Irregular discharge against medical advice from the accident and emergency department--a cause for concern.

Pennycook, A G; McNaughton, G W; Hogg, Florence

doi:10.1136/emj.9.2.230

Cited by 36 publications

(38 citation statements)

References 5 publications

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“…It could also result in readmissions with longer hospital stays, prolonged illness and ultimately lead to higher costs of care. [12][13][14] The problem of DAMA has been reported in different countries worldwide. [1][2][3][4][5][6] However, this subject has rarely been studied in Arab countries, much less in Oman.…”

Section: 510mentioning

confidence: 99%

Discharge against Medical Advice among Children in Oman : A University Hospital Experience = الخروج ضد المشورة الطبية بين الأطفال في عمان : تجربة مستشفى جامعي

Al-Sadoon¹,

Al-Shamousi²

2013

SQUMJ

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abstract:Objectives: Discharge against medical advice (DAMA) is a major problem in healthcare delivery as it can complicate the health problems from which patients are suffering. The aim of this study was to understand DAMA among children in a tertiary teaching hospital in Oman and to evaluate the documentation of the events in the medical records. Methods: A retrospective survey of the medical records of patients discharged against medical advice over a two-year interval was performed (2004)(2005)(2006). Results: Of the 11,802 admissions, there were 38 cases of DAMA, giving a prevalence rate of 0.32%. In 39.5% of the cases, the discharge happened within 24 hours of hospital admission. The majority of the cases were infants (n = 24; 63.25%). The diagnosis at discharge in some cases included life-threatening conditions. However, in 57.9% of the cases, the reasons for DAMA were neither reported nor documented in the patients' medical records. Conclusion: Although the results of this study yielded a low prevalence rate compared to the rates reported in other studies, the occurrence of DAMA for children in a tertiary hospital is a distressing phenomenon. It was evident that the documentation of the DAMA process was poor. More studies should be conducted to understand the details of the problem. Policies should be established and implemented in order to attempt to reduce DAMA among child patients and to protect them from the consequences of such discharges. Keywords

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Section: 510mentioning

confidence: 99%

Discharge against Medical Advice among Children in Oman : A University Hospital Experience = الخروج ضد المشورة الطبية بين الأطفال في عمان : تجربة مستشفى جامعي

Al-Sadoon¹,

Al-Shamousi²

2013

SQUMJ

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“…In previous studies, DAMA patients were found to be young males from low socio-economic status groups and without health insurance (Ibrahim et al 2007;Nasir & Babalola 2008;Pennycook et al 1992). …”

Section: Discussionmentioning

confidence: 94%

“…Communication plays a major role in the provision of quality medical care. Inconsistency of information, unavailability of healthcare providers for enquiry or explanation, apathy, rudeness and unfriendly welcome have previously been shown to be contributing factors for DAMA (Pennycook et al 1992;Onukwugha et al 2010;Berger 2008).…”

Section: Discussionmentioning

confidence: 99%

Factors Associated with Discharge Against Medical Advice from Emergency Department, Universiti Kebangsaan Malaysia Medical Centre

