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

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

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 ou...

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Bibliographic Details
Published in:BMC emergency medicine Vol. 21; no. 1; p. 31
Main Authors: Abuzeyad, Feras H, Farooq, Moonis, Alam, Salah Farhat, Ibrahim, Mudhaffar Ismael, Bashmi, Luma, Aljawder, Shaikha Sami, Ellouze, Najeh, Almusalam, Abdulla, Hsu, Stephanie, Das, Priya
Format: Journal Article
Language:English
Published: England BioMed Central Ltd 16-03-2021
BioMed Central
BMC
Subjects:
Admission and discharge
Bahrain
DAMA
Data collection
Data entry
Discharge against medical advice
Electronic health records
Emergency medical care
Emergency medical services
Emergency medicine
Emergency service
Health care reform
Health services
Hospitals
Informed consent
Medical records
Medical research
Middle East
Morbidity
Mortality
Patients
Printed materials
United Kingdom
United Kingdom
Bahrain
Discharge against medical advice
Middle East
Bahrain
Emergency medicine
DAMA
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Summary: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. 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. 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. 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.
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ISSN:1471-227X
1471-227X
DOI:10.1186/s12873-021-00422-6