A Retrospective review of Leave against Medical Advice (LAMA) cases in the Emergency Department: Factors and Solutions

• Published in: Current Medical Issues Vol. 23; no. 1; pp. 8 - 11
• Main Authors: Tikhile, Angad, Tyagi, Shweta, Mulay, Sanjay, Ursekar, Rajesh
• Format: Journal Article
• Language: English
• Published: India Wolters Kluwer - Medknow 2025; Medknow Publications and Media Pvt. Ltd
• Edition: 2
• Subjects: Demographic aspects; Emergency medicine; Emergency service; Health aspects; Hospitals; Medical colleges; Medical research; Medicine, Experimental; Original Article; Right to refuse treatment; Social aspects; Statistics; India; readmission; leave against medical advice; Emergency department
• ISSN: 0973-4651; 2666-4054
• DOI: 10.4103/cmi.cmi_89_24

Abstract Background: Leave against medical advice (LAMA) is a constant source of frustration for all emergency physicians irrespective of the setup. These patients have higher healthcare costs and readmission rates and even carry a higher morbidity and mortality. The literature on the subject from India is limited. We conducted this study to find the proportion of patients LAMA from the emergency medicine department (EMD). Materials and Methods: The study was conducted at an EMD of a tertiary care hospital attached to a medical college in western Maharashtra with an aim to estimate the incidence of LAMA cases and describe various characteristics of these patients. Results: A total of 28,802 patients visited EMD during the study period and 6582 patients (22.8%) left against medical advice. Majority of LAMA patients were male (58.3%) and belonged to the age group of 18-40 (52.9%) years. Maximum patients who left against medical advice belonged to the basic specialties such as internal medicine, general surgery, and orthopedics. Among LAMA patients, majority were discharged between 5 PM and 9 AM (n = 4490; 68.2%). Symptomatic improvement (46.8%) and financial constraints (17.3%) were the reason why majority of patients left against medical advice. Conclusion: LAMA remains a significant problem globally. There are very limited data from India on the demography of LAMA patients and reasons for patients choosing to LAMA. Our study provides a few insights into the issue, but large-scale prospective studies are required to plan policies which can help in reducing the LAMA burden.