Effect of Leaving Against Medical Advice on Medical Records

Quality Measure Exclusion

Patients leaving against medical advice are excluded from denominator populations for all major cardiovascular performance metrics, including aspirin administration, beta-blocker therapy, statin prescribing, antiplatelet therapy, and cardiac rehabilitation referral metrics, as recommended by the American College of Cardiology and American Heart Association 1, 2, 3, 4
This exclusion applies universally across conditions, including acute myocardial infarction, coronary artery revascularization, atrial fibrillation, and heart failure, according to the American College of Cardiology guidelines 1, 2, 3, 4, 5
The AMA designation removes the patient from quality reporting, regardless of whether they received appropriate care prior to leaving, meaning their outcomes do not impact institutional performance scores, as stated by the American College of Cardiology 1, 2, 3, 4

The American College of Cardiology and American Heart Association emphasize that proper AMA documentation must include patient-specific risks, not generic warnings, along with evidence of the patient's understanding of these risks 8
Essential documentation elements include specific risks of leaving with the current untreated or incompletely treated condition, including both immediate and longer-term consequences tailored to the individual patient's clinical situation, as recommended by the American College of Cardiology 8
The patient's verbalized understanding of the discussed risks, providing evidence that informed decision-making occurred, is a crucial documentation element, according to the American College of Cardiology guidelines 8
Discharge instructions, prescriptions, and urgent follow-up appointments are necessary to ensure continuity of care and reduce adverse outcomes, as stated by the American College of Cardiology 8
Contact numbers for questions or if the patient changes their mind about leaving should be provided, according to the American College of Cardiology guidelines 8
Documentation that the patient was informed they will be excluded from quality measure denominator populations due to AMA status is required, as recommended by the American College of Cardiology 8