Uncompleted emergency department care and discharge against medical advice in patients with neurological complaints: a chart review.

10.21203/rs.2.9965/v2 ◽

2019 ◽

Author(s):

Carolin Hoyer ◽

Patrick Stein ◽

Angelika Alonso ◽

Michael Platten ◽

Kristina Szabo

Keyword(s):

Emergency Department ◽

Chart Review ◽

Waiting Times ◽

Medical Advice ◽

Emergency Department Care ◽

Against Medical Advice ◽

Sensory Deficits ◽

Presenting Symptoms ◽

Mode Of Presentation ◽

Against Medical Advice Discharge

Abstract Background: Uncompleted emergency department care and against-medical-advice discharge represent relevant medical problems with impact on patient safety and potential medicolegal and socioeconomic consequences. They may also indicate structural or procedural problems in the emergency department (ED) relating to patient management and flow. While patients with neurological complaints frequently leave the ED against medical advice or without being seen, no dedicated analysis of this group of patients aiming at the identification of characteristics associated with irregular ED discharge has been performed so far. Methods: A chart review was performed of all patients with neurological complaints presenting to a German interdisciplinary emergency department between January and December 2017 for neurological evaluation. Demographics, mode of presentation, process times, presenting symptoms and diagnosis were recorded. Patients leaving against medical advice after an informed consent discussion and signing of documentation (DAMA) or leaving prematurely without notifying ED staff (PL) were compared to the total of patients who were admitted or discharged (non-DAMA/PL). Results: Of all patients presenting with neurological symptoms or complaints, 3% left against medical advice and 2.2% left prematurely. DAMA/PL patients were younger (p<.001), and they were more frequently self-presenting (p<0.001). Headaches, seizures and sensory deficits were the most frequent presenting symptoms in DAMA/PL patients, and 56.1% of those presenting with a seizure had a history of epilepsy. The most common documented reason for leaving was the duration of door-to-doctor time. Conclusions: Younger age, self-presenting mode of presentation and presentation with headache, seizures or sensory deficits are associated with premature leave or against-medical advice discharge of patients with neurological complaints from the ED, and long waiting times were given as the major reason for leaving the ED. Increasing ED staff’s awareness of these factors and the optimization of pre-hospital assessment and demand management, thereby positively impacting on patient flow and ED process times, may help to prevent irregular discharges from the ED.

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Uncompleted emergency department care and discharge against medical advice in patients with neurological complaints: a chart review.

10.21203/rs.2.9965/v4 ◽

2019 ◽

Author(s):

Carolin Hoyer ◽

Patrick Stein ◽

Angelika Alonso ◽

Michael Platten ◽

Kristina Szabo

Keyword(s):

Emergency Department ◽

Chart Review ◽

Waiting Times ◽

Medical Advice ◽

Emergency Department Care ◽

Against Medical Advice ◽

Sensory Deficits ◽

Presenting Symptoms ◽

Mode Of Presentation ◽

Against Medical Advice Discharge

Abstract Background: Uncompleted emergency department care and against-medical-advice discharge represent relevant medical problems with impact on patient safety and potential medicolegal and socioeconomic consequences. They may also indicate structural or procedural problems in the emergency department (ED) relating to patient management and flow. While patients with neurological complaints frequently leave the ED against medical advice or without being seen, no dedicated analysis of this group of patients aiming at the identification of characteristics associated with irregular ED discharge has been performed so far. Methods: A chart review was performed of all patients with neurological complaints presenting to a German interdisciplinary emergency department between January and December 2017 for neurological evaluation. Demographics, mode of presentation, process times, presenting symptoms and diagnosis were recorded. Patients leaving against medical advice after an informed consent discussion and signing of documentation (DAMA) or leaving prematurely without notifying ED staff (PL) were compared to the total of patients who were admitted or discharged (non-DAMA/PL). Results: Of all patients presenting with neurological symptoms or complaints, 3% left against medical advice and 2.2% left prematurely DAMA/PL patients were younger (p<.001), and they were more frequently self-presenting (p<0.001). Headaches, seizures and sensory deficits were the most frequent presenting symptoms in DAMA/PL patients, and 56.1% of those presenting with a seizure had a history of epilepsy. The most common documented reason for leaving was the duration of door-to-doctor time. Conclusions: Younger age, self-presenting mode of presentation and presentation with headache, seizures or sensory deficits are associated with premature leave or against-medical-advice discharge of patients with neurological complaints from the ED, and long waiting times were given as the major reason for leaving the ED. Increasing ED staff’s awareness of these factors and the optimization of pre-hospital assessment and demand management, thereby positively impacting on patient flow and ED process times, may help to prevent irregular discharges from the ED.

