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Discharge against Medical Advice in Emergency Department

Payman Asadi, Behzad Zohrevandi, Vahid Monsef Kasmaei, Bahnaz Heidari Bateni
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Abstract

Introduction: Discharge against medical advice (AMA) is the patient voluntarily leaving the hospital against the physician’s advice, which might indicate a problem in the hospital or the quality of care in it. This study aimed to evaluate the frequency and reasons of AMA in the emergency department (ED). Methods: The present cross-sectional study evaluated the reasons of AMA in the ED of Poursina Hospital, Rasht, Iran. The studied population included all the discharged AMA patients from April 2012 to March 2013. Demographic data and data regarding insurance status, insurance provider, number of hospitalization days, admission shift (morning, evening, night), type of disease or reason for referral (multiple trauma, surgery, orthopedics, neurosurgery, neurology), probable readmission in the next 15 days, and reasons for discharge AMA were gathered using a pre-designed checklist. Data were analyzed using SPSS version 20 and chi square test. p < 0.05 was considered significant. Results: 3367 patients were admitted to ED over the course of the study, 1060 (31.4%) of which were discharged AMA (62.92% male). Most discharged AMA patients were married and 20-30 years old. Most had neurological problems and surgery, and were referred in the evening or night shifts. 62.17% of the patients were insured by Ta’min Ejtema’i insurance company. The reasons for discharge AMA was patient related in 1009 (95.19%) cases, medical staff related in 35 cases (3.3%), and hospitalization related in 16 (1.51%) cases. Readmission in the next 15 days was seen in 9.06% of those who were discharged AMA. Conclusion: Based on the results of the present study, most cases of discharge AMA were patient related. Increasing the knowledge of the patients regarding probable consequences, designing outpatient management programs for these patients and improving the quality of medical services can help decrease discharge AMA cases.

Keywords

Patient discharge; emergency service, hospital; patients; patient care management

References

Taqueti VR. Leaving against medical advice. N Engl J Med. 2007;357(3):213-5.

Anis AH, Sun H, Guh DP, Palepu A, Schechter MT, O'Shaughnessy MV. Leaving hospital against medical advice among HIV-positive patients. Can Med Assoc J. 2002;167(6):633-7.

Merkouris A, Papathanassoglou ED, Lemonidou C. Evaluation of patient satisfaction with nursing care: quantitative or qualitative approach? Int J Nurs Stud. 2004;41(4):355-67.

Joolaee S, Givari A, Taavoni S, Bahrani N, REZA PR. Patients’ satisfaction with provided nursing care. Iran J Nurs Res. 2008;2(7):37-44. [Persian].

Forouzanfar MM, Hashemi B, Baratloo A, et al. Discharge against medical advice in emergency department of a general hospital in Tehran. Int Res J Appl Basic Sci. 2013;5(2):1487-90.

Hatamabadi H, Alimohammadi H. Reasons for long-stay admission in a typical overcrowded emergency of a teaching hospital in Tehran capital city. Pajoohandeh Journal. 2008;13(1):71-5.

Hwang SW, Li J, Gupta R, Chien V, Martin RE. What happens to patients who leave hospital against medical advice? Can Med Assoc J. 2003;168(4):417-20.

Saitz R, Ghali WA, Moskowitz MA. The impact of leaving against medical advice on hospital resource utilization. J Gen Intern Med. 2000;15(2):103-7.

Kariman H, Joorabian J, Shahrami A, Alimohammadi H, Noori Z, Safari S. Accuracy of emergency severity index of triage in Imam Hossein hospital-Tehran, Iran (2011). J Gorgan Uni Med Sci. 2013;15(1):115-20. [Persian].

Weingart SN, Davis RB, Phillips RS. Patients discharged against medical advice from a general medicine service. J Gen Intern Med. 1998;13(8):568-71.

Smith DB, Telles JL. Discharges against medical advice at regional acute care hospitals. Am J Public Health. 1991;81(2):212-5.

Moyse HS, Osmun W. Discharges against medical advice: a community hospital’s experience. Can J Rural Med. 2004;9(3):148-53.

Berger JT. Discharge against medical advice: ethical considerations and professional obligations. J Hosp Med. 2008;3(5):403-8.

Devitt PJ, Devitt AC, Dewan M. An examination of whether discharging patients against medical advice protects physicians from malpractice charges. Psychiatr Serv. 2000;51(7):899-902

Yarmohammadian MH, Mojahed F, Vahidi RG, Gholipour K, Shokri A, Rasi V. Clinical Audit of Self-Discharge against Medical Advice in Dr. Soulati Hospital in Urmia, Iran. Direct Gen. 2013;9(7):1006-14. [Persian].

Rangrazjeddi F, Rabiee R. Patient’s Bill of Rights in Kashan's Governmental Hospitals (2003). J Kermanshah Uni Med Sci. 2005;9(1).

Vahdat S, Hesam S, Mehrabian F. Effective factors on patient discharge with own agreement in selected Therapeutic Training Centers of Ghazvin Shahid Rajaei. J Commun Nurs. 2011;20(64):47-52.

Ibrahim SA, Kwoh CK, Krishnan E. Factors associated with patients who leave acute-care hospitals against medical advice. Am J Public Health. 2007;97(12):2204-8.

Alfandre DJ. “I'm going home”: Discharges against medical advice. Mayo Clin Proc. 2009;84(3):255-60.

Kavosi Z, Hatam N, Hayati AH, Nemati J, Bayati M. Factors Affecting Discharge against Medical Advice in a Teaching Hospital in Shiraz, Iran. Health Inform Manag. 2012;9(4):448-56. [Persian].

Farzandipour M, Sheikhtaheri A, Jabali MS. Rate of Informed Decision-Making for Treatment Refusal in University Hospitals of Kashan, Iran. Direct Gen. 2012;9(5):654-61. [Persian].


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