Against medical advice discharges from the emergency department

The emergency department (ED) presents a unique context for patients leaving the acute care setting against medical advice (AMA). We review three common cases, establish definitions, discuss the peer-reviewed literature, debunk the myths and common practices, cover the law and the effect of technology, and finally return to the clinical scenarios to make concrete recommendations for handling patients requesting to leave the ED prior to completion of their episode of care. The advice contained within this chapter will help a practitioner of emergency medicine capably navigate the sometimes murky waters of balancing and accommodating a patient’s request and defending a professional’s responsibilities to the health-care system. It will also serve the wider health-care community to gain insight into the complex environment of health-care delivery in the ED that only gets trickier when patients request to leave.