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Uncompleted emergency department care and discharge against medical advice in patients with neurological complaints: a chart review

BMC Emergency Medicine ◽

10.1186/s12873-019-0273-y ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 4

Author(s):

Carolin Hoyer ◽

Patrick Stein ◽

Angelika Alonso ◽

Michael Platten ◽

Kristina Szabo

Keyword(s):

Emergency Department ◽

Chart Review ◽

Waiting Times ◽

Medical Advice ◽

Emergency Department Care ◽

Against Medical Advice ◽

Sensory Deficits ◽

Presenting Symptoms ◽

Mode Of Presentation ◽

Against Medical Advice Discharge

Abstract Background Uncompleted emergency department care and against-medical-advice discharge represent relevant medical problems with impact on patient safety and potential medicolegal and socioeconomic consequences. They may also indicate structural or procedural problems in the emergency department (ED) relating to patient management and flow. While patients with neurological complaints frequently leave the ED against medical advice or without being seen, no dedicated analysis of this group of patients aiming at the identification of characteristics associated with irregular ED discharge has been performed so far. Methods A chart review was performed of all patients with neurological complaints presenting to a German interdisciplinary emergency department between January and December 2017 for neurological evaluation. Demographics, mode of presentation, process times, presenting symptoms and diagnosis were recorded. Patients leaving against medical advice after an informed consent discussion and signing of documentation (DAMA) or leaving prematurely without notifying ED staff (PL) were compared to the total of patients who were admitted or discharged (non-DAMA/PL). Results Of all patients presenting with neurological symptoms or complaints, 3% left against medical advice and 2.2% left prematurely. DAMA/PL patients were younger (p < .001), and they were more frequently self-presenting (p < 0.001). Headaches, seizures and sensory deficits were the most frequent presenting symptoms in DAMA/PL patients, and 56.1% of those presenting with a seizure had a history of epilepsy. The most common documented reason for leaving was the duration of door-to-doctor time. Conclusions Younger age, self-presenting mode of presentation and presentation with headache, seizures or sensory deficits are associated with premature leave or against-medical-advice discharge of patients with neurological complaints from the ED, and long waiting times were given as the major reason for leaving the ED. Increasing ED staff’s awareness of these factors and the optimization of pre-hospital assessment and demand management, thereby positively impacting on patient flow and ED process times, may help to prevent irregular discharges from the ED.

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Uncompleted emergency department care and discharge against medical advice in patients with neurological complaints: a chart review.

10.21203/rs.2.9965/v5 ◽

2019 ◽

Author(s):

Carolin Hoyer ◽

Patrick Stein ◽

Angelika Alonso ◽

Michael Platten ◽

Kristina Szabo

Keyword(s):

