Factors Influencing Early Readmission after Discharge against Medical Advice from the Emergency Department.

Byeong-Keon Moon,Jaelan Shim,Deulle Min,Ryeok Ahn

doi:10.3390/healthcare9080986

Abstract

Discharge against medical advice (DAMA) and readmissions are important issues worldwide and can lead to adverse clinical outcomes, financial burden, and exposure of healthcare workers to unintended medical disputes. This study aimed to identify factors that affect readmissions within 48 h after DAMA. This retrospective study utilized the medical records of patients who visited an emergency medical center in Korea for treatment and were readmitted during a 10-year period. Factors predicting readmission after being DAMA were identified using logistic regression analysis. The total number of patients who were DAMA during the study period was 5445, of which 351 were readmitted to the emergency department within 48 h (6.4%). Factors influencing readmission included medical aid (odds ratio (OR) = 2.02, 95% confidence interval (CI): 1.46–2.83) and foreign worker insurance (OR = 2.07, 95% CI: 1.04–4.09) as their health insurance, as well as presenting for readmission by car (OR = 1.41, 95% CI: 1.08–1.82). Healthcare workers should treat patients who are DAMA and those who are likely to return with a more careful and preventative management strategy so that potential clinical, legal, and economic impacts of DAMA can be mitigated.

Highlights

Discharge against medical advice (DAMA) is when a patient chooses to leave the hospital before a physician advises discharge [1]
Males accounted for more than half (57.5%) of patients who were readmitted to the emergency department (ED), and males were more likely to be readmitted after DAMA than females (42.5%)
The national health insurance accounted for the largest percentage (78.3%), followed by medical aid (14.0%), industrial accident insurance for foreign workers (2.8%), and private insurance (1.7%)

Summary

Introduction

Discharge against medical advice (DAMA) is when a patient chooses to leave the hospital before a physician advises discharge [1]. It is considered an escape (absence without leave, absconding, or elopement) when the patient leaves the hospital without notification from an involuntary unit or walks out of a voluntary unit. Dissatisfaction with medical services due to delays and costs often leads to DAMA [11]. It could be the result of symptom improvement after treatment administration in the ED [5]

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