Patients Leaving Against Medical Advice-A National Survey

• Published in: Indian journal of critical care medicine Vol. 23; no. 3; pp. 143 - 148
• Main Authors: Paul, Gunchan, Gautam, P L, Mahajan, Rubina Khullar, Gautam, Nikhil, Ragavaiah, Suresh
• Format: Journal Article
• Language: English
• Published: India Jaypee Brothers Medical Publishers 01-03-2019
• Subjects: Original Research; Discharge against medical advice; Left against medical advice; Intensive care unit; National survey
• ISSN: 0972-5229; 1998-359X
• DOI: 10.5005/jp-journals-10071-23138

Leaving against medical advice (LAMA) is a common health concern seen worldwide. It has variable incidence and reasons depending upon disease, geographical region and type of health care system.
We approached anesthesiologists and intensivists for their opinion through ISA and ISCCM contact database using Monkey Survey of 22 questions covering geographical area, type of healthcare system, incidence, reasons, type of disease, expected outcome of LAMA patients etc.
We received only 1154 responses. Only 584 answered all questions. Out of 1154, only 313 respondents were from government medical colleges or hospitals while remaining responses were from private and corporate sector. Most hospitals had >100 beds. ICUs were semi-closed and supervised by critical-care physicians. LAMA incidence was maximum from ICU (45%) followed by ward (32%) and emergency (25%). Most patients of LAMA had ICU stay for >1 week (60%). Eighty percent of the respondents opined that financial constraints are the most common reason of LAMA. Unsatisfactory care was rarely considered as a factor for LAMA. Approximately 40% patients had advanced malignancy or disease. Nearly 2/3rd strongly believed that insurance cover may reduce the LAMA rate.
Most patients get LAMA from the ICU after a stay of week. Financial constraints, terminal medical illness, malignancy and sepsis are major causes of LAMA. Remedial methods suggested to decrease the incidence include a good national health policy by the state; improved communication between the patient, caregivers and heathcare team; practice of palliative and end-of-life care support; and lastly, awareness among the people about advance directives.
Paul G, Gautam PL
. Patients Leaving Against Medical Advice-A National Survey. Indian J Crit Care Med 2019;23(3):143-148.