scholarly journals Determinants of discharge against medical advice from a rural neurosurgical service in a developing country: A prospective observational study

2020 ◽  
Vol 11 ◽  
pp. 290
Author(s):  
Toyin Ayofe Oyemolade ◽  
Amos Olufemi Adeleye ◽  
Oluwakemi C. Ogunyileka ◽  
Folawemimo M. Arogundade ◽  
Ayodele J. Olusola ◽  
...  
Keyword(s):  
Health Literacy ◽  
Observational Study ◽  
Developing Country ◽  
Financial Constraints ◽  
Prospective Observational Study ◽  
Medical Advice ◽  
Contributory Factor ◽  
Against Medical Advice ◽  
Common Causes ◽  
Discharge Against Medical Advice

Background: In low-resource regions of the world, discharge against medical advice (DAMA) is one empiric contributory factor to poor in-hospital outcome that is not often mentioned. This study aims to investigate the determinants of DAMA from a rural neurosurgical service in a developing country. Methods: This was a prospective observational study of all patients who discharged against medical advice in our service between November 2018 and October 2019. Results: There were 88 patients, 67 (76.1%) males, in the study, (M:F = 3.2:1), representing 17.4% of our patient population in the study period. The peak incidence was in the 20–29 years age group which accounted for 37.5% of the cases. About 55% of the patients presented directly to our center; 31.8% were referred from other hospitals, while 3.4% came from traditional caregivers and 1.1% from religious homes. Head injury was the most common indication for presentation (76.1% of the cases). The duration of hospital stay ranged from 2 h to 14 days. Majority of the patients (87.5%) left the hospital within 8 h of presentation. The reason for DAMA was financial constraints in 50% of cases, inadequate health literacy in 20.5%, financial constraints and poor health literacy together in 12.5%, religious misgivings in 4.5%, and traditional belief in 2.3%. Neurotrauma was predictive of early DAMA (P = 0.001). Conclusion: The rate of DAMA was high in our study. Financial constraints with other socioeconomic limitations were the most common causes of DAMA in our environment.

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

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.

scholarly journals Prognostic value of initial Glasgow Coma Score in comatosed patients on medical floor

2016 ◽  
Vol 12 (2) ◽  
Author(s):  
Muhammad Arif Nadeem ◽  
Khadija Irfan ◽  
Khawaja A Irfan Waheed
Keyword(s):  
Observational Study ◽  
Hospital Stay ◽  
Glasgow Coma Score ◽  
Prognostic Value ◽  
Prospective Observational Study ◽  
Medical Advice ◽  
Against Medical Advice ◽  
Lost To Follow Up ◽  
Category Score

Objective: An open non-randomized prospective observational study of comatosed patients was conducted to correlate initial Glasgow Coma Score (GCS) with the outcome in patients having medical coma at Mayo Hospital, Lahore between January 2002 to September 2003. Methods: A total of 273 patients were followed throughout their hospital stay to determine the outcome after the current episode of coma. A thorough history and examination was obtained for each case. The 3 category Glasgow Coma Score was recorded as an indication of the degree of unconsciousness. One of three possible outcome categories was established, recovery (discharge), death, and referral or self discharge (by attendants) against medical advice. Results: The outcome of 248 patients (90.84%) was established i.e. 152 (61.29%) were discharged after recovery and 96 (38.71%) died. The remaining 25 (09.16%) patients were lost to follow up. Four subcategories of the Glasgow Coma Score were made, at 3-point intervals. In the lowest score category ( score 3-5) there was 59.67% mortality and only 30.66% patients were successfully treated and discharged. In the category of GCS 6-8, 30.91% died and 60% were discharged, while in the 9-11 category, 26.47% died and 66.18% were discharged. In the highest score category (12-15), 27.27% deaths occurred, probably related to the severity of main event, and 62.50% were discharged. Conclusion: The depth of coma as reflected by the initial GCS can reliably be used to predict the outcome in comatosed patients.

scholarly journals Why Do Patients Leave against Medical Advice? Reasons, Consequences, Prevention, and Interventions

Healthcare ◽  
2021 ◽  
Vol 9 (2) ◽  
pp. 111
Author(s):  
Asseel Albayati ◽  
Steven Douedi ◽  
Abbas Alshami ◽  
Mohammad A. Hossain ◽  
Shuvendu Sen ◽  
...  
Keyword(s):  
Hospital Admissions ◽  
Medical Advice ◽  
Preventive Strategies ◽  
Against Medical Advice ◽  
Cause Analysis ◽  
Persistent Problem ◽  
Root Cause ◽  
Discharge Against Medical Advice ◽  
Leaving Against Medical Advice

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.

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

Seizure ◽  
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

scholarly journals Informal psychiatric patients requesting discharge

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.

Discharge against medical advice at a general hospital in Catalonia

2003 ◽  
Vol 25 (1) ◽  
pp. 46-50 ◽  
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

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.

Discharge against Medical Advice in Some Paediatric Wards

1988 ◽  
Vol 18 (3) ◽  
pp. 125-127 ◽  
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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