Factors affecting leave against medical advice from the emergency department

Background Leave against medical advice (LAMA) is defined as a patient leaving the hospital against the doctor's advice, sometimes avoiding routine and potentially lifesaving procedures. The rate of LAMA can be a reflection of the effectiveness of communication, treatment and processes of the hospital. We aimed to identify the reasons for LAMA from an emergency department (ED) of a tertiary care hospital in New Delhi. Methods 400 consecutive patients going LAMA from the ED were enrolled in the study. Demographic data, triage category and reasons for LAMA were collected using questionnaires. Statistical analysis was performed and results analyzed. Results 103 (25.8%) patients went LAMA as they felt better after initial treatment and refused further in-hospital care. Other reasons for LAMA decisions included non-availability of intensive care unit (ICU) beds (82; 20.5%), financial constraints (69; 17.3%) and perceived risk of infection (59; 14.8%). Age, gender or triaging categories had no significant effect (p>0.05). Multiple logistic regression analysis revealed that the lack of health insurance and low family income were independent risk factors for LAMA decision. Conclusion In our study, the leading causes of LAMA were a patient feeling better after initial treatment, a lack of ICU beds, financial constraints and a perceived risk of infection.