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Uncompleted emergency department care: patients who leave against medical advice.
Acad Emerg Med. 2007 Oct; 14(10):870-6.AE

Abstract

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.

Authors+Show Affiliations

Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

17766732

Citation

Ding, Ru, et al. "Uncompleted Emergency Department Care: Patients Who Leave Against Medical Advice." Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine, vol. 14, no. 10, 2007, pp. 870-6.
Ding R, Jung JJ, Kirsch TD, et al. Uncompleted emergency department care: patients who leave against medical advice. Acad Emerg Med. 2007;14(10):870-6.
Ding, R., Jung, J. J., Kirsch, T. D., Levy, F., & McCarthy, M. L. (2007). Uncompleted emergency department care: patients who leave against medical advice. Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine, 14(10), 870-6.
Ding R, et al. Uncompleted Emergency Department Care: Patients Who Leave Against Medical Advice. Acad Emerg Med. 2007;14(10):870-6. PubMed PMID: 17766732.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Uncompleted emergency department care: patients who leave against medical advice. AU - Ding,Ru, AU - Jung,Julianna J, AU - Kirsch,Thomas D, AU - Levy,Frederick, AU - McCarthy,Melissa L, Y1 - 2007/08/31/ PY - 2007/9/4/pubmed PY - 2007/12/6/medline PY - 2007/9/4/entrez SP - 870 EP - 6 JF - Academic emergency medicine : official journal of the Society for Academic Emergency Medicine JO - Acad Emerg Med VL - 14 IS - 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. SN - 1553-2712 UR - https://www.unboundmedicine.com/medline/citation/17766732/Uncompleted_emergency_department_care:_patients_who_leave_against_medical_advice_ L2 - https://onlinelibrary.wiley.com/resolve/openurl?genre=article&amp;sid=nlm:pubmed&amp;issn=1069-6563&amp;date=2007&amp;volume=14&amp;issue=10&amp;spage=870 DB - PRIME DP - Unbound Medicine ER -