Reasons for Discharge against Medical Advice: A Case Study of Emergency Departments in Iran

International Journal of Health Policy and Management, 2013, 1, 1-7

7 Pages Posted: 8 Jul 2013

See all articles by Kaveh Noohi

Kaveh Noohi

Kerman University of Medical Sciences

Samaneh Komsari

Kerman University of Medical Sciences

Nouzar Nakhaee

Kerman University of Medical Sciences

Vahid Yazdi

Kerman University of Medical Sciences

Date Written: July 2, 2013

Abstract

Background: Incomplete hospitalization is the cause of disease relapse, readmission, and increase in medical costs. Discharge Against Medical Advice (DAMA) in emergency department (ED) is critical for hospitals. This paper aims to explore the underlying reasons behind DAMA in ED of four teaching hospitals in Kerman, Iran.

Methods: This was a cross-sectional study in which the samples were drawn from the patients who chose to leave against medical advice from the ED of teaching hospitals in Kerman from February to March 2011. The sampling was based on census. Data were gathered by a researcher-constructed questionnaire. The reasons for DAMA were divided into three parts: reasons related to patient, medical staff, and hospital environment. The questionnaire was filled out by a face-to-face interview with patient or a reliable companion.

Results: There were 121 cases (5.6%) of DAMA out of the total admissions. The main reason of AMA discharges was related to patient factors in 43.9% of cases, while two other factors (i.e., hospital environment and medical staff) constituded 41.2% and 35.2% of cases, respectively. The majority of patients 65.9% (80 cases) were either uninformed or less informed of the entailing side effects and outcomes of their decision to discharge against medical advice.

Conclusion: In comparison to studies conducted in other countries, the rate of DAMA is markedly higher in Iran. The results revealed that patients awareness of the consequences of their decisions is evidently inadequate. The study suggests a number of recommendations. These include, increasing patient awareness of the potential side effects of DAMA and creating the necessary culture for this, improving hospital facilities, and a more careful supervision of medical staff performance.

Suggested Citation

Noohi, Kaveh and Komsari, Samaneh and Nakhaee, Nouzar and Yazdi, Vahid, Reasons for Discharge against Medical Advice: A Case Study of Emergency Departments in Iran (July 2, 2013). International Journal of Health Policy and Management, 2013, 1, 1-7. Available at SSRN: https://ssrn.com/abstract=2289007

Kaveh Noohi (Contact Author)

Kerman University of Medical Sciences ( email )

Kerman
Iran

HOME PAGE: http://ijhpm.kmu.ac.ir

Samaneh Komsari

Kerman University of Medical Sciences ( email )

Kerman
Iran

HOME PAGE: http://ijhpm.kmu.ac.ir

Nouzar Nakhaee

Kerman University of Medical Sciences ( email )

Kerman
Iran

HOME PAGE: http://ijhpm.kmu.ac.ir

Vahid Yazdi

Kerman University of Medical Sciences ( email )

Kerman
Iran

HOME PAGE: http://ijhpm.kmu.ac.ir

Register to save articles to
your library

Register

Paper statistics

Downloads
23
Abstract Views
222
PlumX Metrics