Discharge against medical advice: Ethical considerations and professional obligations

Berger, Jeffrey T.

doi:10.1002/jhm.362

Cited by 53 publications

(58 citation statements)

References 48 publications

(43 reference statements)

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“…31 This discrepancy highlights an urgent need for the education and involvement of nurses as stakeholders in the challenging AMA discharge process. Although the percentage of physicians who thought they were not obligated to provide medications and arrange follow-up for AMA patients was lower than the percentage of nurses, these beliefs contradict best practice guidelines for AMA discharges, 22,23 and this finding calls attention to the need for interventions to improve adherence to professional and ethical guidelines in this aspect of clinical practice.…”

Section: Discussionmentioning

confidence: 96%

Discharges Against Medical Advice at a County Hospital: Provider Perceptions and Practice

Stearns¹,

Bakamjian²,

Sattar³

et al. 2017

Journal of Hospital Medicine

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Section: Discussionmentioning

confidence: 96%

Discharges Against Medical Advice at a County Hospital: Provider Perceptions and Practice

Stearns¹,

Bakamjian²,

Sattar³

et al. 2017

Journal of Hospital Medicine

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“…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%

“…To address this, we suggest that a standard DAMA protocol must be followed. This includes providing choice of treatment, informing the patient about likely sequelae of DAMA, determining their competency in decision-making and instituting appropriate follow-up after a DAMA episode (Berger 2008;Naess et al 2001). …”

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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Section: Introductionmentioning

confidence: 99%

“…Such premature termination of care could prolong duration of illness and put children at risk of complications, death or to uncertain and precarious alternative therapies 1,2 . The child right perspectives not only uncover legal responsibility shortcomings of caregivers (for decisions to withdraw consent) but also pose medico-legal challenges for the healthcare provider and the health system 2,3,4,5 . An understanding of the factors associated with premature termination of hospital care of sick children could help improve caregiver compliance with provisions of care and reduce its occurrence 4,5 .…”

Section: Introductionmentioning

confidence: 99%

Premature discharge of children from hospital admission at Ahmadu Bello University Teaching Hospital Zaria: A 3-year review

Lw¹,

Musa²,

Musa³

et al. 2014

Nig. J. Paed.

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Introduction: Leaving hospital care prematurely could threaten the healthy survival of and expose children to a risk of harmful alternatives. It is also a concern and a challenge to healthcare providers and the health system. A better understanding of its characteristic could help mitigate the impact on children. Objective: To determine the prevalence, types of, and reasons for premature hospital discharge amongst children. Methods: We carried out a threeyear retrospective review of case notes of children who were taken away from hospital admission by their parents/caregivers before they were due for discharge. Socio-demographic, clinical and discharge information were collected and data was entered into Microsoft® Excel® for Mac 2011 (Version 14.1.0), cleaned and analysed. Results were presented as percentages, statistical means and standard deviations, tables and charts. Results: There were 56 cases of premature discharge out of 2858 admissions, giving a prevalence of 2.0%. Under-five children constituted 65.4%, with a male: female ratio of 2.3:1. Thirty-one (55.3%) children were absconded with while 25 (44.7%) were taken away by caregivers against medical advice. The commonest diagnoses were protein-energy malnutrition and pneumonia and majority were from poor socio-economic family background. The commonest reasons for discharge AMA were unaffordable costs and perception of improvement of child's medical condition. Conclusion: Socio-economic factors were significant determinants of utilization of in-patient hospital services for the children studied. There is a need for provision of affordable health care as well as efficient discharge policy to protect children from potential risks associated with premature hospital discharge.

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Discharge against medical advice: Ethical considerations and professional obligations

Abstract: This article examines the ethical and professional implications of discharge AMA.

Cited by 53 publications

References 48 publications

Discharges Against Medical Advice at a County Hospital: Provider Perceptions and Practice

Discharges Against Medical Advice at a County Hospital: Provider Perceptions and Practice

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

Premature discharge of children from hospital admission at Ahmadu Bello University Teaching Hospital Zaria: A 3-year review

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