Physician Practices in Against Medical Advice Discharges. Academic Article uri icon

Overview

abstract

  • BACKGROUND: Patients discharged against medical advice (AMA) have disproportionately high health care costs and increased morbidity, mortality, and hospital readmissions. Although patient risk factors for discharge AMA are known, there are little data regarding physician discharge practices surrounding AMA discharges. METHODS: We performed a cross-sectional analysis of patients discharged AMA from a large, urban, academic medical center. Our study predictors included patient demographics and admission characteristics: primary service team, time of discharge, documentation of anticipated AMA discharge, and length of stay. The primary outcomes were physician discharge practices including a scheduled follow-up appointment, documentation of informed consent, documentation of a risk/benefit discussion, and notification of the attending physician. Our coprimary outcome was the incidence of 30-day hospital readmission. RESULTS: Among AMA discharges, 33% had follow-up appointments scheduled upon discharge. There was documentation of a risk/benefit discussion (69%), informed consent (63%), and notification of the attending physician (72%) in most discharges. Physician discharge practices were not associated with 30-day hospital readmission. CONCLUSIONS: Adherence to discharge best practices in AMA discharges was inconsistent and suboptimal, particularly for scheduling follow-up appointments, but was not associated with hospital readmission. Our results highlight the difficulty in facilitating safe transitions of care for patients discharged AMA.

publication date

  • January 1, 2020

Research

keywords

  • Guideline Adherence
  • Patient Discharge
  • Patient Readmission
  • Physicians
  • Treatment Refusal

Identity

PubMed Central ID

  • PMC7218753

Scopus Document Identifier

  • 85090177041

Digital Object Identifier (DOI)

  • 10.1097/JHQ.0000000000000227

PubMed ID

  • 31688424

Additional Document Info

volume

  • 42

issue

  • 5