Factors Associated With Leaving Against Medical Advice From Inpatient Substance Use Detoxification Treatment

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Ulziibat S. Person ◽  
Megan Lin ◽  
Joshua Fogel ◽  
Allison Parrill ◽  
Daniel Bishev ◽  
...  
Keyword(s):  
Substance Use ◽  
Medical Advice ◽  
Against Medical Advice ◽  
Factors Associated ◽  
Leaving Against Medical Advice

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

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.  

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

Healthcare ◽  
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.

Leaving against medical advice: Pediatric surgical perspective

2018 ◽  
Vol 32 (1) ◽  
pp. 18
Author(s):  
Anand Pandey ◽  
Piyush Kumar ◽  
Anurag Srivastava ◽  
Archika Gupta ◽  
Jiledar Rawat ◽  
...  
Keyword(s):  
Medical Advice ◽  
Against Medical Advice ◽  
Leaving Against Medical Advice

scholarly journals 780. Inpatient Addiction Medicine Consultations at the Urban/Rural Frontier: Improving Quality of Care and Linkage to Outpatient Services for Patients with Substance Use Disorder in Central Kentucky

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S346-S346
Author(s):  
Laura Fanucchi ◽  
Devin Oller
Keyword(s):  
Substance Use ◽  
Substance Use Disorder ◽  
Medical Advice ◽  
Outpatient Services ◽  
Addiction Medicine ◽  
Against Medical Advice ◽  
Opioid Treatment ◽  
Rural Counties ◽  
Discharge Against Medical Advice ◽  
The University

Abstract Background When persons with opioid use disorder (OUD) are hospitalized with medical complications (e,g. endocarditis, viral hepatitis) they frequently do not receive medications for the underlying OUD. In recent years, a number of hospitals have implemented addiction medicine consultation (AMC) services to help address this treatment gap, though these are all in large urban centers. AMCs provide comprehensive substance use disorder (SUD) assessments, manage SUDs, initiate pharmacotherapy for OUD, and arrange linkage to ongoing treatment. The aim of this study was to describe the initial implementation and outcomes of a new AMC at the University of Kentucky Hospital, a 945-bed tertiary referral center with a large rural catchment. Methods The Addiction Consultation and Education Service(ACES) began October, 2018 and was comprised of several physicians and an APRN. A patient navigator assisted with prior authorizations and outpatient linkage. ACES referred to a new bridge clinic at the University for ongoing office-based opioid treatment as well as to community programs and licensed opioid treatment programs. Patient demographics, SUD diagnoses, and comorbidities (including details of the injection-related infections) are collected from the electronic health record, as well as key process metrics including: time-to-consultation and medication initiation, length of stay(LOS), discharge against medical advice(AMA), and details of linkage to outpatient services. Results From October-December, 91 patients were seen, 73 met DSM-5 criteria for OUD, 82 had a medical complication of SUD, and 53 lived in rural counties (Rural-Urban Continuum Codes 4–9). Average LOS was 19.5 days. Among OUD patients, 71% underwent buprenorphine/naloxone induction, 9% were started on methadone. Less than 6% of patients started on buprenorphine or methadone left against medical advice. Conclusion AMCs are a key part of providing comprehensive care for persons hospitalized with infectious complications of substance use. Initiating medication for OUD likely decreases rates of discharge against medical advice. Compared with other AMCs, a greater percentage of patients seen by ACES resided in rural counties. Establishing a bridge clinic prior to starting an AMC is critical to ensure ongoing care. Disclosures All authors: No reported disclosures.

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