Discharge Against Medical Advice Research Articles

Hospital and emergency department discharge against medical advice in Western Australian Aboriginal children aged 0-4 years from 2002 to 2018: A cohort study.

Discharge against medical advice (DAMA) is a priority issue for the health system. Little is known about the factors associated with DAMA for Aboriginal and/or Torres Strait Islander (Aboriginal) children in Australia. Investigate the associations between DAMA for hospital admissions and emergency department (ED) presentations and: (i) child, family and episode of service characteristics and (ii) 30-day readmission/ re-presentation. We conducted a cohort study of Aboriginal children born in Western Australia (2002-2013) who had ≥1 hospital admissions (n = 16,931) or ED presentations (n = 26,546) within the first 5 years of life. The outcome of interest was hospital and ED DAMA and adjusted odds ratio were derived using multilevel mixed-effects logistic regression. In the Hospital Cohort, there were 43,149 hospitalisations for 16,931 children, with 684 hospitalisations (1.6%) recorded as DAMA. In the ED Cohort, there were 232,082 ED presentations in 26,546 children, with 10,918 ED presentations (4.7%) recorded as DAMA. DAMA occurring in hospitals between 2014 and 2018, the adjusted odds decreased by 75% compared to the period between 2002 and 2005. The adjusted odds of ED DAMA increased by 46% over the same period. Hospital admissions in regional and remote hospitals were almost seven times the adjusted odds of DAMA compared with hospital admissions in Perth metropolitan hospitals. The adjusted odds of ED DAMA decreased by 12% for ED presentations in regional and remote hospitals compared to those in Perth metropolitan hospitals. There was no evidence of hospital DAMA being associated with hospital readmission within 30 days and limited evidence of ED DAMA being associated with re-presenting to an ED within 30 days. The study identified several important determinants of DAMA, including admission status, triage status, location and calendar year. These findings could inform targeted measures to decrease DAMA, particularly in regional and remote communities.

Discharges against medical advice: time to take another look. A retrospective review of discharges against medical advice focused on prevention

ABSTRACT Background Discharges against medical advice (DAMA) increase the risk of death. Methods We retrieved DAMA from five hospitals within a large health system and reviewed 10% of DAMA from the academic site between 2016 and 2021. Results DAMA increased at the onset of the pandemic. Patients who discharged AMA multiple times accounted for a third of all DAMA. Detailed review was completed for 278 patients who discharged AMA from the academic site. In this sample, women comprised 52% of those who discharged AMA multiple times. Relative to the proportion of all discharges from the academic site during the study period, Black patients were overrepresented among DAMA (21% vs. 34%, p < .05). Patients with multiple AMA discharges were younger, more likely to be unmarried, or have substance use disorders (SUD) than those who discharged AMA once. The most common reason for requesting premature discharge noted in n = 77, 28% of instances was related to patient obligations outside the hospital. Hospital policies and procedures contributed in n = 29, 10% of instances. Reasons for requesting premature discharge and documentation of key safety processes were similar by gender and race however the sample may be underpowered to detect differences. Capacity was evaluated in 109 (39%). Among those who consumed alcohol (n = 81 (29%)) or had SUDs (n = 112 (40%)), information on the amount or timing of last use was missing in n = 39 (48%) and n = 74 (66%), respectively. Critical tools to manage illness were provided in 45 (16%) of DAMA reviewed. Conclusions Drivers of AMA discharge may differ by AMA discharge frequency. Recognition of the common reasons for requesting premature discharge may help destigmatize AMA discharges and also identifies early assessments by social work colleagues as an important prevention strategy. Opportunities also exist in anticipating and preventing withdrawal symptoms and in revising hospital practices that contribute to DAMA.

