Against‐Medical‐Advice Discharges from the Hospital

Optimizing Prevention and Management to Promote High Quality, Patient-Centered Care

  • David Alfandre

Table of contents

  1. Front Matter
    Pages i-xii
  2. Ethical, Legal, and Empirical Considerations

  3. Preventing and Managing Against Medical Advice Discharges Across the Spectrum of Care

    1. Front Matter
      Pages 83-83
    2. Holly Fleming, David S. Olson Jr., David Alfandre, Cynthia Geppert
      Pages 85-105
    3. Jay M. Brenner, Thomas E. Robey
      Pages 107-123
    4. Armand H. Matheny Antommaria
      Pages 143-157
  4. Back Matter
    Pages 177-181

About this book


This first-of-its-kind text provides a multidisciplinary overview of a significant problem in hospital-based healthcare:  patients who decline inpatient medical care and leave the hospital against medical advice (AMA).   Compared to standard hospital discharges, AMA discharges are associated with worse health and health services outcomes.   Patients discharged AMA have been found to have disproportionately higher rates of substance use, psychiatric illness, and report stigmatization and reduced access to care.  By providing a far reaching examination of AMA discharges for a wide academic and clinical audience, the book serves as a reference for clinical care, research, and the development of professional guidelines and institutional policy.  The book provides both a broad overview of AMA discharges with chapters on the epidemiology, ethical and legal aspects, as well as social science perspectives.  For clinicians in the disciplines of hospital medicine, pediatrics, emergency medicine, nursing, and psychiatry, the book also provides a patient-centered analysis of the problem, case-based discussions, and a discussion of best practices.  This comprehensive review of AMA discharges and health care quality will interest physicians and other health care professionals, social workers, hospital administrators, quality and risk managers,  clinician-educators,  and health services researchers.


AMA discharge consultation-liaison psychiatry institutional liability substance use ethics

Editors and affiliations

  • David Alfandre
    • 1
  1. 1.VHA National Center for Ethics in Health Care, Department of Veterans AffairsNYU School of MedicineNew YorkUSA

Bibliographic information

  • DOI
  • Copyright Information Springer International Publishing AG, part of Springer Nature 2018
  • Publisher Name Springer, Cham
  • eBook Packages Medicine
  • Print ISBN 978-3-319-75129-0
  • Online ISBN 978-3-319-75130-6
  • Buy this book on publisher's site