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 Discharge against medical advice from the emergency department in a university hospital

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Feras H. Abuzeyad ◽  
Moonis Farooq ◽  
Salah Farhat Alam ◽  
Mudhaffar Ismael Ibrahim ◽  
Luma Bashmi ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cross Sectional Study ◽  
Small Sample ◽  
Medical Advice ◽  
University Hospital ◽  
High Risk Population ◽  
Cross Sectional ◽  
Against Medical Advice ◽  
Level 3 ◽  
Collection Form

Abstract Background Patients discharged against medical advice (DAMA) act as a high-risk population for the Emergency Department (ED), regardless of their presentations, and can pose a serious burden for the hospital. This study examines the prevalence, demographic and clinical characteristics, reasons, and clinical outcomes of a small sample of DAMA patients in a teaching university hospital, including readmission, morbidity, and mortality. Methods A prospective, descriptive cross-sectional study was conducted in the ED of King Hamad University Hospital (KHUH) with 98,992 patient visits during a 1-year period from June 2018 to June 2019. Consenting DAMA patients were asked to complete a data collection form. Results Patients (n = 413) had a mean age of 44.1 years with a female majority (57.1%). The majority were categorized as triage level-3 (87.7%). The main reasons for DAMA included refusal of the procedure/operation (23.2%), long ED waiting time (22.2%), subjective improvement with treatment (17.7%), and children at home (14.8%), whereas the least selected reason was dissatisfaction with medical care (1.2%). Follow-up of DAMA patients revealed that 86 cases (20.8%) were readmitted to the ED within 72 h of which 41 (47.7%) cases were morbidity and 2 (2.3%) were mortality. Marital status was a predictor of DAMA patients who revisit the ED within 72 h. Conclusion The results act as a pilot study to examine a small sample of DAMA patients’ characteristics, diagnosis, and ED revisits. Hospitals should investigate further the DAMA population on a larger scale, reasons for refusing procedures, and utilize this knowledge to improve the healthcare process.

scholarly journals Cases of Left Against Medical Advice from the Emergency Department of a Tertiary Care Hospital in Kathmandu: A Descriptive Cross-Sectional Study

2020 ◽  
Vol 58 (232) ◽  
Author(s):  
Manish Nath Pant ◽  
Saswat Kumar Jha ◽  
Sauravi Shrestha
Keyword(s):  
Emergency Department ◽  
Informed Consent ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Medical Advice ◽  
Care Hospital ◽  
Sectional Study ◽  
Cross Sectional ◽  
Against Medical Advice

Introduction: Left against medical advice is a worldwide phenomenon. Patients leaving against Left against medical advice do not provide the health professionals with legal impunity. A well-informed consent should be present with surety that they are well understood by the patient before they leave. The study was undertaken to study the prevalence of patients that leave against medical advice. Methods: This is a descriptive cross-sectional study done in the emergency department of a tertiary care hospital from 1st February 2020 to 31 July 2020. Ethical approval was taken from the Institutional Review Committee (ref. no. 130120205). The sample size was calculated and the convenient sampling method was used. Data were analyzed in the Statistical Package of the Social Sciences version 22. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: Out of 5834 visits, 332 (5.96%) (4.70-7.22 at 95% Confidence Interval) patients left against medical advice. The mean age was 36.48 years (3 days-91 years) and males 173 (52.3%) were prone to leave than females. Only 50 (15.1%) cases had well-informed consent with complications documented. Hundred (30.5%) patients had wanted to come on follow up the next day in the out-patient department while 41 (12.4%) had to leave because of financial reasons. Only seven (2.9%) of well-oriented patients gave their consent and the remaining 233 (97.1%) were by the kin present. Only 76 (23%) patients were sent home with a well-documented medicine prescription. Conclusions: The proportion of patients who left against medical advice was more than the studies done in a similar setting.

scholarly journals Leave Against Medical Advice amongst Pediatric Patients Admitted in a Tertiary Teaching Hospital in Nepal: A Descriptive Cross-sectional Study

2021 ◽  
Vol 59 (241) ◽  
pp. 897-901
Author(s):  
Sahisnuta Basnet ◽  
Ganesh B.K ◽  
Aslam Ansari ◽  
Suraj Adhikari
Keyword(s):  
Confidence Interval ◽  
Teaching Hospital ◽  
Pediatric Patients ◽  
Cross Sectional Study ◽  
Medical Advice ◽  
Sectional Study ◽  
Cross Sectional ◽  
Against Medical Advice ◽  
Tertiary Teaching ◽  
Tertiary Teaching Hospital

