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.

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 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.

scholarly journals Prevalence and Clinical Significance of Drug–Drug and Drug–Dietary Supplement Interactions among Patients Admitted for Cardiothoracic Surgery in Greece

Pharmaceutics ◽  
2021 ◽  
Vol 13 (2) ◽  
pp. 239
Author(s):  
Marios Spanakis ◽  
Maria Melissourgaki ◽  
George Lazopoulos ◽  
Athina E. Patelarou ◽  
Evridiki Patelarou
Keyword(s):  
Dietary Supplement ◽  
Clinical Significance ◽  
Healthcare Providers ◽  
Well Being ◽  
Cross Sectional Study ◽  
Medical Advice ◽  
Cardiothoracic Surgery ◽  
University Hospital ◽  
Cross Sectional ◽  
Evidenced Based

Background: Drug interactions represent a major issue in clinical settings, especially for critically ill patients such as those with cardiovascular disease (CVD) who require cardiothoracic surgery (CTS) and receive a high number of different medications. Methods: A cross-sectional study aimed at evaluating the exposure and clinical significance of drug–drug (DDIs) and drug–dietary supplement interactions (DDSIs) in patients admitted for CTS in the University Hospital of Crete Greece. DDIs were evaluated regarding underlying pharmacological mechanisms upon admission, preoperation, postoperation, and discharge from CTS clinic. Additionally, upon admission, the use of dietary supplements (DSs) and if patients had informed their treating physician that they were using these were recorded with subsequent analysis of potential DDSIs with prescribed medications. Results: The study employed 76 patients who were admitted for CTS and accepted to participate. Overall, 166 unique DDIs were identified, with 32% of them being related to pharmacokinetic (PK) processes and the rest (68%) were related to possible alterations of pharmacodynamic (PD) action. CVD medications and drugs for central nervous system disorders were the most frequently interacting medications. In total, 12% of the identified DDIs were of serious clinical significance. The frequency of PK-DDIs was higher during admission and discharge, whereas PD-DDIs were mainly recorded during pre- and postoperation periods. Regarding DS usage, 60% of patients were using DSs and perceived them as safe, and the majority had not informed their treating physician of this or sought out medical advice. Analysis of medical records showed 30 potential combinations with prescribed medications that could lead in DDSIs due to modulation of PK or PD processes, and grapefruit juice consumption was involved in 38% of them. Conclusions: An increased burden of DDIs and DDSIs was identified mostly upon admission for patients in CTS clinics in Greece. Healthcare providers, especially prescribing physicians in Greece, should always take into consideration the possibility of DDIs and the likely use of DS products by patients to promote their well-being; this should only be undertaken after receiving medical advice and an evidenced-based evaluation.

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

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.

scholarly journals Factors affecting prehospital time delay of the injured patients arriving at the Emergency Department of Beni-Suef University Hospital in Egypt: A cross-sectional study

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0252044
Author(s):  
Doaa Mahmoud Khalil ◽  
Elmorsy Elmorsy ◽  
Ahmed Arafa ◽  
Hesham Ahmed Nafady ◽  
Lamiaa Saleh
Keyword(s):  
Emergency Department ◽  
Time Delay ◽  
Cross Sectional Study ◽  
University Hospital ◽  
Sectional Study ◽  
Cross Sectional ◽  
Factors Affecting ◽  
Consciousness Level ◽  
Injured Patients ◽  
Prehospital Time

Purpose This study aimed to assess the factors affecting the prehospital time delay of the injured patients arriving at the Emergency Department of Beni-Suef University Hospital in Upper Egypt. Materials and methods In this cross-sectional study, the following data were retrieved from the hospital records of 632 injured patients between 1/1/2018 and 31/3/2018: age, sex, residence, means of transportation to the hospital, prehospital time delay, consciousness level on admission, source of injury, and type of worst injury. Results The prehospital time delay (>one hour) of the injured patients was positively associated with age >60 years and rural residence but inversely associated with consciousness level with odds ratios (95% confidence intervals) of 5.14 (2.26–11.68), 3.49 (2.22–5.48), and 0.56 (0.32–0.96), respectively. Conclusion The prehospital time delay of the injured patients arriving at the Emergency Department of Beni-Suef University Hospital in Egypt was associated with old age, rural residence, and consciousness level.

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.

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