Factors Influencing Patients to Decide to Discharge Themselves against Medical Advice at Tertiary Hospitals: A Cross-Sectional Study

Abstract

Background: Discharged against medical advice (DAMA) is defined as any instance when a patient wants to leave the hospital against the managing physician’s decision. This study aimed to identify factors that influence patients to decide to be DAMA. Methods: A descriptive, cross-sectional study. The study was conducted in the emergency department (ED) of King Fahad Medical City (KFMC)-Saudi Arabia-Riyadh city. A questionnaire in both Arabic and English was distributed to all participants to fill in either English or Arabic. Results: Between 1 March and 30 April 2021, 510 responses were collected. Most of the study participants (31.4%) were over the age of 54. Our findings showed that 12.5% of our participants had taken discharge against medical advice in the past. Results Regarding Factors That Influence Patients to Decide on DAMA Showed: Regarding Inappropriate behavior and disrespect of the physician or staff to the patient and his relatives, 262 (51.4%) participants, 85 (16.7%) participants, and 163 (32%) participants agreed, neutral, and disagreed, respectively. Regarding the Lack of physicians’ and nurses’ attention to the patient and his relatives (emotionally), our result showed that 278 (54.5%) participants, 95 (18.6%) participants, and 137 (26.9%) participants agreed, neutral, and disagree, respectively. Regarding failure to inform the patient or his relatives of his condition, it showed that 257 (50.4%) participants, 95 (18.6%) participants, and 158 (31%) participants agreed, neutral, and disagreed, respectively. Regarding feeling better from DAMA, our result showed 226 (44.3%) participants, 119 (23.3%) participants, and 165 (32.4%) participants agreed, neutral, and disagreed, respectively. Regarding patients’ or their relative’s tiredness of hospital stay, the result showed that 166 (32.5%) participants, 104 (20.4%) participants, and 240 (47.1%) participants agreed, neutral, and disagreed, respectively. Conclusion: The long wait time to be seen by a physician was the major factor that forced patients to leave the emergency department against medical advice.