Discharge against medical advice in the neonatal unit of Rivers State University Teaching Hospital, Nigeria: a two-year prospective study

Background: Discharge against medical advice (DAMA) is a silent contributor to neonatal morbidity and mortality in Nigeria. Parents' autonomous decision to discontinue medical care of their babies admitted remains an ethical contention that is frustrating for pediatricians and portends poor neonatal outcomes. DAMA remains a challenge arising from an interplay of parental and hospital-related factors. Hence, epidemiologic data are needed, where none previously exists. Aim of the study was to determine the prevalence, neonate and family sociodemographic characteristics, morbidity pattern and reasons for DAMA among neonates admitted to the Rivers State University Teaching Hospital. Methods: A prospective observational study was conducted among neonates admitted from April 2021 to March 2023. Results: Of 1830 neonatal admissions, 87 were discharged against medical advice giving a DAMA prevalence of 4.8%, of which 48 (55.8%) were females. Most, 66 (75.9%) were born at term, 51 (58.6%) had normal birth weight, 38 (43.7%) admitted at &lt;2 hours of life and (41.4%) were above 2nd birth order. Forty-seven (54%) of mothers, 41 (47.1%) of fathers had tertiary education and 61 (70.1%) were of low/middle socioeconomic class. Neonatal sepsis (61.2%) and neonatal jaundice (31.8%) were the commonest morbidities. Most, 65 (74.7%) of DAMA cases occurred in the 1st week of life and the father 63 (73.3%) was the main requestor of DAMA. The commonest reason for DAMA was financial constraints 50 (57.5%). Conclusions: The prevalence of DAMA was 4.8%. Neonatal sepsis and neonatal jaundice were the commonest morbidity with financial constraints being the main reason for DAMA. The father was the requestor for DAMA in the majority of the cases.

Incidence of Discharge Against Medical Advice in Queensland Hospital Emergency Departments Among Indigenous Patients from 2016 to 2021.

The incidence of discharge against medical advice (DAMA) in emergency departments (EDs) among Indigenous people is a growing concern in Australia. This study aimed to determine the incidence of ED DAMA in public hospitals in Queensland (QLD) from 2016 to 2021 and investigate the disparities in ED DAMA between Indigenous and non-Indigenous patients. The study also assessed the impact of the COVID-19 pandemic on the incidence of ED DAMA. A descriptive epidemiological study was conducted using aggregated data from QLD public hospital EDs. The data was retrieved from Clinical Excellence QLD, Healthcare Improvement Unit, in the QLD Health Open Data Portal for the period 1 January 2016 to 31 December 2021. Incidence rates and unadjusted odds ratios were calculated and compared using the chi-square test to identify differences between Indigenous and non-Indigenous patients. The annual incidence of DAMA in EDs was 7.7% among Indigenous patients, compared to 4.8% among non-Indigenous patients, with the highest rate (8.9%) reported in 2021 among Indigenous patients. The incidence of ED DAMA was higher for Indigenous patients in major cities (20.0%) than in very remote areas (7.4%). Patients in triage categories 4 (10.0%) and 3 (7.3%) accounted for the vast majority of ED DAMA events among Indigenous patients. The acute group A hospitals had the highest incidence of ED DAMA (10.9% for Indigenous patients and 6.5% for non-Indigenous patients). The COVID-19 pandemic had no impact on the incidence of ED DAMA. Indigenous patients experience a disparity in ED DAMA incidence. Addressing this issue requires collaborative efforts from healthcare providers, policymakers, and community organizations.

Gender Specific Difference and Clinical Spectrum of COVID-19 Patients Admitted in Tertiary Care Hospital of Northern India