Introduction: Leave against medical advice has a potentially deleterious effect on the health of a child. This is particularly alarming in case of pediatric patients as they are unable to understand the implications of it and rely on parents to make decisions regarding their health. This study was undertaken to find out the prevalence of leave against medical advice among pediatric patients admitted in a tertiary teaching hospital in Nepal. Methods: A descriptive cross-sectional study was conducted in the Department of Pediatrics, Manipal Teaching Hospital between August 2019 and July 2020. Ethical clearance was obtained from the Institutional Review Committee (Ref: 256). Convenient sampling method was used. Data entry and analysis was done on Statistical Package for Social Sciences version 23. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data.Results: Out of 1608 pediatric admissions taken in our study, the prevalence of leave against medical advice was found to be 67 (4.2%) at 95% Confidence Interval (3.22-5.18). Maximum 22 (33%) and minimum 6 (9%) patients respectively belonged to the age group from birth to 7 days and more than 10 years. Out of 67 cases, there were 36 (54%) males and 31 (46%) females.Conclusions: The prevalence of leave against medical advice among admitted pediatric patients in our study was similar to that of other studies. It is a social health problem which can be prevented by increasing the awareness and facilitating the use of health insurance schemes. More effective communication is required between the treating physicians and the parents to prevent this detrimental practice.

scholarly journals Effects of Iranian healthcare transformation plan on discharge against medical advice rate and related factors in 2012 and 2016

BMJ Open ◽  
2019 ◽  
Vol 9 (9) ◽  
pp. e024291
Author(s):  
Ali Taghizadieh ◽  
Saber Azami-Aghdash ◽  
Reza Piri ◽  
Mohammad Naghavi-Behzad ◽  
Hossein Jabbari Beyrami
Keyword(s):  
Cross Sectional Study ◽  
Medical Advice ◽  
Public Confidence ◽  
Two Phase ◽  
Related Factors ◽  
Cross Sectional ◽  
Against Medical Advice ◽  
North West ◽  
Discharge Against Medical Advice ◽  
Healthcare Transformation

ObjectiveDischarge against medical advice (DAMA) is a critical problem in hospitals and has several consequences for healthcare systems. The aim of this study was to determine and compare the rate of DAMA and its related factors before and after executing the healthcare transformation plan (HTP) in Iran.MethodsIn a two-phase, cross-sectional study, the DAMA information of 200 patients in 2016 (after HTP) and the patients of a previous study in 2012 (before HTP) was compared. Samples were randomly selected from the main referral centre in the north-west of Iran. Data were collected using a validated and reliable questionnaire and analysed using the SPSS V.16 software.ResultsIn the post-HTP plan period, the rate of DAMA was 3.9%, while this rate was 5.49% in 2012 (p=0.029). A total of 15% (108 out of 721) of patients in the postreform group and 13.5% (101 out of 747) in the prereform group were rehospitalised (p=0.411). The three main categories of reasons for DAMA in 2012 and 2016 were as follows: patient-related factors, 27% vs 45%; staff-related factors, 33% vs 30%; and hospital-related factors (basic amenities), 40% vs 25%. In both periods, the average scores of patient satisfaction were almost the same; however, satisfaction regarding environmental and human factors in hospitals had changed significantly after HTP (p<0.05).ConclusionsThere was a decrease in the rate of DAMA after HTP in Iran. Considering DAMA as a multifactorial phenomenon, this might be due to the higher relative satisfaction after HTP, indicating an increase in public confidence in general hospitals.

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 A Study of Patients who leave the Accident & Emergency Department against Medical Advice: An Eastern Nigeria Tertiary Institution Experience

2019 ◽  
Vol 2 (2) ◽  
pp. 121-125
Author(s):  
GC Oguzie ◽  
O A Lasebikan ◽  
DOC Chukwumam ◽  
DC Oparaocha ◽  
CJ Onyempka ◽  
...  
Keyword(s):  
Emergency Department ◽  
Medical Center ◽  
Distinct Group ◽  
Healthcare Services ◽  
Cross Sectional Study ◽  
Medical Advice ◽  
Tertiary Institution ◽  
Cross Sectional ◽  
Against Medical Advice ◽  
Accident And Emergency

