Against Medical Advice Discharge: A Quality Improvement Project

Abstract

Against Medical Advice Discharge (AMAD) is a significant challenge in healthcare, often resulting in adverse patient outcomes, increased readmission rates, and legal risks for providers. This quality improvement project aims to standardize and enhance the AMAD process at the American University of Beirut Medical Center (AUBMC) by addressing inefficiencies, improving documentation, and integrating best practices. Using the Define, Measure, Analyze, Improve, and Control (DMAIC) framework, the study systematically evaluates the current AMAD process, identifies key gaps—including inconsistent documentation, unclear risk management involvement, and a lack of standardized workflows—and proposes targeted interventions. Key recommendations include the development of a detailed AMAD policy, refinement of the AMA documentation process within the Electronic Health Record (EHR), and the implementation of structured training programs for healthcare providers. These interventions are expected to improve patient safety, ensure legal compliance, and facilitate better tracking and analysis of AMAD cases.