A qualitative assessment of discharge against medical advice among patients hospitalized for injection-related bacterial infections in West Virginia

Background: A patient decides to leave the hospital against medical advice. Is this an erratic eccentric behavior of the patient, or a gap in the quality of care provided by the hospital? With a significant and increasing prevalence of up to 1–2% of all hospital admissions, leaving against medical advice affects both the patient and the healthcare provider. We hereby explore this persistent problem in the healthcare system. We searched Medline and PubMed within the last 10 years, using the keywords “discharge against medical advice,” “DAMA,” “leave against medical advice,” and “AMA.” We retrospectively reviewed 49 articles in our project. Ishikawa fishbone root cause analysis (RCA) was employed to explore reasons for leaving against medical advice (AMA). This report presents the results of the RCA and highlights the consequences of discharge against medical advice (DAMA). In addition, the article explores preventive strategies, as well as interventions to ameliorate leaving AMA.

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A nationally representative study on discharge against medical advice among those living with epilepsy

Seizure ◽

10.1016/j.seizure.2020.11.018 ◽

2021 ◽

Vol 84 ◽

pp. 84-90

Author(s):

Parul Agarwal ◽

Huaqing Xi ◽

Nathalie Jette ◽

Jung-yi Lin ◽

Churl-Su Kwon ◽

...

Keyword(s):

Medical Advice ◽

Against Medical Advice ◽

Representative Study ◽

Discharge Against Medical Advice ◽

Nationally Representative

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Informal psychiatric patients requesting discharge

Psychiatric Bulletin ◽

10.1192/pb.18.4.209 ◽

1994 ◽

Vol 18 (4) ◽

pp. 209-211

Author(s):

Robin McGilp ◽

Brian Kidd ◽

Cameron Stark ◽

Tom Henderson

Keyword(s):

Substance Abuse ◽

Psychiatric Patients ◽

Medical Advice ◽

Psychotic Illness ◽

Against Medical Advice ◽

The Past ◽

History Of ◽

Self Harm ◽

Discharge Against Medical Advice ◽

Retrospective Investigation

A retrospective investigation of case-notes compared 54 incidents of informal psychiatric in-patients being detained in hospital on an emergency basis with 66 incidents of discharge against medical advice (AMA). The characteristics of the two groups were compared. Detained patients were more likely to have been detained previously, to be suffering from a psychotic illness, and to have threats of violence or self-harm mentioned in their case-notes. AMA patients were more likely to have a history of substance abuse but were no more likely than the detained group to have been discharged AMA in the past. The results suggest that psychiatrists in this hospital are using current legislation on detention appropriately.

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Discharge against medical advice at a general hospital in Catalonia

General Hospital Psychiatry ◽

10.1016/s0163-8343(02)00253-0 ◽

2003 ◽

Vol 25 (1) ◽

pp. 46-50 ◽

Cited By ~ 17

Author(s):

Rosó Duñó ◽

Esther Pousa ◽

Jordi Sans ◽

Carles Tolosa ◽

Ada Ruiz

Keyword(s):

General Hospital ◽

Medical Advice ◽

Against Medical Advice ◽

Discharge Against Medical Advice

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Rate and causes of discharge against medical advice from a university hospital emergency department in Iran: an ethical perspective

Journal of Medical Ethics and History of Medicine ◽

10.18502/jmehm.v13i15.4391 ◽

2020 ◽

Author(s):

Sanaz Rouhbakhsh Halvaei ◽

Hojat Sheikh Motahar Vahedi ◽

Ayat Ahmadi ◽

Maryam Sadat Mousavi ◽

Alireza Parsapoor ◽

...

Keyword(s):

Emergency Department ◽

Medical Staff ◽

Medical Advice ◽

University Hospital ◽

P Value ◽

Emergency Ward ◽

Ethical Perspective ◽

Against Medical Advice ◽

Discharge Against Medical Advice ◽

Clinical Records

Discharge against medical advice (DAMA) is a common problem in the health-care system. It imposes risks to both patients and medical staff and could be the subject of ethical deliberation. This cross-sectional study was conducted in 2017 on 400 patients who were discharged against medical advice from the emergency ward of Shariati Hospital, Tehran, Iran. Patients’ information was collected using clinical records and telephone calls. The collected data were analyzed using STATA software. DAMA rate was 12% in the emergency department of Shariati Hospital. Male gender was found to be a risk factor for DAMA (OR: 1.90; CI (95%): 1.44 - 2.52; P < 0.0001). In addition, younger patients were more likely to leave hospital against medical advice (p-value: 0.04). The more common reasons for DAMA were feeling better, long delay in diagnostic and therapeutic procedures and the hectic ambience of the emergency ward. Patients’ self-discharge is a multi-dimensional phenomenon that is affected by patients’ characteristics, medical conditions and hospital circumstances. It raises some ethical concerns, mainly due to a conflict between patients’ autonomy and beneficence. It is helpful for the medical staff to create an effective relationship with patients who are at higher risk of DAMA, in order to increase their compliance and prevent the consequences of leaving hospital against medical advice.

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Discharge against Medical Advice in Some Paediatric Wards

Tropical Doctor ◽

10.1177/004947558801800313 ◽

1988 ◽

Vol 18 (3) ◽

pp. 125-127 ◽

Cited By ~ 1

Author(s):

H S Goyea

Keyword(s):

Hospital Care ◽

Preventive Health Care ◽

Medical Advice ◽

Preventive Health ◽

Against Medical Advice ◽

The Poor ◽

Discharge Against Medical Advice ◽

The Cost ◽

The University ◽

Family Opposition

Sixty-four cases of discharge against medical advice (DAMA) from 3 paediatric units in the University of Benin Teaching Hospital within a period of 18 months were analysed. The incidence was highest among the very young, even when they were still very ill. Financial problems accounted for 65.6% of the cases. Other reasons included difficulties related to the siblings (9.4%), the wish to try traditional methods (7.8%), family opposition (1.6%) and distance from the hospital (4.1%). It is recommended that greater attention be given to preventive health care, and placing the cost of hospital care within the reach of the poor. Improved communication is also recommended as a way of helping parents seek alternatives to DAMA.

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