Publication: Discharge against medical advice in emergency department Hospital Universiti Sains Malaysia; Associated factors, reasons, and short term follow up rate
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Date
2020
Authors
Mukhtar, Faizatul Anum
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Abstract
Introduction: Discharge against medical advice (DAMA) is studied worldwide in multiple setting alongside the quality improvement of health service delivery. There were currently limited studies on DAMA in the emergency department in Malaysia. This study aims to look at the prevalence of DAMA in the study setting, their associated factors, reasons, and short term follow up rate. Methods: This was a prospective case-control study among 264 patients (88 cases and 176 control) over a three- month period of June 2019 until August 2019 in Emergency Department (ED) of Hospital Universiti Sains Malaysia, Kelantan. Consented phone call interviews were conducted day three to day five after the discharge of DAMA patients to find out on any 72-hour follow-up to any health facility and their reason for DAMA. Results: Prevalence of DAMA in ED was 6.36 in 1000 patient population. When adjusted with other confounding factors, in every year increase of age, the odds of having DAMA was 8% higher (AOR: 1.08, 95% CI: 1.01 - 1.17), and female was lower compared to male (AOR: 0.27, 95% CI: 0.12 - 0.62). For the interaction effect between age and triage, the odds of having DAMA was 9% lower (AOR: 0.91, 95% CI: 0.83 - 0.99) in green zone patients interacting with increasing age compared to the red zone. DAMA was 35% higher (AOR: 1.35, 95% CI: 1.00 - 1.82) in green zone patients interacting with the increasing length of stay in ED compared to red zone patients. One-fifth of DAMA patient came for short term follow up, and most others were well. DAMA were due to socioeconomic reasons mostly, but the highest percentage of reason subcategory expressed for DAMA was the 'relief of symptoms or feeling well'. Conclusion: DAMA was associated with increasing age, male patient, and interaction of triage factor to the age and length of stay in the hospital. Although the prevalence of DAMA was low, tailored finding in the studied facility could prompt further improvisation in administrative and practice setting by further understanding of DAMA associated factors and reasoning
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Keywords
discharge against medical advice , emergency department