Against Medical Advice Discharge: A Narrative Review and Recommendations for a Systematic Approach

Emily G Holmes; Benjamin S Cooley; Sheryl B Fleisch; Donald L Rosenstein

doi:10.1016/j.amjmed.2020.12.027

Against Medical Advice Discharge: A Narrative Review and Recommendations for a Systematic Approach

Am J Med. 2021 Jun;134(6):721-726. doi: 10.1016/j.amjmed.2020.12.027. Epub 2021 Feb 18.

Authors

Emily G Holmes¹, Benjamin S Cooley², Sheryl B Fleisch³, Donald L Rosenstein⁴

Affiliations

¹ Department of Psychiatry, Indiana University, Indianapolis. Electronic address: egholmes@iu.edu.
² Department of Psychiatry, Indiana University, Indianapolis.
³ Department of Psychiatry, University of Florida, Gainesville.
⁴ Departments of Psychiatry and Medicine, University of North Carolina, Chapel Hill.

PMID: 33610522
DOI: 10.1016/j.amjmed.2020.12.027

Abstract

Approximately 1%-2% of hospitalizations in the United States result in an against medical advice discharge. Still, the practice of discharging patients against medical advice is highly subjective and variable. Discharges against medical advice are associated with physician distress, patient stigma, and adverse outcomes, including increased morbidity and mortality. This review summarizes discharge against medical advice research, proposes a definition for against medical advice discharge, and recommends a standard approach to a patient's request for discharge against medical advice.

Keywords: Against medical advice; Morbidity; Patient safety; Quality.

Publication types

Review

MeSH terms

Hospitalization / trends
Humans
Patient Discharge / standards*
Patient Discharge / trends
Risk Factors
Treatment Refusal / psychology*
Treatment Refusal / trends
United States