From the Research
Discharge against medical advice (DAMA) is associated with an increased risk of morbidity and mortality, and patients who decide to DAMA tend to be young males from a lower socioeconomic background with a history of mental health or substance misuse disorder. The implications of Against Medical Advice (AMA) are significant, and it is essential to understand the causes, consequences, and possible corrective measures to address this issue. According to a recent study published in the British journal of hospital medicine (London, England : 2005) 1, patients who discharge themselves against medical advice comprise 1%-2% of hospital admissions, and this act impacts both the patient and the staff, leading to inadequate assessment or treatment of medical problems.
The consequences of DAMA are far-reaching, and it is crucial to identify the reasons behind this decision. A study published in Healthcare (Basel, Switzerland) 2 explored the reasons for leaving against medical advice and found that it affects both the patient and the healthcare provider. The study employed Ishikawa fishbone root cause analysis (RCA) to explore the reasons for leaving against medical advice and highlighted the consequences of discharge against medical advice.
To mitigate the risks associated with DAMA, it is essential to ensure that patients receive proper care and information before discharge. A study published in the Journal of trauma nursing : the official journal of the Society of Trauma Nurses 3 emphasized the importance of nurses' role in patients considering an AMA discharge, ensuring that patients leave with information about their injuries, possible issues of concern after discharge, medications, and follow-up information.
Healthcare providers should prioritize patient-centered care and shared decision-making to improve the quality of care for patients discharged AMA, as recommended by a study published in the Journal of general internal medicine 4. This approach can help reduce the stigma associated with patients discharged AMA and promote high-quality care. Additionally, a study published in The Journal of emergency medicine 5 highlighted the importance of a proper AMA discharge, including an assessment of capacity, proper documentation, and adequate disclosure, to create significant liability protection for providers.
Key considerations for healthcare providers include:
- Ensuring that patients receive proper care and information before discharge
- Prioritizing patient-centered care and shared decision-making
- Reducing the stigma associated with patients discharged AMA
- Implementing proper AMA discharge procedures to create liability protection for providers
- Addressing the social determinants of health that contribute to DAMA, such as socioeconomic status and mental health or substance misuse disorders.