Leaving Against Medical Advice: Current Problems and Plausible Solutions

Area of Science:

• Emergency Medicine
• Healthcare Management
• Patient Outcomes

Background:

• Leaving against medical advice (LAMA) is associated with adverse health outcomes and poor healthcare resource utilization.
• Understanding patient demographics and contributing factors to LAMA is crucial for improving care.
• Current practices and local guidelines surrounding LAMA require evaluation.

Purpose of the Study:

• To conduct a single-center audit of patients leaving against medical advice from the emergency department.
• To establish patient demographics and identify contributing factors for LAMA.
• To benchmark findings against local clinical policy guidelines.

Main Methods:

• A retrospective audit of electronic health records (Salamtak®) from 2018-2023.
• Convenience pilot sample of 120 patients who signed LAMA from the ED.
• Data collection included demographics, ED length of stay, insurance status, mental capacity assessment, reasons for LAMA, PRO involvement, reattendances, and mortality.

Main Results:

• The majority of LAMA cases (80.8%) occurred during evening/night shifts.
• Social reasons (37.5%) were the most common cause for LAMA.
• 11.6% of patients were re-attended within one week, with no reported mortalities.

Conclusions:

• Leaving against medical advice is a significant issue in emergency departments, influenced by social factors and ED operational aspects.
• A patient-centric approach, potentially using less stigmatizing nomenclature like 'premature discharge,' is recommended.
• Healthcare providers should be familiar with local guidelines and implement harm reduction strategies and escalation plans for LAMA cases.