scholarly journals Discharge against medical advice from neurology wards of a teaching hospital: A prospective observational study

2019 ◽  
Vol 7 (1) ◽  
pp. 115-120
Author(s):  
Akshay Navalkishor Lakhotia ◽  
Ajoy Sodani ◽  
Mukesh Dube ◽  
Kapil Telang ◽  
Rahul Jain ◽  
...  
Keyword(s):  
Observational Study ◽  
Teaching Hospital ◽  
Prospective Observational Study ◽  
Medical Advice ◽  
Against Medical Advice ◽  
Discharge Against Medical Advice

scholarly journals Determinants of discharge against medical advice from a rural neurosurgical service in a developing country: A prospective observational study

2020 ◽  
Vol 11 ◽  
pp. 290
Author(s):  
Toyin Ayofe Oyemolade ◽  
Amos Olufemi Adeleye ◽  
Oluwakemi C. Ogunyileka ◽  
Folawemimo M. Arogundade ◽  
Ayodele J. Olusola ◽  
...  
Keyword(s):  
Health Literacy ◽  
Observational Study ◽  
Developing Country ◽  
Financial Constraints ◽  
Prospective Observational Study ◽  
Medical Advice ◽  
Contributory Factor ◽  
Against Medical Advice ◽  
Common Causes ◽  
Discharge Against Medical Advice

Background: In low-resource regions of the world, discharge against medical advice (DAMA) is one empiric contributory factor to poor in-hospital outcome that is not often mentioned. This study aims to investigate the determinants of DAMA from a rural neurosurgical service in a developing country. Methods: This was a prospective observational study of all patients who discharged against medical advice in our service between November 2018 and October 2019. Results: There were 88 patients, 67 (76.1%) males, in the study, (M:F = 3.2:1), representing 17.4% of our patient population in the study period. The peak incidence was in the 20–29 years age group which accounted for 37.5% of the cases. About 55% of the patients presented directly to our center; 31.8% were referred from other hospitals, while 3.4% came from traditional caregivers and 1.1% from religious homes. Head injury was the most common indication for presentation (76.1% of the cases). The duration of hospital stay ranged from 2 h to 14 days. Majority of the patients (87.5%) left the hospital within 8 h of presentation. The reason for DAMA was financial constraints in 50% of cases, inadequate health literacy in 20.5%, financial constraints and poor health literacy together in 12.5%, religious misgivings in 4.5%, and traditional belief in 2.3%. Neurotrauma was predictive of early DAMA (P = 0.001). Conclusion: The rate of DAMA was high in our study. Financial constraints with other socioeconomic limitations were the most common causes of DAMA in our environment.

scholarly journals Discharge against medical advice and premature leave of neurological patients from an interdisciplinary emergency department: a retrospective observational study.

2019 ◽  
Author(s):  
Carolin Hoyer ◽  
Patrick Stein ◽  
Angelika Alonso ◽  
Michael Platten ◽  
Kristina Szabo
Keyword(s):  
Emergency Department ◽  
Observational Study ◽  
Patient Flow ◽  
Waiting Times ◽  
Medical Advice ◽  
Retrospective Observational Study ◽  
Against Medical Advice ◽  
Presenting Symptoms ◽  
Neurological Patients ◽  
Discharge Against Medical Advice

Abstract Background: Discharge against medical advice (DAMA) or premature leave (PL) from the emergency department represent relevant medical problems with impact on patient safety and potential medicolegal consequences. They may also indicate structural or procedural problems in the ED. To date, no dedicated analysis of DAMA/PL exists for neurological patients presenting to the ED. Methods: A retrospective observational study was performed of all patients with neurological complaints presenting to a German interdisciplinary emergency department between January and December 2017. DAMA/PL patients were compared to the total of patients who were admitted or discharged regularly (non-DAMA/PL). Results: Of all neurological cases, 3% left against medical advice and 2.2% left prematurely. DAMA/PL patients were younger (p<.001), and their presentation was more frequently self-motivated (p<0.001. Waiting times did not differ between DAMA/PL and non-DAMA/PL patients (p=.166) but treatment duration was significantly shorter in the former (p<.001) Headaches, seizures and sensory deficits were the most frequent presenting symptoms in DAMA/PL patients, and in 56.1% of those presenting with a seizure had a history of epilepsy. The most common documented reason for leaving was the length of waiting time. Conclusions: Both individual and structural/systemic reasons contribute to DAMA/PL in neurological patients. Optimization of pre-hospital assessment and the development of alternative models of care for patients with non-urgent conditions appear to be promising targets for future improvements regarding demand management and the direction of patient flow.