Objectives: In a tertiary care hospital in Northern India, we examined the demographic, biochemical, and clinical risk factors related to gender differences in COVID-19 patients who were hospitalized. Materials and Methods: The study was carried out in a hospital with tertiary care. In this retrospective comparative observational study the data was collected from march 2020 to end of COVID pandemic. Analyses were done on the n = 1068 individuals who were hospitalized during the study period. Results: There were 1068 individuals evaluated in the trial, with a male-to-female ratio of 2.3:1. Males and females had similar mean ages (55.84 vs. 55.44 years). Difference was found to be statistically significant in asthmatic boys and females (P = 0.01). In our study, a novel severity score (NSS) was utilized to forecast inpatient mortality in COVID-19 patients. NSS scores were higher for men (2.95) than for women (2.65), with P = 006. Under the categories “Expired,” “discharged against medical advice (DAMA),” and “Discharged,” all the criteria that have been previously analyzed were compared. Based on the number of comorbidities, there was a clear, significant difference between patients who were discharged, expired, and under DAMA, with a P = 0.001. Majority of patients with comorbidities that most frequently impacted the cardiovascular and respiratory outcomes. Conclusion: Studies conducted globally found that men experienced a higher rate of mortality. Our study also indicates that when the number of comorbidities rises, the death rate rises. Therefore, individuals with a larger number of comorbidities, such as hypertension, diabetes, coronary artery disease, and peripheral vascular disease, should exercise particular vigilance.

Comparison of PRISM IV and PIM III prognostic scores as mortality indicators among paediatric intensive care unit patients &amp;nbsp;

Introduction: Identifying prognosis of patients admitted in the paediatric intensive care unit (PICU) is of paramount importance to better allocate medical resources, reduce patient-doctor conflict and for overall better patient care. Many scoring systems have been formulated to accomplish this task including paediatric risk of mortality (PRISM) IV and paediatric index of mortality (PIM) III.Objectives: To compare PRISM IV and PIM III as prognostic scoring tools in the PICU of a tertiary healthcare centreMethod: This prospective observational study was conducted in the PICU, Dhiraj hospital, SBKS MI&amp;RC, Gujarat, India, from March 2021 to September 2022. It included all patients from age 1 month to 18 years who were admitted in the PICU for &gt;24 hours and gave consent for this study. They were thoroughly examined and investigations were done within the first hour of admission as per standard guidelines and their PRISM IV and PIM III scores were calculated and data were analysed.Results: A total of 74 patients was enrolled in this study. Whilst 43 (58.1%) patients were discharged, 18 (24.3%)] were discharged against medical advice(DAMA) moribund, 4 were DAMA (non-moribund) and 9 (12.2%) died. Receiver Operating Characteristic (ROC) curves were made for both PRISM IV and PIM III scores. Discriminatory powers of PIM III (AUC 0.725; 95% CI: 0.609 to 0.823) and PRISM IV (AUC 0.8; 95% CI: 0.691 to 0.884) were acceptable. Whilst PRISM IV was the better predictor of mortality at cut off point of &gt;4 with area under curve of 0.8 for correctly predicting mortality, this difference was not statistically significant (p value=0.354). Multivariate logistic regression analysis showed that the duration of stay(days) and PRISM IV value &gt;4 were significant independent risk factors of mortality after adjusting for confounding factors.Conclusions: Both PRISM IV and PIM III were good prognostic scoring tools in the PICU of the tertiary healthcare centre. Multivariate logistic regression analysis showed that the duration of stay(days) and PRISM IV value &gt;4 were significant independent risk factors of mortality after adjusting for confounding factors.

Discharge against medical advice in pediatrics: A review and recommendation of a five-component approach

Patients who are discharge against medical advice (DAMA) present significant challenges on clinical, ethical, financial, and legal levels. Despite its multilevel impact, the factors explaining and predicting DAMA in different regions of the world remain underevaluated, especially in pediatrics. This article aims to provide a scope of review of the phenomenon of DAMA in pediatrics and guide healthcare providers on how to deal with common scenarios of DAMA requests through a five-component approach. A literature search was performed using PubMed with the following keywords: “leave against medical” OR “discharge against medical” AND “pediatrics” OR “child*” without a time limit. This search yielded 30 articles, and two more were added as secondary sources. DAMA is associated with several health adverse outcomes such as a higher prevalence of morbidity, complications, and even mortality. Financial burden associated with medical care seems to be a major factor driving the parental decision as well as difficulties in arranging care for other siblings, the perception that the child’s condition has improved sufficiently to be discharged, parental preferences for traditional or alternative medicine, and dissatisfaction with treatments. Dealing with DAMA requests requires skilled communication paired with a good understanding and the ability to translate the concepts of informed consent and shared-decision making into clinical practice.

