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Aim <p>Discharges against medical advice (AMA) present significant challenges in trauma care, often resulting in poor health outcomes and increased healthcare costs. This study aimed to identify factors contributing to AMA discharges in trauma patients at a level II trauma center and explore strategies to reduce these incidents.</p> Subject and methods <p>This retrospective review analyzed the medical records of trauma patients discharged AMA in 2022. Data included demographics, injury details, toxicology results, documented reasons for AMA discharges, and subsequent healthcare encounters. Contributing factors were categorized into social, medical, and financial domains, and five representative case studies were reviewed for thematic insights.</p> Results <p>Among 4,593 trauma patients, 1.1% (<i>n</i> = 48) left AMA. The majority were male (77.1%) and White (77.1%), with an average age of 43.9&#xa0;years. Substance use disorder (35.4%), financial concerns, and personal obligations were frequent drivers of AMA discharges. Nearly half (45.8%) tested positive for drugs or alcohol. Common outcomes included return visits for complications such as infections and sepsis.</p> Discussion <p>AMA discharges in trauma patients are driven by multifaceted factors, including substance use, financial constraints, and personal responsibilities. Targeted strategies such as enhanced patient education, financial counseling, addiction support, and flexible discharge planning may reduce AMA rates and improve patient outcomes. Future research should prospectively evaluate the effectiveness of these targeted interventions.</p>

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Against medical advice discharges in trauma patients: how do we get there and how we do we improve?

  • 期刊论文

  • 发表日期：

    2025年7月18日

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  • Martha Dixon,
  • Krishna Bhadriraju,
  • Christopher Hendrix,
  • Mani Cheruvu,
  • Steven Katsis

摘要

Aim

Discharges against medical advice (AMA) present significant challenges in trauma care, often resulting in poor health outcomes and increased healthcare costs. This study aimed to identify factors contributing to AMA discharges in trauma patients at a level II trauma center and explore strategies to reduce these incidents.

Subject and methods

This retrospective review analyzed the medical records of trauma patients discharged AMA in 2022. Data included demographics, injury details, toxicology results, documented reasons for AMA discharges, and subsequent healthcare encounters. Contributing factors were categorized into social, medical, and financial domains, and five representative case studies were reviewed for thematic insights.

Results

Among 4,593 trauma patients, 1.1% (n = 48) left AMA. The majority were male (77.1%) and White (77.1%), with an average age of 43.9 years. Substance use disorder (35.4%), financial concerns, and personal obligations were frequent drivers of AMA discharges. Nearly half (45.8%) tested positive for drugs or alcohol. Common outcomes included return visits for complications such as infections and sepsis.

Discussion

AMA discharges in trauma patients are driven by multifaceted factors, including substance use, financial constraints, and personal responsibilities. Targeted strategies such as enhanced patient education, financial counseling, addiction support, and flexible discharge planning may reduce AMA rates and improve patient outcomes. Future research should prospectively evaluate the effectiveness of these targeted interventions.