# Discharge Against Medical Advice From the Emergency Department: Results From a Private Hospital in Beirut

## TL;DR

This study explores why patients leave the emergency department against medical advice in a Beirut hospital, finding financial issues as the main reason.

## Contribution

The study provides insights into AMA discharge trends and reasons in a private hospital in Beirut, highlighting financial barriers.

## Key findings

- Financial coverage was the leading reason for AMA discharges, accounting for 52% of cases.
- AMA discharge rates increased from 3.6% in 2019 to 10% in 2021 before declining in 2022.
- Interventions at a larger scale are needed to reduce AMA discharges, particularly addressing financial barriers.

## Abstract

Introduction: Discharge against medical advice (AMA) is a common problem worldwide. These patients experience higher mortality rates in the following month and higher Emergency Department (ED) revisit rates. This study examines the characteristics, reasons, and clinical outcomes of the patients leaving the ED AMA.

Methods: This is a cross-sectional study conducted at the ED of the Lebanese American University Medical Center from 2019 to 2022.

Results: Over the four years, 42,672 patients have presented to the ED. Among them, 2,767 have left AMA (6.4%). The numbers varied among the years, from 477 (3.6%) in 2019, going up to 751 (7%) in 2020, then to 907 (10%) in 2021, and 632 (5.8%) in 2022. Many reasons were found. The most common reason for leaving AMA was the financial coverage, which accounted for 1442 cases (52%). Other common causes were the COVID-19 isolation cost (started in 2020) with 677 cases (24.5%), cold cases referred to clinics (301 cases; 10.9%), and the long waiting time for a bed being available (284 cases; 10.3%). Other causes were only 63 (2.3%).

Conclusion: Discharge AMA varies from one ED to another but is mainly linked to the economic situation in the country, the financial coverage of the population, and the system within the hospital. Interventions at a larger scale shall be conducted to reduce the rate of its occurrence.