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 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.

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 Incidence of Road Traffic Injury and Associated Factors among Patients Visiting the Emergency Department of Tikur Anbessa Specialized Teaching Hospital, Addis Ababa, Ethiopia

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Bewket Tadesse Tiruneh ◽  
Berihun Assefa Dachew ◽  
Berhanu Boru Bifftu
Keyword(s):  
Emergency Department ◽  
Teaching Hospital ◽  
Associated Factors ◽  
Road Traffic ◽  
Addis Ababa ◽  
Psychological Problem ◽  
Road Traffic Injury ◽  
Public Health Issue ◽  
Cross Sectional ◽  
Traffic Injury

Background. Road traffic injuries are a major public health issue. The problem is increasing in Africa.Objective. To assess the incidence of road traffic injury and associated factors among patients visiting the emergency department of Tikur Anbessa Specialized Teaching Hospital, Addis Ababa, Ethiopia.Methods. Institutional based cross-sectional study design was conducted. A total of 356 systematically selected study subjects were included in the study. Bivariate and multivariate logistic regressions were performed to identify associated factors with road traffic injury. Odds ratios with 95% confidence interval were computed to determine the level of significance.Results. The incidence of road traffic injury in the emergency department of Tikur Anbessa Specialized Teaching Hospital was 36.8%. Being a farmer (AOR = 3.3; 95% CI = 1.06–10.13), conflict with family members (AOR = 7.7; 95% CI = 3.49–8.84), financial problem (AOR = 9.91; 95% CI = 4.79–6.48), psychological problem (AOR = 17.58; 95% CI = 7.70–12.14), and alcohol use (AOR = 2.98; 95% CI = 1.61–5.27) were independently associated with road traffic injury.Conclusion and Recommendation. In this study the incidence of road traffic injury was high. Alcohol is one of the most significant factors associated with Road Traffic Injury. Thus urgent education on the effect of alcohol is recommended.

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 A rapid clinic-based service for an emergency department of a tertiary teaching hospital during a dengue outbreak

Medicine ◽  
2021 ◽  
Vol 100 (14) ◽  
pp. e25311
Author(s):  
Hsin-I. Shih ◽  
Yi-Ting Huang ◽  
Chih-Chia Hsieh ◽  
Tzu-Ching Sung
Keyword(s):  
Emergency Department ◽  
Teaching Hospital ◽  
Dengue Outbreak ◽  
Tertiary Teaching ◽  
Tertiary Teaching Hospital

scholarly journals Audit of documentation proficiency of emergency department patients who are discharged against medical advice before and after implementation of a checklist

2016 ◽  
Vol 5 (4) ◽  
pp. 28
Author(s):  
Sze Joo Juan ◽  
Ghee Hian Lim ◽  
Beng Leong Lim
Keyword(s):  
Emergency Department ◽  
Primary Outcome ◽  
Medical Advice ◽  
Against Medical Advice ◽  
Documentation Quality ◽  
Before And After ◽  
Discharge Against Medical Advice ◽  
Emergency Department Patients ◽  
A Prospective Study

Objective: Documentation of the discharge against medical advice (AMA) is poorly performed in the emergency department (ED). Little is known about the impacts of a checklist on this. Our study aimed to compare the quality of AMA documentation before and after implementation of a checklist.Methods: A retrospective review was conducted followed by a prospective study; each over three months of AMA interactions in our ED pre and post implementation of a checklist. An 11-point checklist was used to determine documentation quality during these two periods. Quality was assessed based on the number of points fulfilled on this tool. Documentation was classified as “good” (8-11), “average” (4-7) and “poor” (0-3). The primary outcome measured was the proportions of discharged AMA records that showed “good”, “average” and “poor” documentation. Secondary outcomes were compliance rates to each of the categories of the checklist before and after its use.Results: 339 and 309 complete records were retrieved from the retrospective and prospective arms respectively. The proportions of case records in the three grades before and after use of the checklist respectively were: poor, 199/339 (59%) vs. 7/313 (2%); fair, 133/339 (39%) vs. 66/313 (21%) and good 7/339 (2%) vs. 240/313 (77%); all p-values were statistically significant. There were also statistically significant differences in compliance rates to each of the categories of the checklist pre and post checklist implementation.Conclusions: This study shows improvement in quality and compliance rates in the audit categories after the implementation of an AMA checklist.

scholarly journals Prevalence of road traffic injury and its associated factors at hospitals in Wolaita Zone

2019 ◽  
Author(s):  
Samuel Hailu Weldemariam ◽  
Tigabu Addisu Lendado
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Road Traffic ◽  
Multivariate Logistic Regression Analysis ◽  
Road Traffic Injury ◽  
Cross Sectional ◽  
Road Traffic Crashes ◽  
Traffic Injury ◽  
Trauma Victims ◽  
Associated Risk Factors

Abstract Background Road traffic injury is defined as fatal or non-fatal cases incurred as a result of road traffic crashes. It accounts for an estimated 1.2 million people death and as many as 50 million injury in each year worldwide. This study was aimed to determine prevalence and associated risk factors of road traffic injury.Objective To determine the prevalence and its associated risk factors of road traffic injury.Method Facility based cross-sectional study with sample size of 309 was used for conducting study in two selected hospitals in Wolaita Zone.Systematic sampling method was applied to select study subject based on inclusion criteria. Data was collected by questionnaires which was developed from reviewing different literatures and analysed by using SPSS version 20statistical software.Result Among the total of trauma victims who visited emergency department of hospitals, approximately half of victims (49.2%) were due to road traffic injury followed by falling injury 60 (19.4%) and burns 35 (11.3%). After adjusting for confounding in multivariate logistic regression analysis, sex and living places are independent factors of road traffic injury. Two of them are highly significantly associated with road traffic injury and being male and urban resident had thirteen times AOR 13.08 95% CI (6.15-27.85) and more than two times AOR 2.69 95%CI (1.55-4.64) increased odd of road traffic injury respectively.Conclusion Road traffic injury was leading injury types among trauma victims visiting emergency department of Hospitals. Therefore, strong road safety policy at local and country level is needed to reduce vulnerability of individuals and vehicle related injury.

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