Factors influencing discharge against medical advice (DAMA) cases at a multispecialty hospital

Abstract

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.

Keywords

• discharge against medical advice
• patients
• root cause analysis