Who Left the Hospital Against Medical Advice During the Early COVID-19 Pandemic?

Patients leaving against medical advice (AMA) presents a challenge to hospitals as they try to manage costs and improve patient outcomes in an ever-increasing competitive market. Investigating AMA discharges that occurred during the early COVID-19 pandemic presents a unique opportunity to better understand this phenomenon and be better prepared for the future. This retrospective analysis of 34 379 patients from a nationwide private healthcare system across 20 states analyzed patients during the early stages of the pandemic who chose to leave against medical advice (AMA) after being admitted with COVID-19 infection and identified several patient characteristics associated with subsequent AMA discharge. These patient characteristics included being younger than 50; identifying as male sex; having non-white ethnicity, including both Black and Hispanic; having either Medicaid or no health insurance; and the presence of specific medical comorbidities. The identified medical comorbidities were substance abuse, renal failure, deep vein thrombosis, hypertension with heart failure, hypertension with chronic kidney disease stage 5, rheumatoid arthritis or collagen vascular diseases, alcohol abuse, chronic pulmonary disease, hypertensive encephalopathy, and solid tumor. This study confirms some of the findings in previous studies looking at AMA discharges and has some interesting findings as it relates specifically to the COVID-19-infected patient population. An additional understanding of the factors leading to AMA discharges can help providers and administrators prevent suboptimal discharge outcomes in the future.

Clinical characteristics, in-hospital management, and outcomes of patients with in-hospital vs. community-onset ischaemic stroke: a hospital-based cohort study

Lack of high-quality national-level data on in-hospital ischaemic stroke hinders the development of tailored strategies for this subgroup's identification, treatment, and management. We analyzed and compared clinical characteristics, in-hospital management measures, and outcomes, including death or discharge against medical advice (DAMA), major adverse cardiovascular events (MACEs), disability at discharge, and in-hospital complications between in-hospital and community-onset ischaemic stroke enrolled in the Chinese Stroke Center Association registry from August 2015 to December2022. The cohort comprised 14,948 in-hospital and 1,366,898 community-onset ischaemic stroke patients. In-hospital ischaemic stroke exhibited greater stroke severity, higher prevalence of comorbidities, more pre-admission medications, and had suboptimal management measures, for example, the onset-to-needle time within 4.5h (83.3% vs. 93.1%; difference,-9.8% [-11.4% to-8.3%]), and antithrombotics at discharge (78.6% vs. 90.0%; difference,-11.4% [95% CI,-12.1% to-10.7%]). After adjusting for covariates, in-hospital ischaemic stroke remains associated with higher risks of unfavorable outcomes, including in-hospital death/DAMA (13.9% vs. 8.6%; adjusted risk difference [aRD], 2.2% [95% CI, 1.8%-2.7%]; adjusted odds ratio [aOR], 1.35 [95% CI, 1.25-1.45]), MACE (12.6% vs. 6.5%; aRD, 4.1% [95% CI, 3.5%-4.7%]; aOR, 1.68 [95% CI, 1.52-1.85]), and complications (23.7% vs. 12.1%; aRD, 6.5% [95% CI, 5.1%-7.9%]; aOR, 1.72 [95% CI, 1.64-1.80]), except for disability at discharge (41.1% vs. 33.1%; aRD, 0.4% [95% CI,-1.7% to 2.5%]; aOR, 0.99 [95% CI, 0.88-1.11]). In-hospital ischaemic stroke demonstrated more severe strokes, worse vascular risk profiles, suboptimal management measures, and worse outcomes compared to community-onset ischaemic stroke. This emphasizes the urgent need for improved hospital systems of care and targeted quality improvement initiatives for better outcomes in in-hospital ischaemic stroke. National Key R&D Programme of China and Beijing Hospitals Authority.

