Annals for Hospitalists Inpatient Notes - Challenging the Myths of the Against Medical Advice Discharge

2021 ◽  
Vol 174 (10) ◽  
pp. HO2-HO3
Author(s):  
David Alfandre
Keyword(s):  
Medical Advice ◽  
Against Medical Advice ◽  
Against Medical Advice Discharge

scholarly journals Uncompleted emergency department care and discharge against medical advice in patients with neurological complaints: a chart review.

2019 ◽  
Author(s):  
Carolin Hoyer ◽  
Patrick Stein ◽  
Angelika Alonso ◽  
Michael Platten ◽  
Kristina Szabo
Keyword(s):  
Emergency Department ◽  
Chart Review ◽  
Waiting Times ◽  
Medical Advice ◽  
Emergency Department Care ◽  
Against Medical Advice ◽  
Sensory Deficits ◽  
Presenting Symptoms ◽  
Mode Of Presentation ◽  
Against Medical Advice Discharge

Abstract Background: Uncompleted emergency department care and against-medical-advice discharge represent relevant medical problems with impact on patient safety and potential medicolegal and socioeconomic consequences. They may also indicate structural or procedural problems in the emergency department (ED) relating to patient management and flow. While patients with neurological complaints frequently leave the ED against medical advice or without being seen, no dedicated analysis of this group of patients aiming at the identification of characteristics associated with irregular ED discharge has been performed so far. Methods: A chart review was performed of all patients with neurological complaints presenting to a German interdisciplinary emergency department between January and December 2017 for neurological evaluation. Demographics, mode of presentation, process times, presenting symptoms and diagnosis were recorded. Patients leaving against medical advice after an informed consent discussion and signing of documentation (DAMA) or leaving prematurely without notifying ED staff (PL) were compared to the total of patients who were admitted or discharged (non-DAMA/PL). Results: Of all patients presenting with neurological symptoms or complaints, 3% left against medical advice and 2.2% left prematurely DAMA/PL patients were younger (p<.001), and they were more frequently self-presenting (p<0.001). Headaches, seizures and sensory deficits were the most frequent presenting symptoms in DAMA/PL patients, and 56.1% of those presenting with a seizure had a history of epilepsy. The most common documented reason for leaving was the duration of door-to-doctor time. Conclusions: Younger age, self-presenting mode of presentation and presentation with headache, seizures or sensory deficits are associated with premature leave or against-medical-advice discharge of patients with neurological complaints from the ED, and long waiting times were given as the major reason for leaving the ED. Increasing ED staff’s awareness of these factors and the optimization of pre-hospital assessment and demand management, thereby positively impacting on patient flow and ED process times, may help to prevent irregular discharges from the ED.

scholarly journals Uncompleted emergency department care and discharge against medical advice in patients with neurological complaints: a chart review.

2019 ◽  
Author(s):  
Carolin Hoyer ◽  
Patrick Stein ◽  
Angelika Alonso ◽  
Michael Platten ◽  
Kristina Szabo
Keyword(s):  
Emergency Department ◽  
Chart Review ◽  
Waiting Times ◽  
Medical Advice ◽  
Emergency Department Care ◽  
Against Medical Advice ◽  
Sensory Deficits ◽  
Presenting Symptoms ◽  
Mode Of Presentation ◽  
Against Medical Advice Discharge

Abstract Background: Uncompleted emergency department care and against-medical-advice discharge represent relevant medical problems with impact on patient safety and potential medicolegal and socioeconomic consequences. They may also indicate structural or procedural problems in the emergency department (ED) relating to patient management and flow. While patients with neurological complaints frequently leave the ED against medical advice or without being seen, no dedicated analysis of this group of patients aiming at the identification of characteristics associated with irregular ED discharge has been performed so far. Methods: A chart review was performed of all patients with neurological complaints presenting to a German interdisciplinary emergency department between January and December 2017 for neurological evaluation. Demographics, mode of presentation, process times, presenting symptoms and diagnosis were recorded. Patients leaving against medical advice after an informed consent discussion and signing of documentation (DAMA) or leaving prematurely without notifying ED staff (PL) were compared to the total of patients who were admitted or discharged (non-DAMA/PL). Results: Of all patients presenting with neurological symptoms or complaints, 3% left against medical advice and 2.2% left prematurely. DAMA/PL patients were younger (p<.001), and they were more frequently self-presenting (p<0.001). Headaches, seizures and sensory deficits were the most frequent presenting symptoms in DAMA/PL patients, and 56.1% of those presenting with a seizure had a history of epilepsy. The most common documented reason for leaving was the duration of door-to-doctor time. Conclusions: Younger age, self-presenting mode of presentation and presentation with headache, seizures or sensory deficits are associated with premature leave or against-medical advice discharge of patients with neurological complaints from the ED, and long waiting times were given as the major reason for leaving the ED. Increasing ED staff’s awareness of these factors and the optimization of pre-hospital assessment and demand management, thereby positively impacting on patient flow and ED process times, may help to prevent irregular discharges from the ED.

