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Current discharge rate against medical advice (AMA) from Emergency Departments (ED) is estimated at 0.1-2.7% in general population. The AMA rate is all the more concerning when the differentials include potentially lethal diagnoses like Acute Coronary Syndrome(ACS). Our objective is to identify the demographic factors which influence the patient's decision to leave AMA from the ED by analyzing a national database.
The National Hospital Ambulatory Medical Care Survey(NHAMCS) is a limited access dataset that includes ED visit-based data. Patients from the years 2007-2009 were included in the analysis. We investigated multiple demographic factors-age, sex, urban status, geographical location, severity of pain and weekday vs weekend visits by comparing the cohort of AMA patients with ACS vs those without ACS.
In a total of 104,566 documented ED visits, 1.1% (1135) patients left AMA. This included 16.38% (186)ACS patients and 83.61%(949) non-ACS patients. Patients who left AMA with ACS were significantly more likely to be males compared to females(Odds Ratio OR1.414; 95% CI: 1.017-1.966) and weekday ED visits compared to weekend visits(OR1.887;1.277-3.025). Geographic regions [Northeast (OR1.3;0.85-1.19), Midwest(OR0.82;0.50-1.13), South(OR1) and West(OR0.90;0.54-1.13)], urban status vs non-urban (OR1.32; 0.732-2.3) did not correlate with AMA rates. The severity of the pain [mild (OR1), moderate(OR2.24;0.091-5.0) and severe(OR0.9;0.43-2.29)] was not associated with AMA rates.
Our study elicits the demographic factors which play a role in the decision-making to be discharged AMA. Male sex and weekday ED visits are associated with higher AMA rates. Geographic region, urban status and severity of pain do not influence AMA rates. An understanding of these demographic variables can help identify the population at higher risk to leave AMA which could potentially help reduce ACS related morbidity and mortality.
Poster Sessions, Expo North
Saturday, March 09, 2013, 10:00 a.m.-10:45 a.m.
Session Title: Chest Pain and MI: The Good, the Bad and the Readmission Rate
Abstract Category: 22. Performance Improvement
Presentation Number: 1132-271
- 2013 American College of Cardiology Foundation