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JCOM Abstract

J Clin Outcomes Manage 
2007 Dec;14(12):645-653
Optimizing outcomes when patients leave against medical advice
Schmidt MJ, Dostal KU

Abstract Objective: To examine the epidemiology of patients leaving against medical advice (AMA) and offer recommendations for delivering high-quality care. Design: Case presentations and review of the literature. Main results: The AMA discharge can be a high-risk situation for both health care providers and patients, and a thorough understanding of the issues surrounding the AMA discharge is necessary when faced with these encounters. It is important to recognize patient risk factors for leaving AMA, including drug and alcohol abuse disorders, lack of health insurance, and longer waiting times in the emergency department. Patient autonomy should be recognized and respected; however, an assessment of decision-making capacity is required to determine whether a patient can act autonomously. Conclusion: Being knowledgeable about the dangers of AMA discharge, patient risk factors for leaving AMA, and the concept of patient autonomy and decision-making capacity can help providers optimize care when the AMA discharge is unavoidable.

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