Discharge Against Medical Advice: A One Year Retrospective Study in District General Hospital

The purpose of this study was to analyze patient satisfaction on the quality of inpatient services to DAMA (Discharge Against Medical Advice) intentions in the Pare District General Hospital of Kediri Regency. The results of the analysis of physician interaction quality data obtained significance values (P = 0.018 <α = 0.05), with the physician attitude indicator of significance value (P = 0.694> α = 0.05); indicator of physician behavior (P = 0.002 <α = 0.05); indicator of physician expertise (P = 0.027 <α = 0.05). Thus the quality of the doctor's interaction influences the patient's intention to go home. The results of data analysis on the quality of nurse interaction (P = 0.040 <α = 0.05) with indicators of nurse attitudes (P = 0.179> α = 0.05), indicators of nurse behavior (P = 0.023 <α = 0.05), indicators of expertise nurses (P = 0.034 <α = 0.05. Thus the quality of the interaction of nurses affects the intention of the patient to go home. The results of the influence of physical environmental quality on the patient's intention to go home forced (P = 0.177> α = 0.05), thus the quality The environment does not affect the intention of the patient to go home forced.The results of the effect of the quality of the results on the patient's intention to go home forcibly (P = 0.266> α = 0.05) Thus the quality of the results does not affect the patient's intention to go home. Tujuan Penelitian ini adalah menganalisis kepuasan pasien pada kualitas layanan rawat inap terhadap niat DAMA (Discharge Against Medical Advice) di Rumah Sakit Umum Daerah Pare Kabupaten Kediri. Hasil analisis data kualitas interaksi dokter diperoleh nilai signifikansi (P = 0,018 < α = 0,05), dengan indikator sikap dokter nilai signifikansi (P = 0,694 > α = 0,05); indikator perilaku dokter (P = 0,002 < α = 0,05); indikator keahlian dokter (P = 0,027 < α = 0,05). Dengan demikian kualitas interaksi dokter berpengaruh terhadap niat pasien pulang paksa. Hasil analisis data kualitas interaksi perawat (P = 0,040 < α = 0,05) dengan indikator sikap perawat (P = 0,179 > α = 0,05), indikator perilaku perawat (P = 0,023 < α = 0,05), indikator keahlian perawat (P = 0,034 < α = 0,05. Dengan demikian kualitas interaksi perawat berpengaruh terhadap niat pasien pulang paksa. Hasil pengaruh kualitas lingkungan fisik terhadap niat pasien untuk pulang paksa (P = 0,177 > α = 0,05), dengan demikian kualitas lingkungan tidak berpengaruh terhadap niat pasien untuk pulang paksa. Hasil pengaruh kualitas hasil terhadap niat pasien untuk pulang paksa (P = 0,266 > α = 0,05). Dengan demikian kualitas hasil tidak berpengaruh terhadap niat pasien pulang paksa.

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522 Audit of Acute Lower Gastrointestinal Bleed Management in a District General Hospital

British Journal of Surgery ◽

10.1093/bjs/znab134.444 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

S Mallick ◽

R Salem ◽

A Payne

Keyword(s):

Retrospective Study ◽

General Hospital ◽

Current Practice ◽

Length Of Hospital Stay ◽

District General Hospital ◽

British Society ◽

Median Length ◽

Gastrointestinal Bleed ◽

Lower Gastrointestinal Bleed ◽

One Year

Abstract Introduction Acute Lower Gastrointestinal Bleed (ALGIB) is a common emergency surgical referral. This project aims to audit current practice at a district general hospital against new British Society of Gastroenterology guidelines, which gives recommendations regarding assessment (Oakland score), investigation and management. Method A retrospective study was undertaken over one year (2019) of patients presenting to A&E or referred via GP with ALGIB. Patients were identified through the coding department. An online proforma was used for data collection, which was analysed with SPSS. Results 76 appropriate patients identified. Median length of hospital stay was 1 day. 10 patients (13.2%) scored ≤8 (probability of safe discharge 95%), 19 (11.8%) patients scored ≤9 (probability of safe discharge 93%) and 57 patients (75%) scored ≥10. 19 patients discharged the same day, of which 3 (15.8%) scored ≤8 and 8 (42.1%) scored ≤9. 23 patients admitted overnight, of which 5 (21.7%) scored ≤8 and 6 (26.1%) scored ≤9. Of 66 patients classified as ‘major’, 41 (62.1%) did not have a colonoscopy. Conclusions Introduction of a scoring mechanism and disseminating guidelines will enable GPs and A&E doctors to safely discharge ALGIB patients with appropriate outpatient investigations and reduce surgical admissions. There is currently poor compliance with inpatient investigations.

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Predictors and Outcome of Discharge Against Medical Advice From the Psychiatric Units of a General Hospital

Psychiatric Services ◽

10.1176/ps.49.9.1187 ◽

1998 ◽

Vol 49 (9) ◽

pp. 1187-1192 ◽

Cited By ~ 59

Author(s):

Kenneth P. Pages ◽

Joan E. Russo ◽

Dane K. Wingerson ◽

Richard K. Ries ◽

Peter P. Roy-Byrne ◽

...

Keyword(s):

General Hospital ◽

Medical Advice ◽

Against Medical Advice ◽

Psychiatric Units ◽

Discharge Against Medical Advice

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Prevalence, causes, and predictors of discharge against medical advice (DAMA) in an emergency setting: an updated systematic review and meta-Analysis

Saudi Journal of Emergency Medicine ◽

10.24911/sjemed/72-1588889104 ◽

2021 ◽

pp. 1

Author(s):

Asaad Shujaa ◽

Theeb Alkahtani

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Medical Advice ◽

Emergency Setting ◽

Against Medical Advice ◽

Discharge Against Medical Advice

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

Healthcare ◽

10.3390/healthcare9020111 ◽

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.

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

Seizure ◽

10.1016/j.seizure.2020.11.018 ◽

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

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Informal psychiatric patients requesting discharge

Psychiatric Bulletin ◽

10.1192/pb.18.4.209 ◽

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.

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