A Study on the Characteristics of the Patients Discharged Against Medical Advice

Hong, Joonhyun; Choi, Kwisook; Lee, Jeonghwa; Lee, Eunmee

Journal of Korean Society Quality Assurance Health Care 2001;8(2): 208.
Published online December 30, 2001.

한 대학병원 자의퇴원 환자의 특성 연구 - 퇴원환자 지료정보 DB를 이용하여 -

홍준현¹, 최귀숙², 이정화¹, 이은미¹

¹세브란스병원 의무기록과
²고려대학교 인간유전체연구소

A Study on the Characteristics of the Patients Discharged Against Medical Advice

Joonhyun Hong¹, Kwisook Choi², Jeonghwa Lee¹, Eunmee Lee¹

¹Medical Record Department, Severance Hospital
²Institute of Human Genomic Study, Korea University

Abstract

Background
The objective of this study is proving the basic data for developing a management system for the discharges against medical advice(AMA) by identifying the characteristics of the AMA patients of an university hospital for 10 years.
Methods
By using discharge abstract data base, we divided the total discharges(435,254) into two groups, discharge against medical advice and discharge with discharge order. We confirmed the characteristics of AMA group by analyzing discharge abstract data of the both groups by SAS software V6.12 and $x^2$ test. Medical records of AMA patients in the year 2000 were reviewed to identify the reasons for AMA which we couldn't extract from discharge abstract DB.
Result
The total number of AMA for 10 years were 9,358(2.15%) and the AMA rate has been continuously decreased for 10 years. Male, admission through emergency room, discharges admission via other hospital, patients without operation during hospitalization, discharges in hopeless or not improved condition showed higher AMA rate. The AMA rate was higher as the age of the patients was higher, and the average length of stay was longer in AMA patients than in those with discharge order. The AMA rate in psychiatry was highest(14.3%) and it was higher in surgery departments than those of medical or other sections. The AMA rate varied by attending physicians even in the same department and it was statistically significant. Patients with the principal diagnosis of "medical observation and evaluation for suspected diseases" showed the highest AMA rate(15.5%), and that of schizophrenia or psychosis was the nest. One hundred twenty-one patients(19.5%) out of 622 AMA in 2000 discharged against medical advice for transfer to order health care facilities. Among them 71 patients(58.7%) discharged with their medical care information, such as copies of medical record, medical certificates, summaries, etc. Written oath of the patients discharged AMA was filed in their medical records in 466 cases(74.9%) although some of them were incomplete.
Conclusion
Characteristics of AMA discharge could be used as the basic data in developing a system to manage the patients who have risk factors to leave the hospital against medical advice. By reducing number of patients leaving the hospital against medical advice we can increase satisfaction of medical providers and consumers.

Key words Against medical advice;Discharge abstract database;AMA rate;