Interventions to improve the AMA-discharge rate for opiate-addicted patients

1. The nursing staff of a chemical dependency unit were troubled by the unit's high against medical advice (AMA) discharge rate. Almost half (46%) the hospital's total AMA discharges (0.9%) were occurring on this 14-bed unit. 2. It was discovered that opiate-addicted patients comprised 26.5% of the unit's AMAs, while representing only 15% of total admissions. At one point, as high as 50% of the opiate-addicted patients were discharged AMA. 3. Many treatment issues and ethical dilemmas are encountered with AMA discharges, such as staff demoralization and debate over who should pay for AMA discharges. 4. Use of the Endicott-Watson Subjective/Objective Opiate Withdrawal Scale yielded a 60% improvement in the AMA discharge rate. When a community resource link was put into place, there was an additional 1% improvement, making the overall improvement rate 61%.