Amna Ibrahim Alshamsi ^* Alaa AbuQuta Alaedin Ibrahim Mahmoud Ibrahim Amna Ali Hassan Esaadi Esam Sabri Altaee Najlaa Saeed AlAli

• Emirates Health Services (EHS), Dubai, United Arab Emirates

Objective: This study investigated the common reasons for leaving against medical advice (LAMA) at Emirates Health Services (EHS) by comparing electronic medical records (EMR) with healthcare professionals' (HCPs) stated reasons and understanding the challenges faced by HCPs in such cases. We also explored patient-related factors associated with LAMA based on HCP interviews to improve patients' outcome.This mixed-method study used EMR data and HCP interviews from four EHS public hospitals with LAMA rates of >2%. EMR variables, including nationality, personal and social reasons, financial reasons, sex, and triage classifications, were dummycoded and tested using the chi-squared test. Twenty interviews were conducted and analyzed using thematic analysis (TA).Results: Quantitative data revealed that 5,521 patients left against medical advice in the four hospitals over six months. The average age of these patients was 35.1 years (SD = 22.4), and 61.3% were male. Personal and social reasons accounted for 65.7% of the patients who opted for LAMA, and 69.9% were classified as triage 3. There was a significant association between Emiratis and non-Emiratis LAMA and triage category reasons X2 (1) = 138.1, p = < 0.001. The odds ratios indicated that Emiratis with triage 3-5 were 2.7 times more likely to leave (95% confidence interval: 2.37-3.38) than non-Emiratis. TA identified two main themes as strategies for managing LAMA: reasons for LAMA and outcomes of LAMA.: The results highlight the perspective of HCPs on the reasons for LAMA, providing insights for developing interventions to influence patient decisions and enhance health outcomes. Interventions may include enhancing HCP-patient communication and educating patients on adherence to medical advice. In conclusion, EHS needs strategies to improve LAMA among patients despite of their nationality.Leaving against medical advice (LAMA) presents a significant challenge for healthcare organizations, particularly when treating acutely ill patients.This study adds to the knowledge of the common reasons for LAMA in a Middle Eastern country.This study addresses a critical research gap regarding LAMA in the United Arab Emirates. The results of this study will inform policymakers regarding reducing the LAMA rates and simplifying the admission process.