scholarly journals Predictors of Discharge Against Medical Advice in a Tertiary Paediatric Hospital

2019 ◽  
Vol 16 (8) ◽  
pp. 1326 ◽  
Author(s):  
Sealy ◽  
Zwi ◽  
McDonald ◽  
Saavedra ◽  
Crawford ◽  
...  
Keyword(s):  
Clinical Characteristics ◽  
Significant Risk ◽  
Tertiary Hospital ◽  
Medical Advice ◽  
Adverse Outcomes ◽  
Admission Diagnosis ◽  
Against Medical Advice ◽  
Paediatric Hospital ◽  
Hospital Site ◽  
Discharge Against Medical Advice

Background: Patients who discharge against medical advice (DAMA) from hospital carry a significant risk of readmission and have increased rates of morbidity and mortality. We sought to identify the demographic and clinical characteristics of DAMA patients from a tertiary paediatric hospital. Methods: Data were extracted retrospectively from electronic medical records for all inpatient admissions over a 5-year period. Demographic characteristics (age, sex, Aboriginality, socioeconomic status and remoteness of residence) and clinical characteristics (admitting hospital site, level of urgency on admission, diagnosis and previous DAMA) were extracted and logistic regression models were used to identify predictors of DAMA with 95% confidence intervals. Results: There were 246,359 admissions for 124,757 patients, of which 1871 (0.8%) admissions and 1730 patients (1.4%) DAMA. Predictors of DAMA in a given admission were hospital site (OR 4.8, CI 4.2–5.7, p < 0.01), a mental health/behavioural diagnosis (OR 3.3, CI 2.2–4.8, p < 0.01), Aboriginality (OR 1.6, CI 1.3–2.1, p < 0.01), emergency rather than elective admissions (OR 0.7ha, CI 0.6–0.8, p < 0.01), a gastrointestinal diagnosis (OR 1.5, CI 1.1–2.0, p = 0.04) and a history of previous DAMA (OR 2.0, CI 1.2–3.2, p = 0.05). Conclusions: There are clear predictors of DAMA in this tertiary hospital admission cohort and identification of these provides opportunities for intervention at a practice and policy level in order to prevent adverse outcomes.

scholarly journals Discharge against medical advice after hospitalisation for acute myocardial infarction

Heart ◽  
2018 ◽  
Vol 105 (4) ◽  
pp. 315-321 ◽  
Author(s):  
Chun Shing Kwok ◽  
Mary Norine Walsh ◽  
Annabelle Volgman ◽  
Mirvat Alasnag ◽  
Glen Philip Martin ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Risk Groups ◽  
Medical Advice ◽  
Adverse Outcomes ◽  
Unplanned Readmission ◽  
Crude Rate ◽  
Against Medical Advice ◽  
Discharge Against Medical Advice ◽  
Poor Outcomes

BackgroundDischarge against medical advice (AMA) occurs infrequently but is associated with poor outcomes. There are limited descriptions of discharges AMA in national cohorts of patients with acute myocardial infarction (AMI). This study aims to evaluate discharge AMA in AMI and how it affects readmissions.MethodsWe conducted a cohort study of patients with AMI in USA in the Nationwide Readmission Database who were admitted between the years 2010 and 2014. Descriptive statistics were presented for variables according to discharge home or AMA. The primary end point was all-cause 30-day unplanned readmissions and their causes.Results2663 019 patients were admitted with AMI of which 10.3% (n=162 070) of 1569 325 patients had an unplanned readmission within 30 days. The crude rate of discharge AMA remained stable between 2010 and 2014 at 1.5%. Discharge AMA was an independent predictor of unplanned all-cause readmissions (OR 2.27 95% CI 2.14 to 2.40); patients who discharged AMA had >twofold increased crude rate of readmission for AMI (30.4% vs 13.4%) and higher crude rate of admissions for neuropsychiatric reasons (3.2% vs 1.3%). After adjustment, discharge AMA was associated with increased odds of readmissions for AMI (OR 3.65 95% CI 3.31 to 4.03, p<0.001). We estimate that there are 1420 excess cases of AMI among patients who discharged AMA.ConclusionsDischarge AMA occurs in 1.5% of the population with AMI and these patients are at higher risk of early readmissions for re-infarction. Interventions should be developed to reduce discharge AMA in high-risk groups and initiate interventions to avoid adverse outcomes and readmission.

scholarly journals Discharge against Medical Advice and Transcending Boundaries in Ghanaian District Hospitals: Issues for Medical Learning

2020 ◽  
Vol 12 (4) ◽  
pp. 53-58
Author(s):  
Kofi Tawiah Mensah
Keyword(s):  
Treatment Options ◽  
Treatment Decision ◽  
Tertiary Hospital ◽  
Medical Advice ◽  
Against Medical Advice ◽  
Care Services ◽  
District Hospitals ◽  
The Face ◽  
Medical Learning ◽  
Discharge Against Medical Advice

There is a case of a 47-year-old man who presented to the Agogo Presbyterian Hospital with a highgrade intestinal obstruction. Although the surgical expertise was available, limitations of laboratory and critical care services at the time necessitated a referral to a tertiary hospital. The patient and his relatives did not have the resources to pursue this treatment decision and opted for a discharge against medical advice (DAMA) to embark on faith-based treatment options. The attending clinician is sometimes frustrated in such complex scenarios by the inability to explore even the slightest survival chances that could result from life-saving surgery in the face of these resource limitations. This article focuses on the ethical and medicolegal dilemmas presented to clinicians by a patient’s request for DAMA. Some pragmatic approaches have been proposed to guide the evaluation and resolution of such challenges at the level of Ghanaian district hospitals for the benefit of medical learning.

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.

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