Background The discharge against medical advice (DAMA) in the Emergency Department (ED) is an issue of great concern because it may result in adverse consequences at a later stage. The reported worldwide prevalence of DAMA ranges from 0.07 to 20% for emergency admissions. The outcomes of DAMA can have significantly damaging effects, causing possible relapses of disease, readmission, and increases in medical costs for the patient. Therefore, it is imperative to identify the predictors of DAMA in ED. Methods It was a cross-sectional study. The medical records used were those of all the patients (n = 11513) admitted to the Emergency Department (ED) of King Abdullah Bin Abdulaziz University Hospital (KAAUH) in Riyadh, Saudi Arabia, between 2017 and 2018. A thorough analysis was performed using IBM SPSS Statistics version 22. Descriptive statistics were reported for quantitative and categorical variables and assessed by independent t-test/chi-square/ANOVA (analysis of variance), where appropriate. Unadjusted and adjusted odds ratios with their 95% CI (confidence interval) were reported by performing logistic regression. A p value of ≤0.05 was considered statistically significant throughout the study. Results The prevalence of DAMA in our study was 1%. In a multivariable analysis, after adjusting for the other covariates, we observed a significant interaction between age and gender. It was observed that the odds of DAMA for ≤40-year-old males were 3.12 times higher than those of a ≤40-year-old female (p value < 0.1). To further investigate this interaction, men and women were modeled separately in multivariable models using the same covariates. We found that, for men, the effect of age (≤40 years) was significant (OR = 3.94, 95% CI 1.31–11.80, p=0.014), while, for women, the effect of age (≤40 years) was not as pronounced (OR = 1.27, 95% CI = 0.66–2.42, p=0.27). Conclusions Our study concluded that DAMA was more likely among younger male patients (≤40 years of age). Most of the patients with DAMA were presented to the urgent care of the Emergency Department. We recommend that patients be given some financial support to bear the expenses of the hospital stay from the healthcare facility or from the state. Future studies should assess the socioeconomic status of the patients and estimate the cost that is incurred by the patients.

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Background: Discharge against medical advice (DAMA) occurs when the patient or their caretaker leaves the hospital against the recommendation of their treating physician. DAMA may expose the children to a high risk of inadequate treatment, which may result in readmission, prolonged morbidity, and mortality. The study aimed to identify the predictors of DAMA in the emergency department (ED) within the pediatric age group. Methods: This was a cross-sectional study. The study used the medical records of pediatric patients ( n = 5609) that were admitted to the ED of King Abdullah Bin Abdulaziz University Hospital (KAAUH) in Riyadh, Saudi Arabia, during 2017 and 2018. Descriptive statistics, Chi-square, or Fisher's exact test were used. Unadjusted and adjusted odds ratios with their 95% CI were reported by performing logistic regression modeling. Results: A significant interaction between age and gender was observed in the multivariate analysis after adjusting for the other covariates. The odds of DAMA for a 5-year-old female child were 4.43 times higher than those of a 5-year-old male child ( P < 0.1). Conclusions: The public should be educated about the consequences of DAMA. Continued health education and the promotion of child survival strategies at the community level, combined with an improvement in the socioeconomic conditions of the population, may further reduce DAMA and improve the chances of survival for children. Future studies should assess the socioeconomic status of the patients and estimate the cost that is incurred by the patients.

Length-of-stay is an important quality measure for emergency departments. The study aimed to find predictors for prolonged LOS in children. A cross sectional study was conducted from Jan 2017 to Mar 2018. Data were extracted from medical records of 5609 pediatric patients admitted to the King Abdullah Bin Abdulaziz University Hospital-ED, Riyadh, Saudi Arabia. Median LOS of the children was 74 mins. Multivariable analysis showed the difference in the expected LOS between patients DAMA and their non-DAMA counterparts was 72 mins. Difference in the expected LOS between patients at emergent and non-urgent triage was 89 mins, between urgent and non-urgent triage was 51 mins and difference between less urgent and non-urgent triage was 16 mins. Future studies should explore the contributing managerial and clinical factors that can explain such associations and might be the focus for future policy changes to reduce LOS in ED pediatric settings in Saudi Arabia.

Almost all universities or colleges have diverted to online learning and teaching modalities due to COVID-19 pandemic. Adaptation of remote learning might not be equally beneficial for all students. We have provided an opinion about how remote learning might become an opportunity for dishonest students and future perspectives for such students. Medical students, who do not take their studies seriously might take this remote learning as an opportunity and use the short cuts to pass their exams because they can easily cheat online in the assignments and exams. Therefore, teaching institutions should develop some strategies to equally assess medical and health sciences students to ensure transparency, justice, and credibility. Conducting oral exams along with the written exams, encouraging students to participate online, asking students to turn on their videos if feasible, and developing a mechanism where these students can explain their work to the teacher can help to overcome challenges.