Discharge Against Medical Advice After Hospitalization for Sepsis: Predictors, 30-Day Readmissions, and Outcomes

BackgroundSepsis is a leading cause of death worldwide. However, little has been known concerning the status of discharge against medical advice (DAMA) in sepsis patients. ObjectiveTo identify factors associated with DAMA, evaluate the association of DAMA with 30-day unplanned readmission and readmitted outcomes after sepsis hospitalization. MethodsUsing the National Readmission Database, we identified sepsis patients who discharged routinely or DAMA in 2017. Multivariable models were used to identify factors related to DAMA, evaluate the association between DAMA and readmission, and elucidate the relationship between DAMA and outcomes in patients readmitted within 30 days. ResultsAmong 1,012,650 sepsis cases, patients with DAMA accounted for 3.88% (n = 39,308). The unplanned 30-day readmission rates in patients who discharged home and DAMA were 13.08% and 27.21%, respectively. Predictors of DAMA in sepsis included Medicaid, diabetes, smoking, drug abuse, alcohol abuse, and psychoses. DAMA was statistically significantly associated with 30-day (odds ratio [OR] 2.18, 95% confidence interval [CI] 2.09–2.28), 60-day (OR 1.98, 95% CI 1.90–2.06), and 90-day (OR 1.88, 95% CI 1.81–1.96) readmission. DAMA is also associated with higher mortality in patients readmitted within 30 days (OR 1.38, 95% CI 1.17–1.63), whereas there were no statistically significant differences in length of stay and costs between patients who discharged home or DAMA. ConclusionsDAMA occurs in nearly 3.88% of sepsis patients and is linked to higher readmission and mortality. Those at high risk of DAMA should be early identified to motivate intervention to avoid premature discharges and associated adverse outcomes.

What Do We Owe to Patients Who Leave Against Medical Advice? The Ethics of AMA Discharges.

Discharges against medical advice (AMA) make up a significant number of hospital discharges in the United States, and often involve vulnerable patients who struggle to obtain adequate medical care. Unfortunately, much of the AMA discharge process focuses on absolving the medical center of liability for what happens to these patients once they leave the acute setting. Comparatively little attention is paid to the ethical obligations of the medical team once an informed decision to leave the acute care setting AMA has been made. Via a case narrative, we offer an ethical framework that we believe can help guide an ethically defensible AMA discharge process. By emphasizing our duty to provide the best care possible under the circumstances, we contend, our ethical obligations to promote the patient's best interests can still be met despite their decision to leave the acute setting against medical advice.

Effect of prior anticoagulation therapy on stroke severity and in-hospital outcomes in patients with acute ischemic stroke and atrial fibrillation

BackgroundWe aimed to assess the prevalence of prior anticoagulation therapy (warfarin or non-vitamin K antagonist oral anticoagulants [NOACs]) among patients with acute ischemic stroke (AIS) and atrial fibrillation (AF) in China and investigate the associations between prior anticoagulation therapy and initial stroke severity and in-hospital outcomes. MethodsWe included consecutive patients with AIS and known history of AF admitted to hospitals in the China Stroke Center Alliance (CSCA) program from January 2019 to July 2019. Multivariate logistic regression analyses were performed to determine the associations between prior anticoagulation therapy and initial stroke severity and in-hospital outcomes. ResultsOf 7181 patients (median [IQR] age, 75.0 [68.0–81.0] years; 48.7% men), 700 (9.7%), 129 (1.8%), and 255 (3.6%) patients received prior subtherapeutic warfarin (international normalized ratio [INR] <2.0), therapeutic warfarin (INR ≥2.0), and NOACs therapy, respectively. A total of 6499 patients had a preadmission CHA2DS2-VASc score ≥ 2, among whom 94.6% were not adequately anticoagulated. Compared with no prior anticoagulation therapy, prior NOACs therapy was associated with reduced risk of moderate or severe stroke at admission (odds ratio [95% CI], 0.64 [0.43–0.94], P = 0.023) and in-hospital mortality or discharge against medical advice (DAMA) (0.46 [0.24–0.86], P = 0.015). However, no significant association was observed between prior therapeutic warfarin therapy and stroke severity or in-hospital mortality or DAMA. ConclusionsAmong patients with AIS and AF in China, the proportion of patients with inadequate anticoagulation prior to stroke remained substantially high. Prior NOACs therapy was associated with reduced stroke severity and less in-hospital mortality or DAMA.

