Patients Discharged "Against Medical Advice" More than Once: A Cross-Sectional Descriptive Analysis of a Vulnerable...

Patients who have been discharged "against medical advice" (AMA) are at increased risk of morbidity and mortality, but there is little research about patients who have had more than one AMA discharge.

We aimed to describe the socio-demographic and clinical characteristics of patients with more than one AMA discharge.

We conducted a cross-sectional, retrospective chart review of a sample of adult patients who were discharged AMA more than once between 2016 and 2021 and abstracted detailed characteristics of this sample.

A total of 81 patients were discharged AMA more than once during the study period.

We reviewed demographics, health insurance, substance use and mental health diagnoses, psychiatric consultations, documentation of prior AMA discharges, admitting medical service, length of stay, number of hospitalizations during the study period, and readmission within 30 days of the first AMA discharge. We also noted the presence of relevant psychosocial stressors.

Among 81 patients reviewed, the average age was 41 years (range 19-76). Most were unmarried (n = 72, 89%) and most had public insurance or were uninsured (n = 74, 91%). More than half (n = 52, 64%) had a readmission within 30 days. The average number of hospitalizations in the study period was 10 (range 2-47). These patients had a high burden of psychosocial stressors including financial stress (56, 69%), housing insecurity (n = 40, 49%), and grief or loss of social support (n = 20, 25%).

Patients who have been discharged AMA more than once represent a vulnerable population with significant unmet needs.