Clinical Characteristics and Discharge Planning for Inpatients Leaving Against Medical Advice — A Retrospective Chart Review

Abstract

Discharge against medical advice (AMA) poses a significant challenge to continuity of care and portends increased risk of 30-day readmission and all-cause mortality, but data on provider practices during these encounters remains limited. Our objective was to characterize individual provider practice patterns and discharge encounter planning for hospitalized patients discharged AMA. We conducted a retrospective chart review of adult inpatients discharged AMA from March 2019 to March 2024 at a tertiary medical center. Demographic information, medical comorbidities, discharge provider practices (e.g., documentation of patient decision-making capacity), and discharge planning such as medication prescription or follow-up appointments were collected, as were data on 30-day readmission risk and outcomes. Of 690 AMA discharges, most patients were male (60%), White (86%), and publicly insured (65%). Substance use disorders (43%) and psychiatric illness (29%) were common. Although 86% of patients signed an AMA form before discharge, only 47% had documented capacity assessments. Only 44% of patients received outpatient prescriptions, while 53% had follow-up appointments ordered. A 34% observed 30-day readmission rate was observed. Discharge AMA was found to vary considerably among providers. Inconsistent performance of key discharge assessment and evaluation elements leads to disparities in patient safety outcomes, including elevated risk of 30-day readmission.