Discharge against medical advice: sociodemographic, clinical and financial perspectives.

Discharge against medical advice (DAMA) presents healthcare providers with clinical, ethical and legal challenges. Patient factors--demographic, social and clinical--may determine the possibility of a hospitalisation ending against medical advice. All cases of DAMA from St Agnes Hospital, Baltimore, were identified from the computerised medical system. Patient factors including demographic, social and clinical variables relating to these discharges were analysed. Readmission data and cost of hospitalisation were also assessed. DAMA represented 1% of all discharges. The average length of stay was 2.3 days, at a cost of $3716.00. The average length of stay of 30-day readmission was 4.7 days, making the cumulative cost of hospitalisation $10,761.56, 56% higher than expected. African Americans, males, lack of medical insurance and substance abuse were strongly associated with DAMA (p<0.01). Careful and proactive management strategies could mitigate the potential clinical, legal and economic implications of DAMA.