TRENDS, MANAGEMENT PATTERNS AND PREDICTORS OF LEAVING AGAINST MEDICAL ADVICE AMONG PATIENTS WITH DOCUMENTED NON-COMPLIANCE ADMITTED FOR ACUTE MYOCARDIAL INFARCTION

BackgroundDischarge against medical advice (AMA) occurs infrequently but is associated with poor outcomes. There are limited descriptions of discharges AMA in national cohorts of patients with acute myocardial infarction (AMI). This study aims to evaluate discharge AMA in AMI and how it affects readmissions.MethodsWe conducted a cohort study of patients with AMI in USA in the Nationwide Readmission Database who were admitted between the years 2010 and 2014. Descriptive statistics were presented for variables according to discharge home or AMA. The primary end point was all-cause 30-day unplanned readmissions and their causes.Results2663 019 patients were admitted with AMI of which 10.3% (n=162 070) of 1569 325 patients had an unplanned readmission within 30 days. The crude rate of discharge AMA remained stable between 2010 and 2014 at 1.5%. Discharge AMA was an independent predictor of unplanned all-cause readmissions (OR 2.27 95% CI 2.14 to 2.40); patients who discharged AMA had >twofold increased crude rate of readmission for AMI (30.4% vs 13.4%) and higher crude rate of admissions for neuropsychiatric reasons (3.2% vs 1.3%). After adjustment, discharge AMA was associated with increased odds of readmissions for AMI (OR 3.65 95% CI 3.31 to 4.03, p<0.001). We estimate that there are 1420 excess cases of AMI among patients who discharged AMA.ConclusionsDischarge AMA occurs in 1.5% of the population with AMI and these patients are at higher risk of early readmissions for re-infarction. Interventions should be developed to reduce discharge AMA in high-risk groups and initiate interventions to avoid adverse outcomes and readmission.

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Continuous aspirin administration in patients of myocardial infraction during their hospital stay - a clinic audit

Annals of King Edward Medical University ◽

10.21649/akemu.v12i1.860 ◽

2016 ◽

Vol 12 (1) ◽

Author(s):

Hammad Ali ◽

Ahmed Ali

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Hospital Stay ◽

Medical Advice ◽

Medical Ward ◽

Recommended Dose ◽

Against Medical Advice ◽

Retrospective Audit ◽

Myocardial Infraction ◽

Acute Mi

This audit was performed to check whether all patients suffering from myocardial infarction have received aspirin in dose of 160 - 325 mg during their stay in the medical ward in Mayo hospital Lahore. Objectives: The audit was performed to assess the application of ACC/AHA guidelines for management of patients with acute MI regarding administration of aspirin in a dose of 160-325 mg daily during their stay in the hospital. Criteria of audit: A dose of 160-325 mg of aspirin should be continued indefinitely daily after an attack of MI7. Standard of audit: All patients who have been diagnosed to have acute myocardial infarction should receive 160- 325 mg of aspirin daily during hospital stay and continuously thereafter. Material and methods: A retrospective audit was conducted in medical ward in Mayo hospital, Lahore in which notes of patients who were admitted with a diagnosis of acute myocardial infarction from 1st Jan 2005 to 31st August 2005 were studied. Results: We found that patients included in this audit had a mean age of 56 years +/- 13.55 out of which 45 patients 84% were discharged, 2% were discharged on request, 4 % were shifted to CCU, 6% left against medical advice and 2% expired. We found out that out of 45 cases only 24.4 % of cases were given aspirin in the recommended dose of 160- 325 mg daily, 40 % of patients received only 75 mg aspirin daily, while 33.3 % of them got 150mg daily and 2.2 % of patients did not receive aspirin during their stay in the hospital.

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Factors Affecting Discharges against Medical Advice in an Emergency Department of a Tertiary Care Center

Journal of KIST Medical College ◽

10.3126/jkistmc.v2i2.33576 ◽

2020 ◽

Vol 2 (2) ◽

pp. 31-35

Author(s):

Trishna Shrestha ◽

Sneha Pradhananga ◽

Kabita Hada Batajoo ◽

Manjita Bajracharya

Keyword(s):

Health Care ◽

Emergency Department ◽

Health Care Costs ◽

Medical Advice ◽

Health Concern ◽

Against Medical Advice ◽

Factors Affecting ◽

Tertiary Center ◽

Care Costs ◽

Leaving Against Medical Advice

Introduction: Patients leaving against the advice of the treating team before being certified as fit is a major concern and challenge for the treating professionals as it possesses adverse medical outcomes. This study hence aimed at identifying the prevalence and major factors affecting such discharges so that advocacy can be done to help prevent it. Methods: A descriptive cross-sectional study was conducted at emergency department of a tertiary center in Lalitpur from 15th May 2019 to 15th August 2019. All the patients visiting the emergency department were included in the study and a non-probability purposive sampling method was used excluding the patients who denied giving reasons for them leaving against medical advice. Data was collected using pre-structured questionnaire and analyzed using SPSS-v21 software. Results: A hundred and fifteen patients (4.08%) left against medical advice out of 2812 patients who presented to emergency department. There were 63 male patients (54.8%), 75 patients of the total patients in the age group of 15-44 years (65.2%) and those living within a distance of 1km from the hospital (53%). The most common reason for the patients leaving against medical advice was found to be due to financial constraint (38.3%) followed by preference to other hospitals (16.5%). Conclusion: Patients leaving against medical advice possesses a small percentage of actual hospital admissions but is still a major health concern as it drastically increases the morbidity, re-admission rates and total health-care costs. Hence, understanding the general characteristics and predictors of such discharges is of utmost importance to help improve the patient outcome and reduce the health-care costs.

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

Healthcare ◽

10.3390/healthcare9020111 ◽

2021 ◽

Vol 9 (2) ◽

pp. 111

Author(s):

Asseel Albayati ◽

Steven Douedi ◽

Abbas Alshami ◽

Mohammad A. Hossain ◽

Shuvendu Sen ◽

...

Keyword(s):

Hospital Admissions ◽

Medical Advice ◽

Preventive Strategies ◽

Against Medical Advice ◽

Cause Analysis ◽

Persistent Problem ◽

Root Cause ◽

Discharge Against Medical Advice ◽

Leaving Against Medical Advice

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.

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