Discharges Against Medical Advice: Provider Accountability and Psychiatric Patients' Rights

1998 ◽  
Vol 36 (1) ◽  
pp. 22-27
Author(s):  
Norma N McGihon
Keyword(s):  
Psychiatric Patients ◽  
Medical Advice ◽  
Against Medical Advice ◽  
Patients Rights

scholarly journals Informal psychiatric patients requesting discharge

1994 ◽  
Vol 18 (4) ◽  
pp. 209-211
Author(s):  
Robin McGilp ◽  
Brian Kidd ◽  
Cameron Stark ◽  
Tom Henderson
Keyword(s):  
Substance Abuse ◽  
Psychiatric Patients ◽  
Medical Advice ◽  
Psychotic Illness ◽  
Against Medical Advice ◽  
The Past ◽  
History Of ◽  
Self Harm ◽  
Discharge Against Medical Advice ◽  
Retrospective Investigation

A retrospective investigation of case-notes compared 54 incidents of informal psychiatric in-patients being detained in hospital on an emergency basis with 66 incidents of discharge against medical advice (AMA). The characteristics of the two groups were compared. Detained patients were more likely to have been detained previously, to be suffering from a psychotic illness, and to have threats of violence or self-harm mentioned in their case-notes. AMA patients were more likely to have a history of substance abuse but were no more likely than the detained group to have been discharged AMA in the past. The results suggest that psychiatrists in this hospital are using current legislation on detention appropriately.

Psychiatrie Patients who Discharge Themselves against Medical Advice*

1983 ◽  
Vol 28 (3) ◽  
pp. 202-205 ◽  
Author(s):  
M.S. Phillips ◽  
H. Ali
Keyword(s):  
Personality Disorder ◽  
Random Sample ◽  
Psychiatric Patients ◽  
Young Male ◽  
Medical Advice ◽  
Hospital Treatment ◽  
Against Medical Advice ◽  
Treatment Staff

Hospital treatment staff are constantly faced with the problem of psychiatric patients who discharge themselves against medical advice before their treatment is completed. A total of 50 patients who signed themselves out of the 9th floor service of the Clarke Institute of Psychiatry, over a two year period, were analyzed. When compared with a random sample of patients who remained for the duration of their treatment, the authors found the A MA patients to have the following characteristics: The patient is likely to be a young male, admitted as an emergency, remain in hospital for three days or less and have a diagnosis of personality disorder or schizophrenia. The authors conclude with a number of recommendations to assist in dealing with the problem.

Cross-Validating Factors associated with Discharges against Medical Advice

1993 ◽  
Vol 38 (4) ◽  
pp. 285-289 ◽  
Author(s):  
Andrew J. Dalrymple ◽  
Mirella Fata
Keyword(s):  
Psychiatric Patients ◽  
Medical Advice ◽  
Multiple Discriminant Analysis ◽  
Strong Negative Correlation ◽  
Against Medical Advice ◽  
Factors Associated ◽  
Discharge Rates ◽  
Back Door ◽  
Full Benefit ◽  
The One

Between six percent and 35% of psychiatric patients discharge themselves from hospital against medical advice (AMA). The discharges may prevent patients from deriving the full benefit of hospitalization and may result in rapid rehospitalization. We examined sociodemographic and clinical characteristics of 195 irregular discharges from a 237 bed psychiatric hospital over a five year period and found that AMA discharges increased over the study period to a peak of 25% in 1986. There was a strong negative correlation between AMA discharge rates and the willingness of physicians to commit patients involuntarily. Multiple discriminant analysis revealed a set of nine variables that accurately classified 78% of cases into regular or irregular discharge categories. Further analysis revealed that there are two distinct subgroups of patients who discharge themselves AMA: those who repeatedly left the hospital AMA in a regular “revolving back door” pattern and those who left AMA only once. The repeat group exceeded the one-time group in terms of prior admissions, appearances before review boards, and percentage of Natives. The repeat group also spent twice as long in hospital, and 27% were readmitted within one-week of the index AMA discharge. Less than three percent of the one-time AMA group was readmitted within a week. These results were cross-validated on a new sample of irregular discharges and matched controls.

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