Emergency Department ◽

Chart Review ◽

Waiting Times ◽

Medical Advice ◽

Emergency Department Care ◽

Against Medical Advice ◽

Sensory Deficits ◽

Presenting Symptoms ◽

Mode Of Presentation ◽

Against Medical Advice Discharge

Abstract Background: Uncompleted emergency department care and against-medical-advice discharge represent relevant medical problems with impact on patient safety and potential medicolegal and socioeconomic consequences. They may also indicate structural or procedural problems in the emergency department (ED) relating to patient management and flow. While patients with neurological complaints frequently leave the ED against medical advice or without being seen, no dedicated analysis of this group of patients aiming at the identification of characteristics associated with irregular ED discharge has been performed so far. Methods: A chart review was performed of all patients with neurological complaints presenting to a German interdisciplinary emergency department between January and December 2017 for neurological evaluation. Demographics, mode of presentation, process times, presenting symptoms and diagnosis were recorded. Patients leaving against medical advice after an informed consent discussion and signing of documentation (DAMA) or leaving prematurely without notifying ED staff (PL) were compared to the total of patients who were admitted or discharged (non-DAMA/PL). Results: Of all patients presenting with neurological symptoms or complaints, 3% left against medical advice and 2.2% left prematurely DAMA/PL patients were younger (p<.001), and they were more frequently self-presenting (p<0.001). Headaches, seizures and sensory deficits were the most frequent presenting symptoms in DAMA/PL patients, and 56.1% of those presenting with a seizure had a history of epilepsy. The most common documented reason for leaving was the duration of door-to-doctor time. Conclusions: Younger age, self-presenting mode of presentation and presentation with headache, seizures or sensory deficits are associated with premature leave or against-medical-advice discharge of patients with neurological complaints from the ED, and long waiting times were given as the major reason for leaving the ED. Increasing ED staff’s awareness of these factors and the optimization of pre-hospital assessment and demand management, thereby positively impacting on patient flow and ED process times, may help to prevent irregular discharges from the ED.

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

10.21203/rs.2.9965/v1 ◽

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.

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Uncompleted Emergency Department Care: Patients Who Leave against Medical Advice

Academic Emergency Medicine ◽

10.1197/j.aem.2007.06.027 ◽

2007 ◽

Vol 14 (10) ◽

pp. 870-876 ◽

Cited By ~ 17

Author(s):

Ru Ding ◽

Julianna J. Jung ◽

Thomas D. Kirsch ◽

Frederick Levy ◽

Melissa L. McCarthy

Keyword(s):

Emergency Department ◽

Medical Advice ◽

Emergency Department Care ◽

Against Medical Advice

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Factors Affecting Discharges against Medical Advice in an Emergency Department of a Tertiary Care Center

Journal of KIST Medical College ◽

10.3126/jkistmc.v2i2.33576 ◽

2020 ◽

Vol 2 (2) ◽

pp. 31-35

Author(s):

Trishna Shrestha ◽

Sneha Pradhananga ◽

Kabita Hada Batajoo ◽

Manjita Bajracharya

Keyword(s):

Health Care ◽

Emergency Department ◽

Health Care Costs ◽

Medical Advice ◽

Health Concern ◽

Against Medical Advice ◽

Factors Affecting ◽

Tertiary Center ◽

Care Costs ◽

Leaving Against Medical Advice

Introduction: Patients leaving against the advice of the treating team before being certified as fit is a major concern and challenge for the treating professionals as it possesses adverse medical outcomes. This study hence aimed at identifying the prevalence and major factors affecting such discharges so that advocacy can be done to help prevent it. Methods: A descriptive cross-sectional study was conducted at emergency department of a tertiary center in Lalitpur from 15th May 2019 to 15th August 2019. All the patients visiting the emergency department were included in the study and a non-probability purposive sampling method was used excluding the patients who denied giving reasons for them leaving against medical advice. Data was collected using pre-structured questionnaire and analyzed using SPSS-v21 software. Results: A hundred and fifteen patients (4.08%) left against medical advice out of 2812 patients who presented to emergency department. There were 63 male patients (54.8%), 75 patients of the total patients in the age group of 15-44 years (65.2%) and those living within a distance of 1km from the hospital (53%). The most common reason for the patients leaving against medical advice was found to be due to financial constraint (38.3%) followed by preference to other hospitals (16.5%). Conclusion: Patients leaving against medical advice possesses a small percentage of actual hospital admissions but is still a major health concern as it drastically increases the morbidity, re-admission rates and total health-care costs. Hence, understanding the general characteristics and predictors of such discharges is of utmost importance to help improve the patient outcome and reduce the health-care costs.

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

BMC Emergency Medicine ◽

10.1186/s12873-021-00422-6 ◽

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.

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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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