Uncompleted Emergency Department Care: Patients Who Leave against Medical Advice

Ru Ding, Julianna J. Jung, Thomas Kirsch, Frederick Levy, Melissa L. McCarthy

Research output: Contribution to journalArticlepeer-review

48 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)870-876
Number of pages7
JournalAcademic Emergency Medicine
Issue number10
StatePublished - Oct 2007


  • against medical advice
  • emergency department
  • quality of care

ASJC Scopus subject areas

  • Emergency Medicine


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