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The following is a summary of “Trends and predictors of leaving before medically advised in US emergency departments from 2016 to 2021,” published in the April 2025 issue of American Journal of Emergency Medicine by Alnashri et al. 

Leaving before medically advised (BMA) was a significant issue in the US healthcare system, contributing to adverse outcomes and costs, while multi-year studies with recent nationwide emergency department (ED) data remained scarce.  

Researchers conducted a retrospective study to examine factors associated with leaving BMA from EDs and trends over time, before and during the COVID-19 pandemic.  

They used data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) from 2016 to 2021. Multivariable logistic regression identified factors linked to leaving BMA, while interrupted time series (ITS) analyses examined trends over time.  

The results showed that out of 721.0 million ED visits, 5.9 million (0.8%) resulted in leaving BMA. Higher odds of leaving BMA were linked to public or no insurance (Medicare: AOR = 1.74, 95% CI = 1.12–2.70; Medicaid/CHIP/State-based: AOR = 1.86, 95% CI = 1.40–2.45; Uninsured/Self-pay: AOR = 1.51, 95% CI = 0.99–2.29), alcohol or substance use disorders (AOR = 2.19, 95% CI = 1.77–2.70), ambulance arrivals (AOR = 1.68, 95% CI = 1.31–2.15), and being male (AOR = 1.32, 95% CI = 1.09–1.62). Lower odds were associated with hospital admissions (AOR = 0.11, 95% CI = 0.05–0.21) and trauma or overdose-related visits (AOR = 0.54, 95% CI = 0.44–0.67). The COVID-19 pandemic significantly raised the likelihood of leaving BMA (AOR = 1.44, 95% CI = 1.06–1.95), with a 53.6% increase in BMA-related ED visits post-March 2020, particularly in the fourth quarters of 2020 and 2021 and the second and third quarters of 2020.  

Investigators concluded that various demographic, socio-economic, and clinical factors were related to higher incidences of leaving ED BMA, with the COVID-19 pandemic further increasing rates. 

Source: sciencedirect.com/science/article/abs/pii/S0735675724007642