Journal of Evidence Based Health Policy, Management & Economics (Sep 2018)

Evaluation of Discharge Against Medical Advice in Victims of Traffic Accidents at the Emergency Department: A Case study

  • Behrooz Pouragha,
  • Roya Rajaee,
  • Marziye Najafi

Journal volume & issue
Vol. 2, no. 3
pp. 202 – 207


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Background: Annually in the world 2.1 million people are killed and more than 50 million people are either injured or disabled in road accidents. Discharge against medical advice (DAMA) has increased risk of morbidity and mortality. This study aimed to evaluate the rate and reasons for DAMA in the traffic accident victims at the emergency department (ED) to provide solutions in reducing its complications. Methods: This is a descriptive and cross-sectional study. The population in this study consisted of the victims of traffic accidents referred to the ED of Imam Khomeini Hospital affiliated by Tehran University of Medical Sciences. The random sampling method was usedand by Cochran formula 147 people were selected and examined for two months. In order to evaluate the validity of checklists, 10 patients were randomly assigned to call and the cause of discharge was requested. Data collection was done through DAMA checklist in the patients’ documents. The finding were entered into spss16 for descriptive statistics and analysis. Results: Most of traffic accident victims (79.6%) discharged with physicians’ recommendations. The DAMA was 17.7% and 2.7% escaped from hospital. In all of patients’ DAMA (26), 46.15 percentage was about all four reasons, 23.08 percentage was treatment reason, and the last reason was due to hospitalized issues (3.85%). Conclusion: Among the four causes of DAMA, treatment problems was higher than others. Patients’ participation in the selection of treatment and focusing on medical equipment are recommended. It is a challenge to the quality of health care services when patients do not adhere to their physicians’ recommendations for treatment.