Learning objectives:

1. Discuss contributors to early discharges. Understand patient perspectives on the ‘AMA’ discharge experience.
2. Explore possible interventions to prevent early discharges and improve associated processes when they cannot be prevented.
3. Presentation Handout. 
4.  

Abstract:

Early discharges, also known as against medical advice” (AMA) discharges, commonly occur in inpatient withdrawal management services. Early discharges are associated with negative clinical outcomes and are costly for the healthcare system. The literature examining early discharges from inpatient withdrawal management settings contains limited information about patient perspectives on this issue. A qualitative descriptive study was conducted to explore the reasons for and experiences of AMA discharges, as described by patients. This study involved semi-structured interviews with people who recently left an inpatient withdrawal management service early. Thirteen participants were interviewed over a 7-month period. Interviews were analyzed using a conventional content analysis approach. Contributors to early discharges included factors related to the treatment experience, as well as circumstances outside of the hospital. Challenges related to COVID-19 restrictions and protocols negatively influenced patient engagement in withdrawal management. Participant experiences of the early discharge process varied, but many reported dissatisfaction and negative emotions. This was the first qualitative study exploring the issue of early discharges from an inpatient withdrawal management service. As such, the findings from this study offer important insights about client experiences and point to opportunities for further research and quality improvement.