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VOLUME 22 , ISSUE 8 ( 2018 ) > List of Articles

RESEARCH ARTICLE

What happens to patients discharged against medical advice?

Babu K. Abraham, Senthilkumar Rajagopalan

Keywords : APACHE score, Critical Care Unit, discharge against medical advice, mortality, standard mortality rate

Citation Information : Abraham BK, Rajagopalan S. What happens to patients discharged against medical advice?. Indian J Crit Care Med 2018; 22 (8):580-584.

DOI: 10.4103/ijccm.IJCCM_101_18

License: CC BY-ND 3.0

Published Online: 01-08-2018

Copyright Statement:  Copyright © 2018; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Introduction: Discharge against medical advice (DAMA) when requested by family members of patients in Indian Critical Care Units (CCUs) leads to loss of follow-up and unknown patient outcomes. Exclusion of these patients from research analysis and quality audits confounds these results. We hence explored the proportion of patients leaving DAMA, reasons, and their outcomes at 30 and 90 days. Methods: This was a prospective study of CCU patients admitted from July 2013 to February 2014. All patients, who were DAMA during this period, were included in this study. Demographics, APACHE data, and outcomes were collected and compared to patients discharged regularly during the same period. Outcomes of DAMA patients at 30 and 90 days were gathered by telephone follow-up. Results: Among the 663 patients admitted to the CCU, 15.1% (100 patients) were DAMA. The baseline APACHE score of the DAMA group was higher than the regular discharge group (29.5 ± 8.6 vs. 26.1 ± 10.3; P = 0.002). During the 30-day follow-up, 23% were alive, 56% dead, and 21% could not be contacted. At 90 days, mortality was 62% and survivors decreased to 14%. Common reasons for DAMA were – wanting to take the patient to another hospital (21%), reluctance for further treatments (12%), financial constraints (9%), and overall poor prognosis (7%). Conclusion: A significant proportion of patients in the CCU get DAMA despite high severity of illness. Understanding the outcomes of these patients will help refine CCU quality audit reports and research study results.


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