{
  "abstract": "Aims and Objectives Discharge against medical advice (AMA) in psychiatric emergencies poses severe risks, including repeated self-harm and suicide. This study investigated factors associated with AMA discharge in patients presenting with self-harm or suicidal ideation, specifically focusing on the impact of ‘Door-to-Psychiatrist’ waiting time.Method and Design This retrospective study analyzed data from the registry of a Regional Psychiatric Emergency Center in Seoul, South Korea, collected between February 2023 and September 2025. A total of 1,005 patients presenting with self-harm or suicidal ideation/attempts were included. Multivariate logistic regression was performed to identify independent predictors of AMA discharge, adjusting for demographic and clinical variables. A threshold analysis was conducted to quantify the incremental risk based on waiting time intervals.Abstract 4472 Figure 1Results and Conclusion Door-to-Psychiatrist time was a robust independent predictor of AMA discharge. Every 1-hour increase in waiting time was associated with a 24% increase in the odds of AMA discharge (adjusted OR [aOR] 1.24, 95% CI 1.11–1.39, p<0.001). Threshold analysis revealed a critical ‘golden hour’; compared to patients evaluated within one hour, the risk of AMA discharge surged by 2.79-fold (95% CI 1.53–5.08) for those waiting 1–2 hours and 5.91-fold (95% CI 3.14–11.14) for those waiting >3 hours. Other significant predictors included alert mental status (aOR 2.17), while caregiver presence (aOR 0.62), physical restraint (aOR 0.16), and poisoning method (aOR 0.37) were protective. Notably, patient age and psychiatric history were not significant in the multivariate model.Systemic factors, particularly the waiting time for psychiatric consultation, are more dominant determinants of AMA discharge than unmodifiable patient characteristics. The findings suggest that reducing Door-to-Psychiatrist time to under one hour or implementing early bridging interventions for delayed consultations is essential to mitigate the risk of premature discharge in psychiatric emergencies.",
  "authors": [
    {
      "affiliations": [
        "Seoul Medical Center"
      ],
      "name": "Daesung Lim"
    },
    {
      "affiliations": [
        "Seoul Medical Center"
      ],
      "name": "Youngjin Kim"
    },
    {
      "affiliations": [
        "Seoul Medical Center"
      ],
      "name": "Sungyeol Ye"
    },
    {
      "affiliations": [
        "Seoul Medical Center"
      ],
      "name": "Moonhwan Kwak"
    },
    {
      "affiliations": [
        "Seoul Medical Center"
      ],
      "name": "Hahnbom Kim"
    },
    {
      "affiliations": [
        "Seoul Medical Center"
      ],
      "name": "Hyunkyung Park"
    },
    {
      "affiliations": [
        "Kangwon National University Hospital"
      ],
      "name": "Heewoo Lee"
    }
  ],
  "title": "4472 Factors associated with against-medical-advice (AMA) discharge among suicide attempt patients visiting a regional psychiatric emergency center in Korea, Seoul",
  "uid": "36ac8d54-fbad-5f45-b32e-b20f9ee39bec"
}