Discharge against medical advice: cross-sectional survey from a regional orthopaedic hospital in sub-Saharan Africa.

Discharge against medical advice (DAMA) is a worldwide phenomenon. It continues to challenge the healthcare system and has profound effects on outcomes of treatment. It is when a patient leaves the hospital against the treating physician's recommendation. The objectives of this study are to identify the prevalence, associated factors, and proffer recommendations to mitigate the anomaly in our local/regional healthcare system. This was a cross-sectional study with data collected from consecutive patients who sought DAMA at the accident and emergency department of the hospital from October 2020 to March 2022. Data were analyzed using SPSS version 26. Descriptive and inferential statistics were used for data presentation. Ninety-nine cases of DAMA out of 4608 patients seen at the Emergency Department during the study period, giving a prevalence rate of 2.14%. 70.7% (70) of these patients were aged 16-44years with male-to-female ratio of 2.5:1. An estimated half the number of the patients who DAMA were traders 44.4% (44), 14.1% (14) were in paid employment, 22.2% (22) were unskilled workers, and 3% (3) unemployed. Financial constraint was the leading cause in 73 (73.7%) cases. The majority of patients had limited or no formal education, and this was significantly associated with DAMA (P = 0.032). Ninety-two patients (92.6%) sought discharge within 72h of admission and 89 (89.9%) admitted to leaving to seek alternative methods of care. DAMA is still a problem in our environment. Comprehensive health insurance must be mandatory for all citizens with improved scope and coverage, especially for trauma victims.

Identifying Risk Factors for AMA Discharge After Injury at a Level 1 Trauma Center.

Discharging a patient against medical advice (AMA) is used to describe when a patient opts to leave the hospital prior to a physician's recommendation while acknowledging the risks of doing so. There are limited published data that identify risk factors for patients leaving AMA, particularly after trauma. This study sought to delineate risk factors for AMA discharge after trauma. Trauma patients who left AMA at our ACS-verified level 1 trauma center were retrospectively included (2021-2022) without exclusions. Demographics, clinical/injury data, and outcomes were collected. The primary outcome was patient-stated reason for leaving AMA. Study variables were summarized with descriptive statistics. During the study period, 262 (8%) of 3218 admitted trauma patients left AMA. Psychiatric disease was present in most patients (n = 197, 75%), including substance abuse (n = 146, 56%), and alcohol abuse (n = 95, 36%). Common patient-stated reasons for leaving AMA were inability/unwillingness to wait for procedure, imaging, or placement (n = 56, 22%); and psychiatric disease other than alcohol/substance abuse (n = 39, 15%). Of the patients who left AMA, 29% (n = 77) returned to the hospital 30days, and 13% (n = 35) were readmitted. Patients who leave AMA are at elevated risk of returning to the hospital, which incurs additional costs in already resource-constrained systems. These findings provide impetus for early identification of high-risk patients and efforts to decrease wait times for imaging, procedures, and placement. These actions may mitigate AMA discharges and their resultant impact on patients and hospitals.

