What is it called when you leave the hospital before discharge?

Studies show that between 1% and 2% of all hospital admissions in the US result in a premature departure against a physician's wishes. When you leave the hospital before the treating physician recommends it, this is referred to as leaving against medical advice, or AMA.

Quick Summary

Departing a hospital stay before your physician recommends discharge is known as an "against medical advice" (AMA) discharge. It is a patient-initiated decision that requires documenting your informed refusal of care to protect the hospital from liability.

Key Points

• Against Medical Advice (AMA): Leaving the hospital before your doctor recommends it is termed "against medical advice" (AMA).

• Significant Risks: Premature discharge dramatically increases risks of readmission, worsening health, and even mortality.

• Understanding Your Rights: Patients have a legal right to leave, but this can be restricted in certain circumstances, such as a risk of harm to self or others.

• Insurance Coverage: Leaving AMA generally does not void your insurance for the current stay, but costs may increase due to readmission.

• Communication Is Key: Before deciding to leave, discuss your concerns openly with the care team and a hospital social worker to explore alternatives.

• The AMA Form: You will be asked to sign a document acknowledging the risks, but you are not legally required to sign it.

Understanding Against Medical Advice (AMA) Discharges

When a patient chooses to leave a hospital prematurely, before the medical team has officially discharged them, this event is recorded as an Against Medical Advice, or AMA, discharge. This is not a casual decision but a formal process that has important consequences for both the patient and the healthcare facility. Hospitals document AMA discharges primarily to protect themselves from liability should the patient's condition worsen or lead to re-admission. The decision to leave AMA is a patient's right, but it should be made with a full understanding of the potential risks and complications involved.

The Legal and Ethical Context

Patients with decisional capacity have the right to refuse medical treatment and leave the hospital. This is a cornerstone of patient autonomy. However, this right is not absolute. There are specific legal and ethical limitations to this right, which include:

• Mental Incapacity: If a patient is deemed unable to make competent decisions due to mental illness, intoxication, or severe delirium, the hospital may have legal grounds to hold them temporarily.
• Risk to Self or Others: If the patient's departure poses a significant risk of harm to themselves or others, a hospital can sometimes get a court order to hold them.
• Minors and Guardianship: Minors or adults with a legal guardian do not have the right to leave AMA; only their legally responsible party can make this decision.

When leaving AMA, a patient will be asked to sign a form acknowledging that they are doing so against the medical team's recommendations. This form is meant to ensure the patient understands the risks and to shield the hospital from future legal issues. However, patients are not legally required to sign this form to leave.

Documenting the AMA Process

For an AMA discharge, healthcare staff will take specific steps to protect the patient and the hospital:

1. The healthcare team will discuss the patient's condition and the risks of leaving with the patient in clear, understandable terms.
2. They will inform the patient that they are leaving AMA and the potential negative consequences.
3. The staff will ask the patient to sign a form acknowledging their decision and the explained risks.
4. They will make an effort to provide follow-up care instructions, prescriptions, and a referral to their primary care physician.
5. All these actions are meticulously documented in the patient's medical record.

The Significant Health Risks and Financial Consequences

Leaving the hospital prematurely can have dire consequences for a patient's health. Numerous studies have consistently shown worse outcomes for patients who leave AMA.

• Higher Readmission Rates: Patients who leave AMA are at a significantly higher risk of being readmitted to the hospital, often for the same condition.
• Increased Mortality: Research shows that patients who leave AMA have a higher risk of death, especially within a month of leaving, due to untreated medical problems.
• Increased Long-Term Costs: While insurance is unlikely to refuse payment for the initial visit, the long-term healthcare costs associated with readmission and potential complications are significantly higher.
• Longer Length of Stay on Readmission: Paradoxically, when patients who leave AMA are readmitted, they often have a longer hospital stay the second time around due to the worsened condition.

Common Motivations for Leaving AMA

Understanding why a patient might choose to leave against medical advice is crucial for both healthcare providers and patients. Reasons are varied and often complex.

