Who determines to discharge against medical advice from an acute psychiatric hospitalization: A clinical study

Subjective: To reduce the nonessential healthcare expenditure and to prevent patients from adverse consequences, we intended in this study to find the prevalence and characteristics of patients with psychiatric disorder with against medical advice (AMA) discharge. Methods: We did a review of medical records for patients who hospitalized on the acute psychiatric ward at Keelung Chang Gung Memorial Hospital in Taiwan from January 1, 2013, to August 31, 2018. Results: We found that 100 patients (8.1%) were discharged AMA out of total 1,237 discharges. Compared to patients with regular discharges, those with AMA discharge were significantly different between the groups in age (p < 0.05), first time admission (p < 0.001), comorbid substance use disorders (p < 0.05), previous suicide attempts (p < 0.01), and length of hospital stay (p < 0.001). With forward stepwise logistic regression model to look for the most influential predictors for AMA discharge, we found that odds ratio (95% confidence interval) of those with suicidal attempt history (1.931 [1.265–2.949], B = 0.658, p < 0.01) and those with the first-time psychiatric admission (3.435 [2.253–5.237], B = 1.234, p < 0.001) significantly predicted those AMA patients. Conclusion: The history of suicide attempt and first-time psychiatric ward admission is the most important predictors for patients with AMA discharge. We suggest that controlled prospective studies can strengthen the study findings and better describe the impact on patients with AMA discharge.