Cases of Left Against Medical Advice from the Emergency Department of a Tertiary Care Hospital in Kathmandu: A Descriptive Cross-Sectional Study (original) (raw)
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Asian Pacific Journal of Health Sciences
Introduction: Discharge against medical advice in the emergency department (ED) is particularly important as the patient may be threatening his life by choosing to leave and thus not receive adequate or timely medical care. Patients who leave against medical advice (LAMA) may be severely ill and at risk of experiencing adverse events and revisit to ED. Reasons for LAMA include, but are not limited to, family obligations or financial responsibilities. In Nepal, however, a paucity of data exists regarding LAMA and factors that might influence it. Therefore, this study will find out the characteristics of patients leaving LAMA and also identify factors and reasons behind LAMA discharges that might allow the physician to decrease such discharges and improve patient care. Methods: A semi-standardized questionnaire was used to record relevant demographic and clinical information’s. The questionnaire included sociodemographic characteristics (age, sex, marital status, education status, occ...
Journal of KIST Medical College, 2020
Introduction: Patients leaving against the advice of the treating team before being certified as fit is a major concern and challenge for the treating professionals as it possesses adverse medical outcomes. This study hence aimed at identifying the prevalence and major factors affecting such discharges so that advocacy can be done to help prevent it. Methods: A descriptive cross-sectional study was conducted at emergency department of a tertiary center in Lalitpur from 15 th May 2019 to 15 th August 2019. All the patients visiting the emergency department were included in the study and a non-probability purposive sampling method was used excluding the patients who denied giving reasons for them leaving against medical advice. Data was collected using pre-structured questionnaire and analyzed using SPSS-v21 software. Results: A hundred and fifteen patients (4.08%) left against medical advice out of 2812 patients who presented to emergency department. There were 63 male patients (54.8%), 75 patients of the total patients in the age group of 15-44 years (65.2%) and those living within a distance of 1km from the hospital (53%). The most common reason for the patients leaving against medical advice was found to be due to financial constraint (38.3%) followed by preference to other hospitals (16.5%). Conclusion: Patients leaving against medical advice possesses a small percentage of actual hospital admissions but is still a major health concern as it drastically increases the morbidity, re-admission rates and total health-care costs. Hence, understanding the general characteristics and predictors of such discharges is of utmost importance to help improve the patient outcome and reduce the health-care costs.
Journal of Nepal Medical Association, 2021
Introduction: Leave against medical advice has a potentially deleterious effect on the health of a child. This is particularly alarming in case of pediatric patients as they are unable to understand the implications of it and rely on parents to make decisions regarding their health. This study was undertaken to find out the prevalence of leave against medical advice among pediatric patients admitted in a tertiary teaching hospital in Nepal. Methods: A descriptive cross-sectional study was conducted in the Department of Pediatrics, Manipal Teaching Hospital between August 2019 and July 2020. Ethical clearance was obtained from the Institutional Review Committee (Ref: 256). Convenient sampling method was used. Data entry and analysis was done on Statistical Package for Social Sciences version 23. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data.Results: Out of 1608 pediatric admissions taken in our study, the prevalence of le...
Journal of BP Koirala Institute of Health Sciences
Introduction: With increasing of workload of emergency room employees, many of the community’s emergency hospitals are now facing another challenge, i.e. the abandonment of patient in emergency Department. It seems undesirable in most hospital service settings due to loss of revenue and ill-will. The hospital’s staffs feel that they have no option but to keep those sufferers until a further plan can be made. It presents a dilemma for the staffs of Emergency and for the hospital administrators as well. The current case report presents an abandoned patient in Emergency Department of B. P. Koirala Institute of Health Sciences (BPKIHS). Case Report: A 70-year old male brought by police and was left abandoned in emergency ward of BPKIHS in altered conscious state. The patient was managed in emergency ward with conservative management nearly for six weeks. Conclusion: The problem is multidimensional, is in conflict of the concept towards achievement of Millennium Development Goals (MDGs) ...
Current Medicine Research and Practice, 2017
Background: Leaving against medical advice (LAMA) is not uncommon worldwide. However there are very few studies on this problem in India so we conducted a prospective study on its occurrence in our department. Patients and methods: Between January and December 2015, we followed 50 consecutive surgical patients who left against medical advice either from our department (24) or from another hospital (26) subsequent to getting admitted under our care. We used a standard questionnaire which we gave to the patients or their relatives. The patients were followed up till their three days after their discharge or death. Results: During the study, the total number of admissions in our department were 966 and of these 24 (2.5%) went LAMA. The largest number of these patients (out of the total of 50 who went LAMA i.e. 24 of ours and 26 from elsewhere) had necrotizing pancreatitis (20%; n = 10), widespread metastases from various carcinomas (12%; n = 6) and intestinal obstruction (12%; n = 6). They came to our department from elsewhere in search for better treatment (n = 12; 46%) and went LAMA from ours mainly for financial reasons (n = 19; 79%). Only 18% (n = 9) of them were insured, 80% (n = 40) paid from their own funds and one used a combination of both methods of payment. Of the 26 patients who came to our department from elsewhere, 21 left the hospital in a stable condition and 5 died during admission. Of those who left our hospital (n = 24), 19 were admitted to other healthcare facilities (2 were lost to follow up) and 3 died. Conclusion: In India the search for better healthcare and financial problems were the main reasons for leaving hospitals against medical advice. This is an unfortunate consequence of the lack of affordable, high quality and universal healthcare in this country.
