Abstract
Background: A patient decides to leave the hospital against medical advice. Is this an erratic eccentric behavior of the patient, or a gap in the quality of care provided by the hospital? With a significant and increasing prevalence of up to 1–2% of all hospital admissions, leaving against medical advice affects both the patient and the healthcare provider. We hereby explore this persistent problem in the healthcare system. We searched Medline and PubMed within the last 10 years, using the keywords “discharge against medical advice,” “DAMA,” “leave against medical advice,” and “AMA.” We retrospectively reviewed 49 articles in our project. Ishikawa fishbone root cause analysis (RCA) was employed to explore reasons for leaving against medical advice (AMA). This report presents the results of the RCA and highlights the consequences of discharge against medical advice (DAMA). In addition, the article explores preventive strategies, as well as interventions to ameliorate leaving AMA.
Highlights
Discharge against medical advice (DAMA) is defined as when a patient chooses to leave a hospital before the healthcare team recommends discharge from the hospital [1]
Franks and Fiscella et al studied an extensive psychiatric database from California, Florida, and New York in 2007. They noticed that there was no association between race/ethnicity and discharges against medical advice after adjusting for the individual and socioeconomic variables [15]. They hypothesized that African Americans are more inclined to leave against medical advice as they feel more than others; they are disrespected and receive unfair treatment by the healthcare system
The results showed that patients left AMA on the day of welfare checks in 13% (125 patients), and most of them were readmitted within 30 days of leaving against medical advice [23]
Summary
Discharge against medical advice (DAMA) is defined as when a patient chooses to leave a hospital before the healthcare team recommends discharge from the hospital [1]. With a significant and increasing prevalence of up to 1–2% of all hospital admissions, leaving against medical advice (AMA) affects both the patient and the healthcare provider [2,3]. This action leaves the patient with inadequately treated medical problems and increased risk for readmissions [1,4]. The treating physician may be struggling to fulfill the pledge they took to benefit the patient and respect their wishes [1] This problem affects both patients and physicians, but there may be solutions to this prevalent issue.
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