Q&A: Strategies to help patients who may leave against medical advice

Q: Patients who leave the hospital against medical advice (AMA) have a much higher 30-day readmission rate than patients with non-AMA discharges. What strategies can case managers use to help patients who may be at risk for leaving AMA?

A: Case managers should first identify the common reasons for an AMA discharge. According to a study conducted by Colleen Morley, DNP, RN, CCM, CMAC, CMCN, ACM-RN, president of CMSA Chicago, the top reasons included:

• A lack of childcare
• Concerns about being kicked out of a methadone program
• Drug withdrawal/substance use issues
• Attending a court hearing
• Attending an important appointment
• Attending a family funeral

Patient screening tools can give case managers notice that a patient may be at risk for leaving AMA, and the case manager can then talk with the patient and offer solutions and resources, says Morley.

Additionally, case managers can help bridge the perceived communication gap between physicians and patients, which is another common reason for AMA discharge.

“We can all be a part of fixing,” says Morley. “If the attending physician is busy, you can send a resident to speak with the patient, if available.”

Editor's note: For more information, please see July's issue of Case Management Monthly.