Why Do Patients Leave against Medical Advice? Reasons, Consequences, Prevention, and Interventions

Asseel Albayati; Steven Douedi; Abbas Alshami; Mohammad A Hossain; Shuvendu Sen; Vito Buccellato; Anamarrie Cutroneo; Jason Beelitz; Arif Asif

doi:10.3390/healthcare9020111

Why Do Patients Leave against Medical Advice? Reasons, Consequences, Prevention, and Interventions

Healthcare (Basel). 2021 Jan 21;9(2):111. doi: 10.3390/healthcare9020111.

Authors

Asseel Albayati¹, Steven Douedi¹, Abbas Alshami¹, Mohammad A Hossain¹, Shuvendu Sen¹, Vito Buccellato¹, Anamarrie Cutroneo¹, Jason Beelitz¹, Arif Asif¹

Affiliation

¹ Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ 07753, USA.

Abstract

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.

Keywords: AMA; DAMA; against medical advice; discharge; quality improvement.

Publication types

Review