Effect of Inpatient Medication-Assisted Therapy on Against-Medical-Advice Discharge and Readmission Rates

2020 ◽  
Vol 133 (11) ◽  
pp. 1343-1349
Author(s):  
Sijie Jason Wang ◽  
Elizabeth Wade ◽  
Jennifer Towle ◽  
Tabitha Hachey ◽  
Jennifer Rioux ◽  
...  
Keyword(s):  
Medical Advice ◽  
Readmission Rates ◽  
Against Medical Advice ◽  
Against Medical Advice Discharge

scholarly journals Uncompleted emergency department care and discharge against medical advice in patients with neurological complaints: a chart review

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Carolin Hoyer ◽  
Patrick Stein ◽  
Angelika Alonso ◽  
Michael Platten ◽  
Kristina Szabo
Keyword(s):  
Emergency Department ◽  
Chart Review ◽  
Waiting Times ◽  
Medical Advice ◽  
Emergency Department Care ◽  
Against Medical Advice ◽  
Sensory Deficits ◽  
Presenting Symptoms ◽  
Mode Of Presentation ◽  
Against Medical Advice Discharge

Abstract Background Uncompleted emergency department care and against-medical-advice discharge represent relevant medical problems with impact on patient safety and potential medicolegal and socioeconomic consequences. They may also indicate structural or procedural problems in the emergency department (ED) relating to patient management and flow. While patients with neurological complaints frequently leave the ED against medical advice or without being seen, no dedicated analysis of this group of patients aiming at the identification of characteristics associated with irregular ED discharge has been performed so far. Methods A chart review was performed of all patients with neurological complaints presenting to a German interdisciplinary emergency department between January and December 2017 for neurological evaluation. Demographics, mode of presentation, process times, presenting symptoms and diagnosis were recorded. Patients leaving against medical advice after an informed consent discussion and signing of documentation (DAMA) or leaving prematurely without notifying ED staff (PL) were compared to the total of patients who were admitted or discharged (non-DAMA/PL). Results Of all patients presenting with neurological symptoms or complaints, 3% left against medical advice and 2.2% left prematurely. DAMA/PL patients were younger (p < .001), and they were more frequently self-presenting (p < 0.001). Headaches, seizures and sensory deficits were the most frequent presenting symptoms in DAMA/PL patients, and 56.1% of those presenting with a seizure had a history of epilepsy. The most common documented reason for leaving was the duration of door-to-doctor time. Conclusions Younger age, self-presenting mode of presentation and presentation with headache, seizures or sensory deficits are associated with premature leave or against-medical-advice discharge of patients with neurological complaints from the ED, and long waiting times were given as the major reason for leaving the ED. Increasing ED staff’s awareness of these factors and the optimization of pre-hospital assessment and demand management, thereby positively impacting on patient flow and ED process times, may help to prevent irregular discharges from the ED.

scholarly journals Uncompleted emergency department care and discharge against medical advice in patients with neurological complaints: a chart review.

