Aspects of Medical Self-Discharge

Background to Project

Previous studies have found that up to 1.5% of patients decided not to follow health professionals' advice and were known to have discharged themselves from hospital [1, 2]. This is significant when almost 15 million patients were admitted in the UK between 2009 and 2010 [3].

Self-discharge appears to be more prevalent in particular departments, such as psychiatry, with particular sections of society thought to be more vulnerable to self-discharging e.g. young males, Black and Minority Ethnic groups, and drug and alcohol users [4, 5].

The reasons given for self-discharge include long waiting time, poor bedside manner, and failure of communication amongst hospital staff [6]. As a result, self-discharge has been framed in negative terms particularly as these patients have higher readmission and in-hospital mortality rates [7].

Yet, self-discharge could be perceived as an expression of patients' rights when entering into the 'hidden contract' between health professionals and patients i.e. do as I say if you wish to get better. If patients are perceived as duty-bound to follow medical advice, self-discharge could offer a way of 'equalling' the balance of power between the two.

Self-discharge is likely to be more prevalent than the reported figures suggest. A number of the 'patient' population are not captured within the reported self-discharge figures, such as those who decide to leave before being seen by a health professional, or those who have been admitted to hospital, but do not inform anyone of their decision to discharge themselves.

Furthermore, there is not a standard self-discharge process across the NHS, nor a consistent policy between departments, wards, and hospitals, thereby making it difficult to ascertain exactly how many people are choosing to leave hospitals, at what stage of the treatment process they are leaving, and for what reasons.

Finally, there is little insight into how hospital management make sense of self-discharge or how health professionals perceive self-dischargers and the concept of self-discharge.


  1. Henson, V.L. & Vickery, D.S. (2005). Patient self discharge from the emergency department: who is at risk? Emergency Medicine Journal, 22, 499-501.
  2. Ibrahim, S.A., Kwoh, C.K. & Krishnan, E. (2007). Factors Associated With Patients Who Leave Acute-Care Hospitals Against Medical Advice. Am J Public Health, 97, 2204-2208.
  3. National Health Service. Hospital Episode Statistics (admitted patient care) England 2010-11.
  4. Hwang, S.W., Li, J., Gupta, R., Chien, V. & Martin, R.E. (2003). What happens to patients who leave hospital against medical advice? CAMJ, 168, 417-420.
  5. Franks, P., Meldrum, S. & Fiscella, K. (2006). Discharges against medical advice: are race/ethnicity predictors? J Gen Intern Med, 21, 955-60.
  6. Onukwugha, E., Saunders, E., Mullins, C.D., Pradel, F.G., Zuckerman, M. & Weir, M.R. (2010). Reasons for discharges against medical advice: a qualitative study. Quality & Safety in Health Care, 19, 420-424.
  7. Choi, M., Kim, H., Qian, H. & Palepu, A. (2011). Readmission Rates of Patients Discharged against Medical Advice: A Matched Cohort Study. PLoS One, 6, e24459.


Problems with this page? Contact the FHM Webmaster
© 2008-2014 Lancaster University - Disclaimer and Copyright notice - Privacy and Cookies Notice