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AMA Discharges

Christine Hamilton

  • Patients who leave AMA are significantly more likely to have hospital readmissions and have higher mortality rates. If paged from the bedside about a patient requesting to leave AMA, call nurse back and then go speak with the patient.

  • Address patient concerns (i.e. pain control, substance withdrawal, fear/anxiety, financial strain, diet) to address reversible causes for contention.

  • Determine capacity to leave: review risks of leaving and medical reasoning to stay (see Medical Decision-Making Capacity under "Psychiatry"). This discussion should be witnessed by nurse or charge nurse if possible. Provider and patient will need to sign AMA discharge form, which nurse can obtain.

  • Send new medications to pharmacy and request hospital follow-up visits if patient leaves

  • Sign discharge order. In the "discharge to" section select "left against medical advice" (for more detailed discharge instructions, see appendices)

  • Clearly document in discharge summary that patient was informed about the risks of leaving, had the capacity to make the decision to leave, and left AMA.

    • *Caveat: if patient at any point becomes threatening or you feel unsafe, allow them to leave or contact security