2019 ◽  
Author(s):  
Carolin Hoyer ◽  
Patrick Stein ◽  
Angelika Alonso ◽  
Michael Platten ◽  
Kristina Szabo
Keyword(s):  
Emergency Department ◽  
Chart Review ◽  
Waiting Times ◽  
Medical Advice ◽  
Emergency Department Care ◽  
Against Medical Advice ◽  
Sensory Deficits ◽  
Presenting Symptoms ◽  
Mode Of Presentation ◽  
Against Medical Advice Discharge

Abstract Background: Uncompleted emergency department care and against-medical-advice discharge represent relevant medical problems with impact on patient safety and potential medicolegal and socioeconomic consequences. They may also indicate structural or procedural problems in the emergency department (ED) relating to patient management and flow. While patients with neurological complaints frequently leave the ED against medical advice or without being seen, no dedicated analysis of this group of patients aiming at the identification of characteristics associated with irregular ED discharge has been performed so far. Methods: A chart review was performed of all patients with neurological complaints presenting to a German interdisciplinary emergency department between January and December 2017 for neurological evaluation. Demographics, mode of presentation, process times, presenting symptoms and diagnosis were recorded. Patients leaving against medical advice after an informed consent discussion and signing of documentation (DAMA) or leaving prematurely without notifying ED staff (PL) were compared to the total of patients who were admitted or discharged (non-DAMA/PL). Results: Of all patients presenting with neurological symptoms or complaints, 3% left against medical advice and 2.2% left prematurely DAMA/PL patients were younger (p<.001), and they were more frequently self-presenting (p<0.001). Headaches, seizures and sensory deficits were the most frequent presenting symptoms in DAMA/PL patients, and 56.1% of those presenting with a seizure had a history of epilepsy. The most common documented reason for leaving was the duration of door-to-doctor time. Conclusions: Younger age, self-presenting mode of presentation and presentation with headache, seizures or sensory deficits are associated with premature leave or against-medical-advice discharge of patients with neurological complaints from the ED, and long waiting times were given as the major reason for leaving the ED. Increasing ED staff’s awareness of these factors and the optimization of pre-hospital assessment and demand management, thereby positively impacting on patient flow and ED process times, may help to prevent irregular discharges from the ED.

scholarly journals Uncompleted emergency department care and discharge against medical advice in patients with neurological complaints: a chart review.

2019 ◽  
Author(s):  
Carolin Hoyer ◽  
Patrick Stein ◽  
Angelika Alonso ◽  
Michael Platten ◽  
Kristina Szabo
Keyword(s):  
Emergency Department ◽  
Chart Review ◽  
Waiting Times ◽  
Medical Advice ◽  
Emergency Department Care ◽  
Against Medical Advice ◽  
Sensory Deficits ◽  
Presenting Symptoms ◽  
Mode Of Presentation ◽  
Against Medical Advice Discharge

Abstract Background: Uncompleted emergency department care and against-medical-advice discharge represent relevant medical problems with impact on patient safety and potential medicolegal and socioeconomic consequences. They may also indicate structural or procedural problems in the emergency department (ED) relating to patient management and flow. While patients with neurological complaints frequently leave the ED against medical advice or without being seen, no dedicated analysis of this group of patients aiming at the identification of characteristics associated with irregular ED discharge has been performed so far. Methods: A chart review was performed of all patients with neurological complaints presenting to a German interdisciplinary emergency department between January and December 2017 for neurological evaluation. Demographics, mode of presentation, process times, presenting symptoms and diagnosis were recorded. Patients leaving against medical advice after an informed consent discussion and signing of documentation (DAMA) or leaving prematurely without notifying ED staff (PL) were compared to the total of patients who were admitted or discharged (non-DAMA/PL). Results: Of all patients presenting with neurological symptoms or complaints, 3% left against medical advice and 2.2% left prematurely DAMA/PL patients were younger (p<.001), and they were more frequently self-presenting (p<0.001). Headaches, seizures and sensory deficits were the most frequent presenting symptoms in DAMA/PL patients, and 56.1% of those presenting with a seizure had a history of epilepsy. The most common documented reason for leaving was the duration of door-to-doctor time. Conclusions: Younger age, self-presenting mode of presentation and presentation with headache, seizures or sensory deficits are associated with premature leave or against-medical-advice discharge of patients with neurological complaints from the ED, and long waiting times were given as the major reason for leaving the ED. Increasing ED staff’s awareness of these factors and the optimization of pre-hospital assessment and demand management, thereby positively impacting on patient flow and ED process times, may help to prevent irregular discharges from the ED.

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