SHM Converge Scientific Abstract ePoster Gallery-Clinical Characteristics and Discharge Planning for Inpatients Leaving Against Medical Advice: A Retrospective Chart Review

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

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This retrospective chart review from Mayo Clinic Arizona examined adult patients discharged against medical advice (AMA) between March 31, 2019, and March 26, 2024. The study aimed to better understand the clinical characteristics of AMA patients, how discharge conversations and planning were handled, and what outcomes followed discharge.<br /><br />A total of 690 patients were identified. The group was 60% male and 40% female. Common characteristics included male sex, substance use disorder, and admission to non-surgical services, especially Hospital Internal Medicine. The median LACE Index score was 59 (IQR 52–73), corresponding to an estimated 31% risk of readmission.<br /><br />Discharge management was inconsistent. Although 647 patients (94%) had a discharge summary written, many key elements of safe AMA discharge planning were not standardized and were sometimes missing, including assessment of decision-making capacity. The study found that AMA discharge practices varied widely across encounters.<br /><br />Post-discharge outcomes showed that 34% of AMA patients were readmitted within 30 days, with a median time to readmission of 5 days after discharge. This underscores the high-risk nature of AMA discharge.<br /><br />The authors conclude that patients leaving AMA are at substantial risk for early readmission, but current management practices are variable and often incomplete. They suggest that future work should examine how discharge planning practices relate to readmission risk and help identify more standardized approaches to safer AMA discharge.

Asset Subtitle

Amogh Havanur

Meta Tag

Author List Amogh Havanur, Colton Erskine, Edward Ziegler, Emily Gardner, Emma Terwilliger, Umesh Sharma

Category Research

Concept Against Medical Advice Discharge

Concept 30-Day Readmission

Concept Retrospective Chart Review

Concept Readmission Risk

Concept Discharge Planning

Distinguished Non-Finalist

Presenter Organization Mayo Clinic Arizona

Presenting Author Amogh Havanur

Track Patient Safety

Keywords

against medical advice

AMA discharge

readmission risk

retrospective chart review

Mayo Clinic Arizona

substance use disorder

discharge planning

decision-making capacity

30-day readmission

hospital internal medicine

Against Medical Advice Discharge

30-Day Readmission

Retrospective Chart Review

Readmission Risk

Discharge Planning