The concept of patients leaving the Accident & Emergency Department against medical advice, Discharging Against Medical Advice (DAMA) or Signing Against Medical Advice (SAMA) is a common occurrence in our sub-region. These groups of patients are often considered high-risk, as they are prone to complications from seeking alternative healthcare services, which might be detrimental to their health. The objective was to determine the characteristics of patients signing against medical advice and the subspecialty with the highest prevalence of patients leaving the hospital against medical advice. A quantitative cross-sectional study design was chosen to accomplish the objectives of the study. A retrospective study was carried out in the Accident & Emergency Department (A & ED) of Federal Medical Center, Owerri (FMCO), to determine the characteristics of this distinct group of patients who left the hospital against medical advice. A review of the records of all patients who left against medical advice between 1st of August 2012 and 31st of July 2014 was done. There were 137 DAMA cases during the study period. The mean age of the DAMA study group was 32.3 years +/- 15.9. The major subspecialty involved was Orthopedics and Trauma with 51.8% (n = 71). The modal age group was between 21 – 30 years with 41.6% (n = 57) while 77.4% were males. In conclusion younger males with orthopedics and trauma cases were the most involved in DAMA and so this group of patients should be counseled as soon as they arrive the Accident and Emergency Department. A further study is needed to find out where they go and their outcome.

scholarly journals A Study of Patients who leave the Accident & Emergency Department against Medical Advice: An Eastern Nigeria Tertiary Institution Experience

2019 ◽  
Vol 2 (2) ◽  
pp. 121-125
Author(s):  
GC Oguzie ◽  
O A Lasebikan ◽  
DOC Chukwumam ◽  
DC Oparaocha ◽  
CJ Onyempka ◽  
...  
Keyword(s):  
Emergency Department ◽  
Medical Center ◽  
Distinct Group ◽  
Healthcare Services ◽  
Cross Sectional Study ◽  
Medical Advice ◽  
Tertiary Institution ◽  
Cross Sectional ◽  
Against Medical Advice ◽  
Accident And Emergency

The concept of patients leaving the Accident & Emergency Department against medical advice, Discharging Against Medical Advice (DAMA) or Signing Against Medical Advice (SAMA) is a common occurrence in our sub-region. These groups of patients are often considered high-risk, as they are prone to complications from seeking alternative healthcare services, which might be detrimental to their health. The objective was to determine the characteristics of patients signing against medical advice and the subspecialty with the highest prevalence of patients leaving the hospital against medical advice. A quantitative cross-sectional study design was chosen to accomplish the objectives of the study. A retrospective study was carried out in the Accident & Emergency Department (A & ED) of Federal Medical Center, Owerri (FMCO), to determine the characteristics of this distinct group of patients who left the hospital against medical advice. A review of the records of all patients who left against medical advice between 1st of August 2012 and 31st of July 2014 was done. There were 137 DAMA cases during the study period. The mean age of the DAMA study group was 32.3 years +/- 15.9. The major subspecialty involved was Orthopedics and Trauma with 51.8% (n = 71). The modal age group was between 21 – 30 years with 41.6% (n = 57) while 77.4% were males. In conclusion younger males with orthopedics and trauma cases were the most involved in DAMA and so this group of patients should be counseled as soon as they arrive the Accident and Emergency Department. A further study is needed to find out where they go and their outcome.

scholarly journals A Study of Patients who leave the Accident & Emergency Department against Medical Advice: An Eastern Nigeria Tertiary Institution Experience

2019 ◽  
Vol 2 (2) ◽  
pp. 121-125
Author(s):  
GC Oguzie ◽  
O A Lasebikan ◽  
DOC Chukwumam ◽  
DC Oparaocha ◽  
CJ Onyempka ◽  
...  
Keyword(s):  
Emergency Department ◽  
Medical Center ◽  
Distinct Group ◽  
Healthcare Services ◽  
Cross Sectional Study ◽  
Medical Advice ◽  
Tertiary Institution ◽  
Cross Sectional ◽  
Against Medical Advice ◽  
Accident And Emergency

The concept of patients leaving the Accident & Emergency Department against medical advice, Discharging Against Medical Advice (DAMA) or Signing Against Medical Advice (SAMA) is a common occurrence in our sub-region. These groups of patients are often considered high-risk, as they are prone to complications from seeking alternative healthcare services, which might be detrimental to their health. The objective was to determine the characteristics of patients signing against medical advice and the subspecialty with the highest prevalence of patients leaving the hospital against medical advice. A quantitative cross-sectional study design was chosen to accomplish the objectives of the study. A retrospective study was carried out in the Accident & Emergency Department (A & ED) of Federal Medical Center, Owerri (FMCO), to determine the characteristics of this distinct group of patients who left the hospital against medical advice. A review of the records of all patients who left against medical advice between 1st of August 2012 and 31st of July 2014 was done. There were 137 DAMA cases during the study period. The mean age of the DAMA study group was 32.3 years +/- 15.9. The major subspecialty involved was Orthopedics and Trauma with 51.8% (n = 71). The modal age group was between 21 – 30 years with 41.6% (n = 57) while 77.4% were males. In conclusion younger males with orthopedics and trauma cases were the most involved in DAMA and so this group of patients should be counseled as soon as they arrive the Accident and Emergency Department. A further study is needed to find out where they go and their outcome.

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