TY - JOUR
T1 - Uncompleted Emergency Department Care
T2 - Patients Who Leave against Medical Advice
AU - Ding, Ru
AU - Jung, Julianna J.
AU - Kirsch, Thomas
AU - Levy, Frederick
AU - McCarthy, Melissa L.
PY - 2007/10
Y1 - 2007/10
N2 - Objectives: To compare the patient characteristics, clinical conditions, and short-term recidivism rates of emergency department (ED) patients who leave against medical advice (AMA) with those who leave without being seen (LWBS) or complete their ED care. Methods: All eligible patients who visited the ED between July 1, 2004, and June 30, 2005 (N = 31,252) were classified into one of four groups: 1) AMA (n = 857), 2) LWBS (n = 2,767), 3) admitted (n = 8,894), or 4) discharged (n = 18,734). The patient characteristics, primary diagnosis, and 30-day rates of emergent hospitalizations, nonemergent hospitalizations, and ED discharge visits were compared between patients who left AMA and each of the other study groups. A Cox proportional hazards model was used to examine the influence of study group status on the risk of emergent hospitalization, adjusted for patient characteristics. Results: Patients who left AMA were significantly more likely to be uninsured or covered by Medicaid compared with those admitted or discharged (p < 0.001). The AMA visit rates were highest for nausea and vomiting (9.7%), abdominal pain (7.9%), and nonspecific chest pain (7.6%). During the 30-day follow-up period, patients who left AMA had significantly higher emergent hospitalization and ED discharge visit rates compared with each of the other study groups (p < 0.001). Insurance status, male gender, and higher acuity level were also associated with a significantly higher emergent hospitalization rate. Conclusions: Patients who leave AMA may do so prematurely, as evidenced by higher emergent hospitalization rates compared with those who LWBS or complete their care.
AB - Objectives: To compare the patient characteristics, clinical conditions, and short-term recidivism rates of emergency department (ED) patients who leave against medical advice (AMA) with those who leave without being seen (LWBS) or complete their ED care. Methods: All eligible patients who visited the ED between July 1, 2004, and June 30, 2005 (N = 31,252) were classified into one of four groups: 1) AMA (n = 857), 2) LWBS (n = 2,767), 3) admitted (n = 8,894), or 4) discharged (n = 18,734). The patient characteristics, primary diagnosis, and 30-day rates of emergent hospitalizations, nonemergent hospitalizations, and ED discharge visits were compared between patients who left AMA and each of the other study groups. A Cox proportional hazards model was used to examine the influence of study group status on the risk of emergent hospitalization, adjusted for patient characteristics. Results: Patients who left AMA were significantly more likely to be uninsured or covered by Medicaid compared with those admitted or discharged (p < 0.001). The AMA visit rates were highest for nausea and vomiting (9.7%), abdominal pain (7.9%), and nonspecific chest pain (7.6%). During the 30-day follow-up period, patients who left AMA had significantly higher emergent hospitalization and ED discharge visit rates compared with each of the other study groups (p < 0.001). Insurance status, male gender, and higher acuity level were also associated with a significantly higher emergent hospitalization rate. Conclusions: Patients who leave AMA may do so prematurely, as evidenced by higher emergent hospitalization rates compared with those who LWBS or complete their care.
KW - against medical advice
KW - emergency department
KW - quality of care
UR - http://www.scopus.com/inward/record.url?scp=34548696417&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=34548696417&partnerID=8YFLogxK
U2 - 10.1197/j.aem.2007.06.027
DO - 10.1197/j.aem.2007.06.027
M3 - Article
C2 - 17766732
AN - SCOPUS:34548696417
SN - 1069-6563
VL - 14
SP - 870
EP - 876
JO - Academic Emergency Medicine
JF - Academic Emergency Medicine
IS - 10
ER -