Risk Factors for Discharge Against Medical Advice at Antepartum Hospitalizations [ID: 1373372

INTRODUCTION: Antepartum obstetrical admissions are often unplanned. Despite counseling, some patients may choose to be discharged against medical advice (DAMA). This study examined patterns of DAMA at antepartum hospitalizations and associated patient characteristics. METHODS: Using 2019 National Inpatient Sample (NIS) data, we identified pregnant patients aged 12–50 years with antepartum admissions. The primary outcome was DAMA determined based on patients' discharge disposition status. Patients' sociodemographic and clinical characteristics were measured based on hospital discharge records and diagnosis/procedure codes. Characteristics of DAMA and non-DAMA patients were compared using chi-square tests and multivariable logistic regression, while accounting for NIS complex sample design to generate nationally representative estimates. RESULTS: Among 214,935 patients in the sample, 8,495 (4.0%) were DAMA. The risk of DAMA was significantly higher among Black than White patients (5.4% versus 3.8%, P&lt;.001, adjusted odds ratio [OR] 1.25, 95% CI 1.09–1.43), Medicaid than privately insured patients (5.4% versus 1.7%, P&lt;.001, adjusted OR 2.49, 95% CI 2.12–2.93), and patients with (versus without) obstetrical/comorbid conditions, such as substance use disorders (11.3% versus 2.7%, P&lt;.001, adjusted OR 3.30, 95% CI 2.76–3.96), prior preterm birth (8.1% versus 3.9%, P&lt;.001, adjusted OR 2.04, CI 1.44–2.89), hypertensive disorders of pregnancy (5.4% versus 3.8%, P&lt;.001, adjusted OR 1.70, 95% CI 1.43–2.03), and chronic hypertension (6.2% versus 3.8%, P&lt;.001, adjusted OR 1.51, 95% CI 1.28–1.79). CONCLUSION: Patients who are DAMA in the antepartum period have certain sociodemographic and clinical characteristics that may place them at higher risk of adverse obstetrical outcomes. Risk-stratified, targeted patient support during admission may be beneficial.

Hospital readmissions and mortality following discharge against medical advice: a five-year retrospective, population-based cohort study in Veneto region, Northeast Italy

ObjectivesThe aim of this study was to examine the odds of readmission and mortality after discharge against medical advice (DAMA) in the Veneto region of Northeast Italy, drawing on data...

Patient outcomes after neonatal tracheotomy: A retrospective case-control study.

Patient outcomes after neonatal tracheotomy: A retrospective case-control study.

Who Determines to Discharge against Medical Advice from an Acute Psychiatric Hospitalization

Subjective: To reduce the nonessential healthcare expenditure and to prevent patients from adverse consequences, we intended in this study to find the prevalence and characteristics of patients with psychiatric disorder with against medical advice (AMA) discharge. Methods: We did a review of medical records for patients who hospitalized on the acute psychiatric ward at Keelung Chang Gung Memorial Hospital in Taiwan from January 1, 2013, to August 31, 2018. Results: We found that 100 patients (8.1%) were discharged AMA out of total 1,237 discharges. Compared to patients with regular discharges, those with AMA discharge were significantly different between the groups in age (p &lt; 0.05), first time admission (p &lt; 0.001), comorbid substance use disorders (p &lt; 0.05), previous suicide attempts (p &lt; 0.01), and length of hospital stay (p &lt; 0.001). With forward stepwise logistic regression model to look for the most influential predictors for AMA discharge, we found that odds ratio (95% confidence interval) of those with suicidal attempt history (1.931 [1.265–2.949], B = 0.658, p &lt; 0.01) and those with the first-time psychiatric admission (3.435 [2.253–5.237], B = 1.234, p &lt; 0.001) significantly predicted those AMA patients. Conclusion: The history of suicide attempt and first-time psychiatric ward admission is the most important predictors for patients with AMA discharge. We suggest that controlled prospective studies can strengthen the study findings and better describe the impact on patients with AMA discharge.

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

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 &lt; 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.&#x0D; Keywords: discharge against medical advice, door to the doctor time, COVID-19, ED

How does discharge against medical advice affect risk of mortality and unplanned readmission? A retrospective cohort study set in a large UK medical admissions unit

ObjectivesTo assess the frequency of discharge against medical advice (DAMA) in a large UK teaching hospital, explore factors which increase the risk of DAMA and identify how DAMA impacts patient...