Why Do Patients Leave Against Medical Advice? Improving Throughput In Your ED

Leaving The ED Too Soon

Hundreds of patients pass through a hospital’s emergency department (ED) daily. These individuals need medical assistance with varying degrees of urgency. Hospitals have nurses, doctors, and other medical professionals available to attend to patients, yet things do not always go to plan. A subset of these patients leaves against medical advice (AMA). Hospitals strive to keep these numbers as low as possible. However, this is still a concerning, unwanted metric. Understanding why patients leave AMA and improving the areas of the ED, like throughput, is vital for healthier patients.

Risks of departing AMA

AMA is when a patient decides to leave the hospital despite the recommendation of a doctor or medical professional to stay. This can happen in the ED or whenever a patient is admitted to the hospital. AMA has severe consequences for both patients and the hospital. For patients, there is the possibility of worsening symptoms and readmission. Patients can also develop poor perceptions of the hospital, delaying treatment further. Worst of all, AMA patients have higher mortality rates than those who agree to stay.

What about hospitals?

For hospitals, AMA restricts the quality of care, which can lead to poor service. Doctors cannot finish the treatment regimen, which increases the hospital’s mortality rate. Eventually, there will be a lack of trust in the facility. Excess readmissions and leaving AMA also lead to lower patient scores on surveys. Hospitals can lose revenue and funding with poor hospital consumer assessment of healthcare providers and systems (HCAHPS) scores.

Long wait times

Why do patients leave against medical advice? Most cases are due to long wait times in the emergency department. If patients wait too long to see a doctor, the patient may leave out of frustration. Some patients feel unheard, even if the condition is minor. This situation creates more angry patients who go against medical advice. Long wait times are sometimes linked to a strained throughput process. If there is a bottleneck for the patient to receive a bed, medical test, or treatment, the patient may leave. In some cases, there are insufficient people to handle the influx and triage of patients.

Coordinating care

Some patients require multiple touchpoints from different areas of care. However, the timeline for each specialty varies. Often, these doctors and facilities do not coordinate effectively, extending the patient’s time in the hospital. Furthermore, the patient may have entered the hospital with skepticism based on experience. The patient may then disagree with the doctor’s advice and the length of time needed for treatment, leading to an early exit.

A change of heart

A large contingent of patients who leave against medical advice just had a change of heart. This sudden change can happen for several reasons. Financial and insurance concerns are some of the biggest reasons for leaving. A recent study revealed that up to 40% of AMA patients depart due to financial constraints. In other cases, the patient will feel that everything is fine now, even without getting checked. This is common among patients with alcohol use disorder (AUD), people who inject drugs (PWID), and people experiencing mental health concerns.

Can hospitals make a difference?

Hospitals can reduce these figures with improved throughput. A complete assessment will help executives determine the bottlenecks and provide solutions. The ED is a great place to start by placing adequate resources and staff to support patients. Using more remote case managers and doctors who can do pre-screening helps. Hospitals can also improve communication, ensuring patients understand the risk of leaving at all touch points. Improving throughput can also mean investing in technology and equipment so doctors can work faster and better. No patient should go against medical advice. If a patient leaves, the reason should not be that the hospital did not do enough to improve throughput.