Rates of readmission and death associated with leaving hospital against medical advice: a population-based study

Garland, Allan; Ramsey, Clare D.; Fransoo, Randy; Olafson, Kendiss; Chateau, Daniel; Yogendran, Marina; Kraut, Allen

doi:10.1503/cmaj.130029

Cited by 92 publications

(85 citation statements)

References 28 publications

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“…Our rates are in the lower range of the results reported by other emergency services [21, 33, 36]. A slight but nonsignificant diminution in the rates of both LWBS and LAMA is noticeable since 2008.…”

Section: Discussioncontrasting

confidence: 65%

Missed Opportunities: Evolution of Patients Leaving without Being Seen or against Medical Advice during a Six-Year Period in a Swiss Tertiary Hospital Emergency Department

Carron

Yersin

Trueb

et al. 2014

BioMed Research International

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Aim. The study aimed at describing the evolution over a 6-year period of patients leaving the emergency department (ED) before being seen (“left without being seen” or LWBS) or against medical advice (“left against medical advice” or LAMA) and at describing their characteristics. Methods. A retrospective database analysis of all adult patients who are admitted to the ED, between 2005 and 2010, and who left before being evaluated or against medical advice, in a tertiary university hospital. Results. During the study period, among the 307,716 patients who were registered in the ED, 1,157 LWBS (0.4%) and 1,853 LAMA (0.9%) patients were identified. These proportions remained stable over the period. The patients had an average age of 38.5 ± 15.9 years for LWBS and 41.9 ± 17.4 years for LAMA. The median time spent in the ED before leaving was 102.4 minutes for the LWBS patients and 226 minutes for LAMA patients. The most frequent reason for LAMA was related to the excessive length of stay. Conclusion. The rates of LWBS and LAMA patients were low and remained stable. The patients shared similar characteristics and reasons for leaving were largely related to the length of stay or waiting time.

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Section: Discussioncontrasting

confidence: 65%

Missed Opportunities: Evolution of Patients Leaving without Being Seen or against Medical Advice during a Six-Year Period in a Swiss Tertiary Hospital Emergency Department

Carron

Yersin

Trueb

et al. 2014

BioMed Research International

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“…30 In addition, high rates of repeat emergency department visits and readmissions for AMA patients, demonstrated here and in other studies, highlight the importance of careful documentation in informing subsequent providers about hospital returnees' ongoing issues. [17][18][19] This study also demonstrated differences between nurses and physicians in their beliefs about arranging follow-up for AMA patients. Nurses were less likely than physicians to think follow-up arrangements should be made for AMA patients and more likely to say these patients should lose the right to follow-up because of the AMA discharge.…”

Section: Discussionmentioning

confidence: 67%

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

Stearns¹,

Bakamjian²,

Sattar³

et al. 2017

Journal of Hospital Medicine

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“…Consequently, many PWUDs are retained for inpatient treatment for extended periods 21 . Some patients are unwilling to stay for these prolonged durations of inpatient therapy and will subsequently leave the hospital against medical advice before completion of IV therapy, therefore, receiving possibly suboptimal oral antimicrobials, or worse, leaving without antimicrobials at all 22,23 …”

Section: Specific Populations With Barriers To Traditional Transitionmentioning

confidence: 99%

Advantages of Outpatient Treatment with Long‐Acting Lipoglycopeptides for Serious Gram‐Positive Infections: A Review

et al. 2020

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Treatment of serious gram-positive infections presents multiple challenges. Treatment often results in prolonged hospitalization for administration of intravenous antimicrobials and presents an inefficient use of hospital resources. Prolonged hospitalization is typically also unfavorable to patient preferences and potentially subjects patients to additional health care-associated complications. Current strategies of transition to outpatient settings-outpatient parenteral antimicrobial therapy and use of oral antibiotics-often do not adequately serve vulnerable populations for whom there is often no alternative to inpatient therapy. Specifically, people who use drugs, those who cannot reliably adhere to unsupervised treatment (poor mental or physical health), people with complicating life circumstances (e.g., homelessness, incarceration, rural location), and those with inadequate health insurance remain hospitalized for weeks longer than persons without such conditions. We suspected that long-acting lipoglycopeptides (laLGP), such as dalbavancin and oritavancin, may be useful in patient transitions to outpatient settings. Thus, we conducted a search of the peer-reviewed literature using the PubMed, Google Scholar, and MEDLINE databases. Based on accumulating literature, it appears that laLGPs offer a reliable alternative therapeutic strategy that addresses many of the personal and systemic barriers to the traditional transitioning approaches. Current evidence also suggests that these agents may be cost-effective from patient, payer, and hospital perspectives. Barriers to broader use of laLGPs include, among others, a relative lack of prospective data regarding efficacy in serious infections, a narrow United States Food and Drug Administration-approved indication restricted to only acute bacterial skin and skin structure infections, and lack of reimbursement infrastructure for inpatient settings.

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Rates of readmission and death associated with leaving hospital against medical advice: a population-based study

Cited by 92 publications

References 28 publications

Missed Opportunities: Evolution of Patients Leaving without Being Seen or against Medical Advice during a Six-Year Period in a Swiss Tertiary Hospital Emergency Department

Missed Opportunities: Evolution of Patients Leaving without Being Seen or against Medical Advice during a Six-Year Period in a Swiss Tertiary Hospital Emergency Department

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

Advantages of Outpatient Treatment with Long‐Acting Lipoglycopeptides for Serious Gram‐Positive Infections: A Review

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