Discharges against medical advice: a community hospital's experience.

OBJECTIVES: To understand the characteristics of patients who leave hospital against medical advice (known as "discharges against medical advice" [DAMA]) in a small community hospital and to study how these patients compare to current literature on the topic. To evaluate chart documentation pertaining to such discharges.

METHODS: A retrospective chart audit was performed, covering a 2-year period, on patients who had discharged themselves against medical advice. The data were compared to the general patient population of the same period. Evaluation of DAMA documentation was also conducted by chart survey.

RESULTS: The rate of DAMA in the study hospital was found to be 0.57%, and the average length of stay was 2.8 days. Patients who leave hospital against medical advice differ from the general patient population: they include a higher proportion of males (p = 0.007), demonstrate a different age distribution (p < 0.001), have shorter stays in hospital (p < 0.001), and have a considerably greater frequency of substance abuse (p < 0.001) and psychiatric conditions (p < 0.001) associated with their admissions. DAMA documentation was included in the charts of 81.6% of patients involved, but only 22.9% of these charts included documentation with respect to patient competency.

CONCLUSION: Patients who leave hospital against medical advice represent a high-risk population: they suffer a greater incidence of mental illness and substance abuse. Potential interventions are limited, but influence strategies may have a role. Early identification of patients at risk may facilitate this process, thereby decreasing the occurrence of DAMA and improving health outcomes. More consistent and comprehensive documentation is needed for these patients.