Factors associated with requests for premature discharge and the decision to support a service user through the discharge against medical advice process
In the Irish mental healthcare system, voluntarily admitted service users can request to leave hospital at any time. Following engagement with treating clinicians, service users remain as voluntary inpatients, are discharged, discharge themselves against medical advice, or are detained under legislation for the purposes of assessment. While detention conflicts with the principle of autonomy and a human rights-based approach, premature discharge is often associated with negative outcomes including reduced time to readmission, poorer quality of life, increased costs, and suicide.
This study is a retrospective review of clinical records to identify factors associated with requests for premature discharge. Considerations of clinicians making the decision to detain the person or to support them through the discharge against medical advice process were also elucidated. Data were collected from clinical records of service users who requested discharge and were subsequently discharged against medical advice or detained involuntarily.
Discharge against medical advice represented 3.5% of all discharges. The most frequent reasons for requests for discharge against medical advice were dissatisfaction with treatment, lack of engagement due to addiction, and leaving without notifying staff. Requests for discharge against medical advice frequently occurred out of hours, and nurses were the clinicians most likely to receive such requests.
Abstract Objective To build on a previous review and updated understanding of how patients experience involuntary detention for their mental health difficulties. Design We provide a narrative synthesis review of qualitative studies. Data sources Using pre-defined search terms, the following databases were searched covering the period 2006 to March 2014: Psychinfo, Medline, Medline In-Process, Embase, Web of Knowledge, Scopus, Science Direct, British Nursing Index and Cinahl Plus. Three journals ...
Last. Michael T. Yin(CUMC: Columbia University Medical Center)H-Index: 31
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The phenomenon of leaving the hospital against medical advice (AMA) despite being quite common and associated with significant deleterious health outcomes remains inadequately understood and addressed. Researchers have identified certain patient characteristics as predictors of AMA discharges, but the patients' reasons for these events have not been comprehensively explored. Moreover, because the medical authority model dominates this research area, providers' experiences of AMA discharges remai...
Abstract Background Involving users/carers in mental health care-planning is central to international policy initiatives yet users frequently report feeling excluded from the care planning process. Rigorous explorations of mental health professionals' experiences of care planning are lacking, limiting our understanding of this important translational gap. Objectives To explore professional perceptions of delivering collaborative mental health care-planning and involving service users and carers ...
: Patients who leave the hospital against medical advice (AMA) present a challenge and concern to health care providers. Patients may leave AMA for a variety of reasons. Nurses play a vital role in patients considering an AMA discharge. Most of all, nurses can help by not perpetuating the concepts that AMA means you leave with nothing. Nurses must ensure that patients leave with information about their injuries, possible issues of concern after discharge, medications or prescriptions for medicat...
Last. Xenya Kantaris(St George's, University of London)H-Index: 5
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Background When mental health service users are detained under a Section of the Mental Health Act (MHA), they must remain in hospital for a specific time period. This is often against their will, as they are considered a danger to themselves and/or others. By virtue of being detained, service users are assumed to have lost control of an element of their behaviour and as a result their dignity could be compromised. Caring for detained service users has particular challenges for healthcare profess...
Aim: Self- discharged patients are at high risk for readmission and ultimately higher cost for care.We intended to find the proportion of patients who leave hospital against medical advice and explore some of their characteristics. Methods: This prospective study of discharge against medical advice was conducted in psychiatric wards of Zare hospital in Iran, 2011. A psychologist recorded some information on a checklist based on the documented information about the patient who wanted to leave aga...
Abstract Little is known about discharge against medical advice (DAMA) among adolescents with mental health problems. The objective of this study was to examine the prevalence of DAMA and provide some insight into the factors that influence DAMA among adolescents with mental health problems using a large dataset from Ontario, Canada. Data on 1811 adolescents aged 14–18 years who were discharged from adult mental health beds between October 2005 and March 2010 were analyzed using logistic regress...
#1Allen Kraut(UM: University of Manitoba)H-Index: 14
#2Randy Fransoo(UM: University of Manitoba)H-Index: 15
Last. Allan Garland(UM: University of Manitoba)H-Index: 31
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Background Prior studies of patients leaving hospital against medical advice (AMA) have been limited by not being population-based or assessing only one type of patient.
#1Allan Garland(UM: University of Manitoba)H-Index: 31
#2Clare Ramsey(UM: University of Manitoba)H-Index: 25
Last. Allen Kraut(UM: University of Manitoba)H-Index: 14
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Background: Leaving hospital against medical advice may have adverse consequences. Previous studies have been limited by evaluating specific types of patients, small sample sizes and incomplete determination of outcomes. We hypothesized that leaving hospital against medical advice would be associated with increases in subsequent readmission and death. Methods: In a population-based analysis involving all adults admitted to hospital and discharged alive in Manitoba from Apr. 1, 1990, to Feb. 28, ...
