Experiences of patient-initiated discharge from an inpatient withdrawal management service: a qualitative descriptive study

Abstract

ABSTRACT Background Patient-initiated discharges, also known as against medical advice discharges, are a common occurrence in inpatient withdrawal management settings. The purpose of this qualitative descriptive study was to gain an understanding of patient perspectives of their reasons for and experiences of patient-initiated discharge from an inpatient withdrawal management service. Methods A consecutive sample of patients were recruited from an inpatient withdrawal management service. Qualitative descriptive methodology was used with semi-structured telephone interviews as the method of data collection. Interviews were transcribed and then analyzed following the principles of conventional content analysis. Results Interviews were conducted with 13 participants. Factors that precipitated patient-initiated discharge were related to external pressures experienced by the patient, dissatisfaction with treatment or the hospital environment, and difficulties related to the COVID-19 pandemic. Participants often experienced strong emotions prior to leaving early and found conversations with staff about patient-initiated discharge difficult. Overall, participants had mixed perceptions of their discharge experience. Conclusions This study is an important addition to the literature as the first to qualitatively examine patient perspectives of patient-initiated discharge from an inpatient withdrawal management service. Future studies should explore interventions to mitigate patient-initiated discharges or improve the associated processes when they cannot be avoided.