J. T. Edwards|Ronald J. Markert|Dean Bricker
Discharge against medical advice: How often do we intervene?
Wright State University|Wright State University|Wright State University
discharges medical advice ama occur 1 2 hospital stays associated increased morbidity readmission rates 30day mortality risk factors associated ama investigated interventions time discharge carefully examinedwe retrospectively reviewed records adult patients discharged ama 2year period general medical service universityaffiliated tertiary care hospital assessed presence documentation addressing informed consent patient decisionmaking capacity health literacy followup plans whether medications prescribed whether warning indicators impending ama apparenttwo hundred ninetyone records reviewed ama notes present 276 948 charts notes authored physicians 163 591 nurses 110 378 encounters informed consent present 88 302 charts mentioned note present chart 111 381 signed 92 316 charts decisionmaking capacity health literacy documented 108 371 75 258 records respectively warning impending ama present 217 746 charts medications prescribed followup plans documented 71 244 91 313 charts respectivelyadvance warning impending ama often present yet minority cases prescription medications development followup plans medical documentation ama dispositions frequently inadequate suggesting missed opportunities intervene well suboptimal medicolegal scenarios