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. 2021 Mar 16;21(1):31.
doi: 10.1186/s12873-021-00422-6.

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

Feras H Abuzeyad  1 , Moonis Farooq  2 , Salah Farhat Alam  2 , Mudhaffar Ismael Ibrahim  2 , Luma Bashmi  3 , Shaikha Sami Aljawder  2 , Najeh Ellouze  2 , Abdulla Almusalam  3 , Stephanie Hsu  3 , Priya Das  3
Affiliations

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

Feras H Abuzeyad et al. BMC Emerg Med. .

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.

Keywords: Bahrain; DAMA; Discharge against medical advice; Emergency medicine; Middle East.

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Conflict of interest statement

The authors declare that they have no competing interests.

References

    1. Machin LL, Goodwin D, Warriner D. An alternative view of self-discharge against medical advice: an opportunity to demonstrate empathy, empowerment, and care. Qual Health Res. 2018;28(5):702–710. doi: 10.1177/1049732318754514. - DOI - PubMed
    1. El-Metwally A, Suliman Alwallan N, Amin Alnajjar A, Zahid N, Alahmary K, Toivola P. Discharge against medical advice (DAMA) from an emergency Department of a Tertiary Care Hospital in Saudi Arabia. Emerge Med Int. 2019;2019:4579380. - PMC - PubMed
    1. El Sayed M, Jabbour E, Maatouk A, Bachir R, Dagher GA. Discharge against medical advice from the emergency department: results from a tertiary care hospital in Beirut, Lebanon. Medicine. 2016;95(6):e2788. - PMC - PubMed
    1. Lee CA, Cho JP, Choi SC, Kim HH, Park JO. Patients who leave the emergency department against medical advice. Clin Exp Emerge Med. 2016;3(2):88. doi: 10.15441/ceem.15.015. - DOI - PMC - PubMed
    1. Ashrafi E, Nobakht S, Keykaleh MS, Kakemam E, Hasanpoor E, Sokhanvar M. Discharge against medical advice (DAMA): causes and predictors. Electron Physician. 2017;9(6):4563–4570. doi: 10.19082/4563. - DOI - PMC - PubMed

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