• Feeling Better: A patient may feel their symptoms have improved and believe they are no longer in danger, even if further treatment is necessary.
• Personal Obligations: Concerns about family responsibilities, childcare, or care for an elderly relative can pressure a patient to leave.
• Financial Worries: Fear over medical bills and hospital costs is a major driving factor for many patients.
• Dissatisfaction with Care: Patients may feel they are not being listened to, or they may be unhappy with the quality of care or the hospital environment.
• Substance Abuse: Patients with substance or alcohol abuse issues are more prone to leaving AMA, sometimes due to the desire to access drugs.
• Administrative Delays: Long wait times in the emergency department or delays in the discharge process can cause frustration and lead patients to leave.

Standard Discharge vs. Against Medical Advice (AMA) Comparison

Feature	Standard Discharge	Against Medical Advice (AMA) Discharge
Medical Approval	Initiated and approved by the treating physician.	Patient initiated; physician advises against it.
Discharge Plan	Coordinated plan with prescriptions, follow-up, and home care instructions provided.	Hospital attempts to provide minimal plan, but it may be rushed or incomplete.
Liability	Hospital and providers have fulfilled their duty of care.	Hospital is largely protected from liability after documenting informed refusal.
Readmission Risk	Significantly lower readmission rates.	Higher risk of readmission for the same or worse condition.
Follow-Up	A clear plan for post-hospital care and follow-up is established.	Follow-up is less certain and often requires the patient to re-engage through the ER.

Making an Informed Decision

Ultimately, the decision to stay or leave is the patient's, provided they have the capacity to make that choice. However, the potential risks of an AMA discharge are severe. Before considering a premature departure, it is highly recommended to communicate openly with your healthcare team. Express your concerns about finances, dissatisfaction with care, or personal obligations. Hospitals often have resources, such as social workers or patient advocates, who can help address these issues and potentially find a solution that allows for a safe, complete course of treatment.

For more information on patient rights and discharge planning, you can review resources from authoritative organizations. For instance, the Agency for Healthcare Research and Quality provides helpful guidelines on patient-centered care and discharge planning [https://www.ahrq.gov/patient-safety/reports/discharge-factsheet.html]. Engaging with these resources can help you feel more empowered and informed about your healthcare decisions.

Conclusion

While every patient has the right to refuse care and leave a hospital, doing so against medical advice is a decision with serious health and financial ramifications. It is crucial to have a clear understanding of the risks, including increased readmission rates and poorer health outcomes. Open communication with your healthcare providers is the best course of action to resolve any issues or concerns and ensure a safe and effective treatment plan is completed. Weighing the urgency of your personal situation against the dangers of interrupting your medical care is a critical part of making this informed choice.

Frequently Asked Questions

What is it called when you leave the hospital before discharge?

Leaving a hospital before your doctor has officially discharged you is called a discharge "against medical advice," or AMA.

What are the risks of leaving against medical advice?

The risks include higher rates of hospital readmission, potential worsening of your medical condition, and an increased risk of mortality.

Does leaving AMA affect my insurance coverage?

Generally, leaving AMA does not void your insurance for the current stay. However, it can lead to higher long-term costs if you require readmission later.

Am I legally required to sign the AMA form?

No, you are not legally obligated to sign the form. However, the hospital will still document that you left against their medical advice to protect themselves from liability.

When can a hospital legally prevent a patient from leaving?

A hospital can restrict a patient from leaving if they are a minor, legally deemed incompetent, or if they pose a significant risk of harm to themselves or others.

What should I do if I want to leave the hospital early?

Before leaving, you should discuss your concerns with your healthcare team and a hospital social worker. They may be able to address your issues and help you complete your care safely.

If I leave against medical advice, can I return to the hospital later?

Yes, you can always return to the hospital if you change your mind. However, you will likely need to be readmitted through the emergency room, as your initial discharge was incomplete.