Administration of emergency medicine| Volume 41, ISSUE 4, P412-417, October 2011

Patients Leaving Against Medical Advice (AMA) from the Emergency Department-Disease Prevalence and Willingness to Return


      Background: How patients fare once they leave the emergency department (ED) against medical advice (AMA), and the extent of illness burden that accompanies them, remains unstudied. Objective: To determine the fate of patients leaving the ED AMA for a defined period of time post-discharge. Methods: This was a prospective follow-up study of a convenience sample of patients leaving the ED AMA during two 6-month periods in consecutive calendar years at an urban academic ED with 32,000 annual patient visits. Results: A total of 199 patients were identified, with 194 enrolled. Categories of discharge diagnoses included cardiovascular, undifferentiated abdominal pain, respiratory, and cellulitis. Of the 194 patients studied, 126 patients (64.9%, 95% confidence interval [CI] 57.6–71.5%) stated that their symptoms had improved or resolved. Of these 126 patients, 109 (86.5%, 95% CI 78.9–91.7%) had their original AMA discharge diagnoses referable to cardiovascular pathology. Ninety-five patients (75.4%, 95% CI 66.7–82.4%) with improved or abated symptoms did not plan to return. Of those with improved or abated symptoms, 31 patients (24.6%, 95% CI 17.6–33.2%) did return, and with further evaluation, 15 of them were found to have significant clinical findings. Of the 68 patients with continuing symptoms, 36 (52.9%, 95% CI 40.5–64.9%) returned for further evaluation. A total of 127 patients did not return. Twenty-five patients (19.7%, 95% CI 15.9–25.4%) expressed a reluctance to return to the same ED for fear of embarrassment. Seven patients (5.5%, 95% CI 4.8–8.7%) who did not seek alternative care but were still having symptoms did not return due to job or family commitments or because they would follow-up with a personal physician. Conclusion: Patients who leave the ED AMA have significant pathology.


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        • Derlet R.
        • Richards J.
        Overcrowding in the nation's emergency departments: complex causes and disturbing effects.
        Ann Emerg Med. 2000; 35: 63-68
        • Derlet R.
        • Richards J.
        • Kravitz R.
        Frequent crowding in the US emergency departments.
        Acad Emerg Med. 2001; 8: 151-155
        • Rowe B.
        • Channan P.
        • Bullard M.
        • et al.
        Characteristics of patients who leave emergency departments without being seen.
        Acad Emerg Med. 2006; 13: 848-852
        • Fernandes C.
        • Daya M.
        • Barry S.
        • Palmer N.
        Emergency department patients who leave without seeing a physician: the Toronto Hospital experience.
        Ann Emerg Med. 1994; 24: 1092-1096
        • Barlas D.
        • Homan C.
        • Rakowski J.
        • Houck M.
        • Thode Jr, H.C.
        How well do patients obtain short-term follow-up after discharge from the emergency department?.
        Ann Emerg Med. 1999; 34: 610-614
        • Magnusson A.
        • Hedges J.
        • Vanko M.
        • McCarten K.
        • Moorhead J.C.
        Follow-up compliance after emergency department evaluation.
        Ann Emerg Med. 1993; 22: 560-567
        • Jerrard D.
        • Osborn T.
        • Olshaker J.
        Patients leaving AMA: do they leave secondary to dissatisfaction with ED services.
        Acad Emerg Med. 1999; 6 (abstract): 400
        • Henry G.
        Risk management and high risk issues in emergency medicine.
        Emerg Med Clin North Am. 1993; 11: 905-922
        • Ding R.
        • McCarthy M.
        • Guohua L.
        • et al.
        Patients who leave without being seen: their characteristics and history of emergency department use.
        Ann Emerg Med. 2006; 48: 668-693
        • Reinke D.
        • Walker M.
        • Boslaugh S.
        • Hodge 3rd, D.
        Predictors of pediatric emergency patients discharged against medical advice.
        Clin Pediatr (Phila). 2009; 48: 263-270