Association Between Door-to-Doctor Time and Discharge Against Medical Advice in Patients with COVID-19 from the ED

Abstract

The cause of Discharge Against Medical Advice (DAMA) is a long response time/doorto- doctor time, which is not according to the recommendation of 5 minutes. This study aimed to determine the association between Door to Doctor Time and DAMA incidence in patients with COVID-19 from the ED. The research design used is a cross-sectional study. This study used a purposive sampling technique (n = 414) in patients with COVID-19 symptoms who came or were referred to the ED in December 2020-April 2021. The data analysis used the Spearman correlation test. The results of this study indicate that most response times with response time indicators arrive until the initial action is not according to recommendations, namely 75 patients (18.1%). In contrast, the response time (response time for initial treatment to supporting laboratory examinations) is dominated by the same response time as many as 54 patients (13.0%). The results of the Spearman correlation show a positive correlation between the two waiting times / Door to Doctor time with an indicator (response time to achieve initial action) with the incidence of DAMA in COVID-19 patients. The correlation value is 0.000 (sig < 0.05), which is 0.436, and (the response to initial handling time until laboratory examination) has a correlation value of 0.413 with the same relationship, namely positive and unidirectional. At the same time, the strength of associations was moderate. The door to Doctor Time / Response time with indicators (response time from arrival to initial action and response time to initial treatment to supporting laboratory tests) is associated with the incidence of DAMA in patients with Covid-19 in the ED. The longer the response time will affect the incidence of DAMA in COVID-19 patients.
 Keywords: discharge against medical advice, door to the doctor time, COVID-19, ED