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  1. Shields, Lisa B. E. MD
  2. LaRocco, Matthew BS, CADP
  3. Young, Matt W. BS
  4. Flanders, Kimberly DNP, MBA, RN, NEA-BC


OBJECTIVE: This study investigated harm reduction (HR) strategies at our institution to decrease the number of patients with a substance use disorder (SUD) who left against medical advice (AMA).


BACKGROUND: HR is a public health strategy used for adult substance use problems for whom abstinence is not feasible.


METHODS: An HR program was established at 1 institution to enhance the care of hospitalized patients with a SUD.


RESULTS: Of the 1780 unique visits for patients with a diagnosis of SUD, 311 patients (17.5%) left our hospital AMA or eloped. The average length of stay for all patients evaluated by the HR team was 6.6 days compared with 4.0 days for those who left AMA. Patients with >1 hospital stay accounted for 22% of our population but represented 34% of the patients who left AMA.


CONCLUSIONS: This study reports the approaches implemented to reduce the AMA rate of patients with a SUD and to promote patient-enhanced care.