a patient-signed AMA discharge form has not been demonstrated to advance patient care and may promote harm by stigmatizing patients 8 and reducing the likelihood that they will pursue follow-up care. 9 Furthermore, given that these forms may be written using institution-centered legalistic language or at an inappropriate reading level, this common hospital practice should be evaluated to assess whether patients comprehend and benefit from the forms, and how the forms influence healthcare decision making. 10 Finally, the authors' finding that 38% of nurses, 22% of physician trainees, and 6% of attendings believe patients discharged AMA lose the "right" to follow-up is noteworthy.…”