Discharge against medical advice from the emergency department in a university hospital

Abstract

Background Patients discharged against medical advice (DAMA) act as a high-risk population for the Emergency Department (ED), regardless of their presentations, and can pose a serious burden for the hospital. This study examines the prevalence, demographic and clinical characteristics, reasons, and clinical outcomes of a small sample of DAMA patients in a teaching university hospital, including readmission, morbidity, and mortality. Methods A prospective, descriptive cross-sectional study was conducted in the ED of King Hamad University Hospital (KHUH) with 98,992 patient visits during a 1-year period from June 2018 to June 2019. Consenting DAMA patients were asked to complete a data collection form. Results Patients (n = 413) had a mean age of 44.1 years with a female majority (57.1%). The majority were categorized as triage level-3 (87.7%). The main reasons for DAMA included refusal of the procedure/operation (23.2%), long ED waiting time (22.2%), subjective improvement with treatment (17.7%), and children at home (14.8%), whereas the least selected reason was dissatisfaction with medical care (1.2%). Follow-up of DAMA patients revealed that 86 cases (20.8%) were readmitted to the ED within 72 h of which 41 (47.7%) cases were morbidity and 2 (2.3%) were mortality. Marital status was a predictor of DAMA patients who revisit the ED within 72 h. Conclusion The results act as a pilot study to examine a small sample of DAMA patients’ characteristics, diagnosis, and ED revisits. Hospitals should investigate further the DAMA population on a larger scale, reasons for refusing procedures, and utilize this knowledge to improve the healthcare process.

COVID-19 outbreak impact on discharge against medical advice from the ED: A retrospective study

“…Previous studies have reported that ED intensity and prolonged ED dwell times increase the rate of DAMA. [ 18 , 19 ]. In our study, the total number of applications to the ED decreased compared to the pre-pandemic period.…”

Validation of a Simple Score for Mortality Prediction in a Cohort of Unselected Emergency Patients

“…Physician-specific factors include patient load at presentation time [ 35 ]—increasing number of patients also increasing admission, risk preference [ 36 , 37 ]—admission is more likely the more risk-adverse the physician is, and individual experience [ 32 ]. Patient-specific factors include living situation (e.g., children at home) [ 38 , 39 ], substance abuse [ 40 ]—patients are less likely to agree to admission, and established and well managed out-patient care or simply the patients [ 41 ] or proxies' preference [ 42 ]. Institutional factors include hospital capacity and inadequate out-patient care [ 34 ], necessitating inpatient care.…”

Exploring the inner roots of discharge against medical advice (DAMA) in an academic psychiatric hospital: a qualitative study

“…One of the explored content was dissatisfaction with the quality of medical care. This content is one of the most common and logical reasons for DAMA that have been mentioned in different fields of medicine [ 16 , 17 ]. The issue of dissatisfaction with the quality of treatment is not limited to DAMA.…”