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Why Do Patients Leave The Emergency Department Against Medical Advice?

Author: Murat Saritemur, Arzu Denizbasi, Ebru Unal Akoglu, Tuba Cimilli Ozturk, Fatma Sari Dogan

Category: JMSR Anesthesiology and IC


Introduction: Leaving against medical advice is a worrying situation which is a problem not only for patients also for physicians. For many different reasons, people may choose to leave the hospital on their own requests. If we know the reasons for leaving, we can find the solution.

Method: This prospective study was conducted at an emergency department of a university hospital that is visited by more than 30.000 patients annually. Demographic characteristics such as sex and age, triage level, insurance status of the patients, length of stay in the emergency department and why they were leaving against medical advice were recorded.

Results: A total of 321 patients which constituted 1.1% of all admissions to the emergency department during the study period left against medical advice. The main reason was refusing the observation or hospitalization (34.6%; n=111) and the second reason was inadequate health insurance (19.6%; n=63) in all study population (Table 1). Although inadequate health insurance was the second reason in males (36 of 153 patients; 24.0%), the second reason was refusing the intervention or medication in females (52 of 168 patients; 31.1%). The patients who left due to dissatisfaction with health care were predominantly male (72.7%; n=24; p=0.002) whereas who left due to refusing the intervention or medication were predominantly female (88.9%; n=48; p<0.001).

Conclusion: Hospitals should endeavor to identify the reasons why patients leave the ED, to document the events in detail and also to solve the problem.

Keywords: Emergency department, leaving Against Medical Advice