Ismail¹

2016

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ABSTRAKPesakit yang pulang tanpa nasihat perubatan (DAMA) p = 0.01). Kebarangkalian DAMA bagi pesakit yang membayar kos perawatan sendiri adalah tiga kali lebih tinggi daripada mereka yang mempunyai surat penjamin daripada majikan atau syarikat insurans. Faktorfaktor lain yang mempengaruhi DAMA adalah keluarga p = 0.03 Kunci kunci: DAMA, kecemasan, hospital, rawatan, discaj 30 Med & Health 2016;11(1): 29-37 Ismail A.K. et al. advice (DAMA) refers to a patient who leaves hospital before the treating physician recommends discharge (Alfandre 2009). Premature withdrawal from treatment has been shown to result in higher rates of hospital readmissions (Hwang et al. 2003). These patients are potentially susceptible to lifethreatening consequences in the absence of optimal medical care (Carrese 2006;Moy & Bartman 1996). Readmission has been shown to lead to longer hospital stays, higher costs of care, increased use of hospital ABSTRACTPatients who self-discharge against medical advice (DAMA) are susceptible to life-threatening consequences. By understanding the factors associated with DAMA, healthcare centres can build strategies to assist patients to receive optimal medical care and prevent unfavourable outcome. The objective of this study was to determine the factors associated with DAMA from the Emergency Department (ED) of Universiti Kebangsaan Malaysia Medical Centre (UKMMC). This was a prospective unmatched case control study conducted over a 4-month period. For every DAMA episode, two patients who were admitted on the same day were randomly selected as control. Following patient consent, data was collected using a standardized questionnaire. Patients were contacted by the investigator for information regarding hospitalization within two weeks of DAMA. Ninety three patients were recruited; 31 DAMA patients and 62 admitted patients. Payment method was significantly associated with DAMA (OR 3.17 95% CI 1.29-7.98; p=0.01).The likelihood of self-paying patients to take DAMA was three times higher than those who had a guarantor letter from their employer or insurance provider. Other factors which influence DAMA were family obligations (OR 4.08 95% CI 1.09-15.26; p = 0.03) and work problems (OR 3.83 95% CI 1.13-12.94; p=0.03). A total of 19.4% of DAMA patients left following symptomatic pain relief. A total of 80.6% DAMA patients were admitted to hospital within two weeks of the DAMA episode. Payment method significantly influences DAMA. Payment planning, social welfare services, non-governmental organization funds and the introduction of a national health policy scheme may aid hospital payment, alleviate financial limitation of patients and reduce DAMA episodes.

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“…[1][2][3][4] This study demonstrated that one person died and 85 patients needed further medical attention after self-discharge, hence from the viewpoint of risk management, ED need to be very concerned with this group of patients. These patients might warrant assessment by a senior doctor prior to their discharge in the first place.…”

Section: Discussionmentioning

confidence: 99%

“…There was also no established method nor resources in place to deal with this problem. 1,2 Patients discharged against medical advice might be expected to have more adverse consequences (exacerbation of illness, death, injury to self or others), [1][2][3] but information on this topic in Singapore was usually anecdotal. On one hand, selfdischarge might reflect problems in the care process in an ED.…”

Section: Introductionmentioning

confidence: 99%

Patients who Self-Discharge from the Emergency Department: a Three-Month Telephone Survey

Lim

Anantharaman²

2004

Hong Kong Journal of Emergency Medicine

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Patients who self-discharge from the emergency department: a threemonth telephone survey YH Lim and V AnantharamanStudy objectives: To determine the main causes and outcomes of patients who self-discharged from the Emergency Department (ED). Methods: Records of all patients who self-discharged from the ED of a tertiary level hospital were traced and telephone interviews were conducted. The duration of the study was from 15 July 2002 to 14 October 2002. Results: There were 28,898 new attendances during the period of study and of these, 450 (1.6%) patients signed the self-discharge form. Of the 357 patients recruited into the study, the majority signed the self-discharge form because of refusal of admission to inpatient units (52.1%) or the ED observation ward (43.4%) for further treatment. One hundred and thirteen (31.7%) patients acknowledged that they were unwell during the interview and 85 (23.8%) patients sought some form of medical attention after leaving the ED. Conclusion: Most of the patients who self-discharged from the ED were for personal reasons and very few were due to financial reasons. (Hong Kong j.

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Irregular discharge against medical advice from the accident and emergency department--a cause for concern.

Cited by 36 publications

References 5 publications

Discharge against Medical Advice among Children in Oman : A University Hospital Experience = الخروج ضد المشورة الطبية بين الأطفال في عمان : تجربة مستشفى جامعي

Discharge against Medical Advice among Children in Oman : A University Hospital Experience = الخروج ضد المشورة الطبية بين الأطفال في عمان : تجربة مستشفى جامعي

Factors Associated with Discharge Against Medical Advice from Emergency Department, Universiti Kebangsaan Malaysia Medical Centre

Patients who Self-Discharge from the Emergency Department: a Three-Month Telephone Survey

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