Patients Who Leave Against Medical Advice in U.S. Emergency Departments

2.50
Hdl Handle:
http://hdl.handle.net/10755/148695
Type:
Presentation
Title:
Patients Who Leave Against Medical Advice in U.S. Emergency Departments
Abstract:
Patients Who Leave Against Medical Advice in U.S. Emergency Departments
Conference Sponsor:Sigma Theta Tau International
Conference Year:2007
Author:Juarez, Altair M., MPH
P.I. Institution Name:Emergency Nurses Association
Title:Senior Research Associate
Co-Authors:Jessica K. Gacki-Smith, MPH; Susan MacLean, RN, PhD
[Scientific session research presentation] Purpose: Patients who leave the emergency department (ED) against medical advice (AMA) accounted for approximately 1,122,000 ED visits in 2004. Patients who leave AMA put themselves at a greater risk for negative health outcomes and likely recidivism to the emergency department. Understanding the ED factors associated with these patients may lead to their early identification, thus reducing their risk of adverse health outcomes. Design: A cross-sectional study was conducted. Sample: A convenience sample of 444 ED managers throughout the United States participated. Framework: A systems model was used to identify the patient flow factors in the emergency department (input, throughput, output) that influenced patients to leave AMA. Methods: A 72-item survey on ED characteristics was developed and reviewed by content experts. Univariate and multivariate analyses examined the relationships between ED characteristics and the annual number of patients who left AMA. Logistic regression analyses were used to predict patients who left AMA. Results: The backward elimination logistic regression model contained five significant variables. Patients were more likely to have left AMA as the collaboration between physicians and nurses decreased (p=0.023), if the hospital was not JCAHO-accredited (p=0.003), as the waiting time for evaluation for non-urgent care decreased (p=0.009), and as the turnover rate (in a quadratic relationship) for registered nurses decreased (p=0.032, turnover rates <13.0%; p=0.014, turnover rates >13.0%). The sensitivity (78.8%) and specificity (81.2%) of the final model were high. Conclusions: The strong predictor model identified five factors in the ED system that influenced patients' decisions to leave AMA.  Although research concerning the patient's actual decision making is warranted, ED nurses and managers might reduce AMA visits and improve patient safety by maintaining stable levels of nurse staffing and facilitating strong nurse-physician collaborative relationships.  The influence of JCAHO accreditation and waiting times for evaluation by acuity warrants further investigation.
Repository Posting Date:
26-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Sigma Theta Tau International

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titlePatients Who Leave Against Medical Advice in U.S. Emergency Departmentsen_GB
dc.identifier.urihttp://hdl.handle.net/10755/148695-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Patients Who Leave Against Medical Advice in U.S. Emergency Departments</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Sigma Theta Tau International</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2007</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Juarez, Altair M., MPH</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Emergency Nurses Association</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Senior Research Associate</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">ajuarez@ena.org</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Jessica K. Gacki-Smith, MPH; Susan MacLean, RN, PhD</td></tr><tr><td colspan="2" class="item-abstract">[Scientific session research presentation] Purpose: Patients who leave the emergency department (ED) against medical advice (AMA) accounted for approximately 1,122,000 ED visits in 2004. Patients who leave AMA put themselves at a greater risk for negative health outcomes and likely recidivism to the emergency department. Understanding the ED factors associated with these patients may lead to their early identification, thus reducing their risk of adverse health outcomes. Design: A cross-sectional study was conducted. Sample: A convenience sample of 444 ED managers throughout the United States participated. Framework: A systems model was used to identify the patient flow factors in the emergency department (input, throughput, output) that influenced patients to leave AMA. Methods: A 72-item survey on ED characteristics was developed and reviewed by content experts. Univariate and multivariate analyses examined the relationships between ED characteristics and the annual number of patients who left AMA. Logistic regression analyses were used to predict patients who left AMA. Results: The backward elimination logistic regression model contained five significant variables. Patients were more likely to have left AMA as the collaboration between physicians and nurses decreased (p=0.023), if the hospital was not JCAHO-accredited (p=0.003), as the waiting time for evaluation for non-urgent care decreased (p=0.009), and as the turnover rate (in a quadratic relationship) for registered nurses decreased (p=0.032, turnover rates &lt;13.0%; p=0.014, turnover rates &gt;13.0%). The sensitivity (78.8%) and specificity (81.2%) of the final model were high. Conclusions: The strong predictor model identified five factors in the ED system that influenced patients' decisions to leave AMA.&nbsp; Although research concerning the patient's actual decision making is warranted, ED nurses and managers might reduce AMA visits and improve patient safety by maintaining stable levels of nurse staffing and facilitating strong nurse-physician collaborative relationships.&nbsp; The influence of JCAHO accreditation and waiting times for evaluation by acuity warrants further investigation.</td></tr></table>en_GB
dc.date.available2011-10-26T09:49:08Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-26T09:49:08Z-
dc.description.sponsorshipSigma Theta Tau Internationalen_GB
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