Discharge against medical advice from a Tehran emergency department

2016 ◽  
Vol 29 (1) ◽  
pp. 24-32 ◽  
Author(s):  
Azar Hadadi ◽  
Patricia Khashayar ◽  
Mojgan Karbakhsh ◽  
Ali Vasheghani Farahani
Keyword(s):  
Emergency Department ◽  
Teaching Hospital ◽  
Cross Sectional Study ◽  
Medical Advice ◽  
Contributing Factors ◽  
Cross Sectional ◽  
Against Medical Advice ◽  
Policy Makers ◽  
Content Type ◽  
Discharge Against Medical Advice

Purpose – The purpose of this paper is to identify the main reasons for discharge against medical advice (DAMA) in the emergency department (ED) of a teaching hospital in Tehran, Iran. Design/methodology/approach – This cross-sectional study was conducted on all the patients who left the ED of a referral teaching hospital against medical advice (AMA) in 2008. A questionnaire was filled out for each patient to determine the reasons behind patient leaving AMA. Findings – In total, 12.8 percent of the patients left the hospital AMA. Dissatisfaction with being observed in the ED, having a feeling of recovery and hospital personnel encouraging patients to leave the hospital were the main reasons for leaving the hospital AMA. Practical implications – Like many other centers, the results showed that poor communication skill and work overload were the main contributing factors to DAMA. The center managed to improve patient satisfaction and thus lowered DAMA rates following this study. Considering the similarities reported in the reports and that of other studies, it could be concluded that policy makers in other centers can also benefit from the results to adopt effective approaches to reduce DAMA rate. Originality/value – To the knowledge no study has evaluated the rate and the reasons behind DAMA in the Iranian EDs.

scholarly journals Characteristics and outcome of road traffic injured patients in the emergency department of a tertiary teaching hospital in Nigeria

2021 ◽  
Vol 7 (3) ◽  
pp. 451
Author(s):  
Oludolapo O. Afuwape ◽  
Temitope O. Alonge ◽  
Achiaka E. Irabor ◽  
Mosi J. Balogun
Keyword(s):  
Emergency Department ◽  
Teaching Hospital ◽  
Road Traffic ◽  
Road Traffic Injury ◽  
Medical Advice ◽  
Against Medical Advice ◽  
Traffic Injury ◽  
Tertiary Teaching ◽  
Tertiary Teaching Hospital ◽  
Discharge Against Medical Advice

<p class="abstract"><strong>Background:</strong> The exit modes from the emergency department (ED) for road traffic injury patients are namely planned discharge; admission to the wards/intensive care unit or transfer to the operating theatre; discharge against medical advice (DAMA). The aim of this study was to assess the characteristics and outcomes of non-poly-traumatized road traffic injury (RTI) related ED admissions of a tertiary health care facility in a developing country and the exit pattern from the ED.</p><p class="abstract"><strong>Methods:</strong> This was a retrospective hospital data-based study of outcome of RTI patients seen in the ED of a tertiary teaching hospital in Nigeria from January to December 2017.<strong></strong></p><p class="abstract"><strong>Results:</strong> 1120 RTI patients were recruited consisting of 774 males and 346 females with a male: female ratio of 2.24:1. The age range was 1 to 94 years with a mean age of 37.5±17.5 years.  Peak ages were in the fourth (24.2%) and third (20.4%) decades of life respectively.  85.5% of the patients were commercial vehicles passengers. Motorcycle accidents constituted 44% of the patients while 41.8% were in cars. The commonest injuries were head injuries (31% m:f 2.7) and fractures (21% m:f 3). There were 11.5% DAMA and 7.1% deaths. Motorcycles injuries had the highest mortality rate while the motorized tricycles injuries had the highest DAMA rates.</p><p class="abstract"><strong>Conclusions:</strong> Motorized tricycles may be considered as a safer means of commercial mode of transportation compared to motorcycles despite its own limitations. There is a need to educate patients against the common practice of discharge against medical advice.</p>

scholarly journals Prognostic value of initial Glasgow Coma Score in comatosed patients on medical floor

2016 ◽  
Vol 12 (2) ◽  
Author(s):  
Muhammad Arif Nadeem ◽  
Khadija Irfan ◽  
Khawaja A Irfan Waheed
Keyword(s):  
Observational Study ◽  
Hospital Stay ◽  
Glasgow Coma Score ◽  
Prognostic Value ◽  
Prospective Observational Study ◽  
Medical Advice ◽  
Against Medical Advice ◽  
Lost To Follow Up ◽  
Category Score

Objective: An open non-randomized prospective observational study of comatosed patients was conducted to correlate initial Glasgow Coma Score (GCS) with the outcome in patients having medical coma at Mayo Hospital, Lahore between January 2002 to September 2003. Methods: A total of 273 patients were followed throughout their hospital stay to determine the outcome after the current episode of coma. A thorough history and examination was obtained for each case. The 3 category Glasgow Coma Score was recorded as an indication of the degree of unconsciousness. One of three possible outcome categories was established, recovery (discharge), death, and referral or self discharge (by attendants) against medical advice. Results: The outcome of 248 patients (90.84%) was established i.e. 152 (61.29%) were discharged after recovery and 96 (38.71%) died. The remaining 25 (09.16%) patients were lost to follow up. Four subcategories of the Glasgow Coma Score were made, at 3-point intervals. In the lowest score category ( score 3-5) there was 59.67% mortality and only 30.66% patients were successfully treated and discharged. In the category of GCS 6-8, 30.91% died and 60% were discharged, while in the 9-11 category, 26.47% died and 66.18% were discharged. In the highest score category (12-15), 27.27% deaths occurred, probably related to the severity of main event, and 62.50% were discharged. Conclusion: The depth of coma as reflected by the initial GCS can reliably be used to predict the outcome in comatosed patients.

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