PREDICTORS AND OUTCOME OF DISCHARGE AGAINST MEDICAL ADVICE FROM THE PSYCHIATRIC UNITS OF A GENERAL-HOSPITAL

Objective: The study examined predictors of discharge against medical advice (AMA) and outcomes of psychiatric patients with AMA discharges, as measured by poorer symptom ratings at discharge and higher rates o f rehospitalization. Methods: A total of 195 patients discharged AMA f rom general hospital psychiatric units were compared retrospectively w ith 2,230 regularly discharged patients. AMA status was defined as sig ning out against medical advice, being absent without leave, or being administratively discharged. All patients received standardized assess ments within 24 hours of admission and at discharge. Demographic chara cteristics, psychiatric history, DSM-IV psychiatric and substance use diagnoses, and scores on an expanded 32-item version of the Psychiatri c Symptom Assessment Scale were compared. Results: The groups did not differ in primary psychiatric diagnoses. Patients discharged AMA were significantly less likely to be Caucasian or to be functionally impair ed due to physical illness. They were more likely to live alone, have a substance use diagnosis, use more psychoactive substances, and have more previous hospitalizations. Patients discharged AMA had significan tly shorter lengths of stay, higher rehospitalization rates, and more severe symptoms at discharge, even when length of stay was taken into account. The differences between the groups in male gender and young a ge were better accounted forby a greater likelihood of substance abuse in these groups. Conclusions: The results suggest a profile of patien ts who may be discharged AMA. Such patients have worse outcomes and ar e more likely to be high utilizers of inpatient resources. Aggressive identification of patients likely to be discharged AMA and early disch arge planning for appropriate outpatient treatment are recommended.