Virginia Research Day 2021

Medical Resident Research Cl inical

13 A Continuous Process Improvement Project to Reduce the Incidence of Hospital Patients Leaving Against Medical Advice

Adam Huryta, DO; Seavon Munoz, DO; Michael Moore, MD Corresponding author: michael.moore1@LPNT.net

SOVAH Health Internal Medicine Residency Program

Background: Each year, about 2% of inpatients leave hospital against medical advice (LAMA) which increases the potential for adverse health outcomes and treatment cost. The 30-day readmission rate of LAMA patients has been about 30%. LAMA patients are typically males, younger age, lack a primary care physician, financial issues, sickness within the family (patient is needed at home), patients feeling better, psychiatric illness, social issues at home, and illicit drug or alcohol problems. Two years ago, we initiated a continuous process improvement (CPI) project with Nursing leadership at Sovah Health- Danville to identify patients at risk for LAMA in order to implement prevention strategies. Over a 3-month 2018 period, 46 patients with a mean age of 49 years, 46% males, 52% Caucasian, and a mean 1.91 length of stay (LOS) left AMA. 91% had third party payer insurance. There was not data available then on why these patients left. Following the initial study, a LAMA screen was added to the inpatient electronic medical record (EMR) discharge process asking the provider for the LAMA reason(s). A follow up study was done over 3 months in 2020.

Methods: An inpatient EMR retrospective study of LAMA patients was done July 1 to September 30, 2020, to analyze LAMA reasons. Data collected included: ethnicity, reason for admission, age, gender, length of stay, history of substance abuse, LOS, and if they had a primary care physician and reasons for leaving AMA, and readmission. This study was granted a waiver for individual informed consent by the Sovah Health IRB since de-identified data was used. Results: Over the 3 months, 28 patients left AMA. Mean age was 43.7 years. Fifteen were Caucasian; 13 were African American; half were male. Daily hospital inpatient census was the same as in our 2018 study. Reasons for leaving AMA were 9 for social issues, 10 for concerns with care being received, 1 was the caregiver for another, and 8 stated no reason. None were due to the patient’s perceived cost of hospitalization or needing to care for a pet. There were 32% readmissions of the 28 LAMA patients. Discussion: This study compared the demographics of LAMA patients from SOVAH Health-Danville in

2020 to 2018 and the reasons for leaving in 2020. As was the case in 2018, AMA patients were relatively younger, half males and half Caucasian. The most common reasons for LAMA were concerns with their hospital care or social issues. Their readmission rate was 32% which is in line with our 2018 study and other studies. The reduced number of AMA patients over 3 months between 2018 and 2020 is not known since no interventions to reduce LAMA were introduced; however, increased awareness of hospital care givers about the AMA potential based on our original study and individual efforts to prevent it could have played a role. This knowledge of LAMA reasons will allow completion of the CPI project with implementation of LAMA specific admission screening and specific interventions to address potential reasons such as setting patients’ expectation of care.

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