Patients who leave the emergency department against medical advice
Clinical and experimental emergency medicine, 2016
Discharge against medical advice (DAMA) from the emergency department (ED) accounts for 0.1% to 2.7% of all ED discharges. DAMA carries a risk of increased mortality and readmissions. Our aim was to investigate the general characteristics of DAMA patients and the differences between them and non-DAMA patients. We reviewed data collected by the National Emergency Medical Center between 2010 and 2011. Subjects were categorized into 2 groups, namely, the DAMA group and the non-DAMA group. We compared these groups with respect to age, gender, trauma or non-trauma status, type of hospital, health insurance, level of consciousness on admission, and diagnosis. Of 8,000,529 patients, 222,389 (2.78%) left against medical advice. The risk factors for DAMA across all age groups were as follows: no medical insurance (odds ratio [OR], 1.993), initial response to voice (OR, 2.753) or pain (OR, 2.101), trauma admission (OR, 1.126), admission to a local emergency medical center (OR, 1.215), and inc...
2021
Background Patient abandonment in the emergency department has been reported in various parts of the world although the implications and social circumstances may vary in context to its definition. The current study intends to review the characteristics of twenty- four (24) abandoned patients in the emergency department of tertiary care hospital of Eastern Nepal. Methods This was a prospective observational study conducted among all abandoned patients presenting to tertiary care hospital in eastern Nepal from July 2018 to July 2020. Results Twenty four (24) patients were enrolled in the study. 22 (91.7%) were male and 2 (8.3%) were female with a mean age of 43.2 ± 14.4SD. The median length of stay (LOS) was 72 (Q1, Q3, 23.5, 960) hours in the emergency department. Seven, 7 (43.75%) cases of mortality were due to medical illness, 4 (25%) cases of mortality were due to surgical illness and 5 (31.25%) cases of mortality were with undifferentiated presentations (p= 0.012). 15 of 24 (62.5...
Journal of Medical Ethics and History of Medicine, 2020
Discharge against medical advice (DAMA) is a common problem in the health-care system. It imposes risks to both patients and medical staff and could be the subject of ethical deliberation. This cross-sectional study was conducted in 2017 on 400 patients who were discharged against medical advice from the emergency ward of Shariati Hospital, Tehran, Iran. Patients’ information was collected using clinical records and telephone calls. The collected data were analyzed using STATA software. DAMA rate was 12% in the emergency department of Shariati Hospital. Male gender was found to be a risk factor for DAMA (OR: 1.90; CI (95%): 1.44 - 2.52; P < 0.0001). In addition, younger patients were more likely to leave hospital against medical advice (p-value: 0.04). The more common reasons for DAMA were feeling better, long delay in diagnostic and therapeutic procedures and the hectic ambience of the emergency ward. Patients’ self-discharge is a multi-dimensional phenomenon that is affected by...
Factors influencing discharge against medical advice (DAMA) cases at a multispecialty hospital
Journal of family medicine and primary care , 2019
Introduction: In Healthcare industry the patient’s perception of quality of service positively influences patient satisfaction, which in turn influences choice of healthcare provider and when the patient is dissatisfied with the care provided it leads to discharge against medical advice. Objectives: Therefore the purpose of this study is to identify the complex reasons for discharge against medical advice (DAMA). Further this study intends to find out the major diagnostic categories in terms of discharge against medical advice. Methods: The study conducted was descriptive in nature and involved in analyzing the reasons for discharge against medical advice among patients in emergency department. There were 91 patients out of total 200 patients who visited emergency department discharged against medical advice. Data collected through interview scheduling and questionnaire. Results: It was found that almost every patient were aware about the costs related in DAMA. Old age patients who are above 60 years of age constituted more (46%). 31 percent of DAMA patients left the hospital for affordability issue, 8 percent preferred other hospital for known physicians, 2 percent preferred other hospital for accessibility. Around 50 percent of patients who left against medical advice were due to Financial Constraints, 26 percent were not willing to proceed with the treatment, and others are due to distance, no progress and other personal reasons. Conclusion: Study concludes that every effort should be made to encourage the patient to stay under the care of the physician. To increase awareness of the patients regarding the dangers and consequences of leaving the hospital, effective communication should be established and strengthened between patients, physician and other medical staff.
2019
Patients taking Discharge Against Medical Advice have an increased risk of hospital readmission, morbidity, mortality, which leads to increase in healthcare costs and puts an undue burden on the healthcare system due to an inadequately treated initial condition. Studies on the incidence, predictors and outcomes of DAMA have been limited in Indian settings. Studying the correlates of DAMA can help in interventions with an aim to reduce the rate of DAMA, increase patient satisfaction, and improve the quality of patient care and services provided at the hospital. Materials and Methodology: This study was a retrospective cross-sectional study and was carried out in a 700 bed multi-speciality tertiary care hospital in Kolkata from January 2018 to October 2019. From, 68,010 patients admitted in the hospital during the said period, 2028 patients took DAMA. Data for the study was collated and entered into SPSS-v19 software. Frequencies and percentages were used to report the results of the ...