Indian Journal of Critical Care Medicine

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Related articles

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

RESEARCH ARTICLE

Retrospective evaluation of patients who leave against medical advice in a tertiary teaching care institute

Anita Sharma, Poonam Arora, Vivek Verma, Nikhil Gautam, J.P. Sharma, Parshotam Lal Gautam

Keywords : Discharge against medical advice, emergency ward, leave against medical advice

Citation Information : Sharma A, Arora P, Verma V, Gautam N, Sharma J, Gautam PL. Retrospective evaluation of patients who leave against medical advice in a tertiary teaching care institute. Indian J Crit Care Med 2018; 22 (8):591-596.

DOI: 10.4103/ijccm.IJCCM_375_17

License: CC BY-ND 3.0

Published Online: 00-08-2018

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


Abstract

Context: Discharge against medical advice or leave against medical advice (DAMA or LAMA) is a global phenomenon. The magnitude of LAMA phenomenon has a wide geographical variation. LAMA reasons are an area of concern for all involved in health-care delivery system. Aims and Objectives: The study aimed to evaluate cases of LAMA retrospectively in a tertiary teaching care institute (1) to find the magnitude of LAMA cases (2) to evaluate demographic and patient characteristics of these cases. Subjects and Methods: We screened hospital record of a referral institute over 1 year after approval from IEC and ICMR, New Delhi. Patient demographics and disease characteristics were noted and statistically analyzed after compilation. Results: A total of 47,583 patients were admitted in the year 2015 through emergency and outpatient department. One thousand five hundred and fifty-six (3.3%) patients got DAMA. The mean age of patient excluding infants was 46.64 ± 20.55 years. There were 62.9% of males. Average hospital stay of these cases was 4.09 ± 4.39 days. Most of the patients (70%) belonged to medical specialties and had longer stay as compared to surgical specialties. Most of LAMA patients were suffering from infections, trauma, and malignancies. Most of the patients had LAMA from ward (62%) followed by Intensive Care Unit (ICU) (28.8%) and emergency (9.2%). In 592 (38%) of LAMA patients, the reason for leaving was not clear. The common cited reasons for LAMA were financial (27.6%) and poor prognosis (20.5%). Conclusions: About 3.3% of patients left hospital against medical advice in our retrospective analysis. Most of these cases did so from ward followed by ICU. Financial reasons and expected poor outcome played a significant role.


PDF Share
  1. Alfandre DJ. “I'm going home”: Discharges against medical advice. Mayo Clin Proc 2009;84:255-60.
  2. Jimoh BM, Anthonia OC, Chinwe I, Oluwafemi A, Ganiyu A, Haroun A, et al. Prospective evaluation of cases of discharge against medical advice in Abuja, Nigeria. ScientificWorldJournal 2015;2015:314817.
  3. Eze B, Agu K, Nwosu J. Discharge against medical advice at a tertiary centre in South Eastern Nigeria: Sociodemographic and clinical dimensions. Patient Intell 2010;2:27-31.
  4. Nasir AA, Babalola OM. Clinical spectrum of discharges against medical advice in a developing country. Indian J Surg 2008;70:68-72.
  5. Naderi S, Acerra JR, Bailey K, Mukherji P, Taraphdar T, Mukherjee T, et al. Patients in a private hospital in India leave the emergency department against medical advice for financial reasons. Int J Emerg Med 2014;7:13.
  6. Aliyu ZY. Discharge against medical advice: Sociodemographic, clinical and financial perspectives. Int J Clin Pract 2002;56:325-7.
  7. Ti L, Milloy MJ, Buxton J, McNeil R, Dobrer S, Hayashi K, et al. Factors associated with leaving hospital against medical advice among people who use illicit drugs in vancouver, Canada. PLoS One 2015;10:e0141594.
  8. Glasgow JM, Vaughn-Sarrazin M, Kaboli PJ. Leaving against medical advice (AMA): Risk of 30-day mortality and hospital readmission. J Gen Intern Med 2010;25:926-9.
  9. Southern WN, Nahvi S, Arnsten JH. Increased risk of mortality and readmission among patients discharged against medical advice. Am J Med 2012;125:594-602.
  10. Azami-Aghdash S, Abolghasem-Gorji H, Moradi-Joo M, Alamspour H, Royani S. Frequency and causes of discharges against medical advice from hospital cardiac care units of East Azerbaijan, Iran. J Anal Res Clin Med 2016;4:90-6.
  11. Azami-Aghdash S, Mohseni M, Etemadi M, Royani S, Moosavi A, Nakhaee M, et al. Prevalence and cause of self-medication in Iran: A systematic review and meta-analysis article. Iran J Public Health 2015;44:1580-93.
  12. Brook M, Hilty DM, Liu W, Hu R, Frye MA. Discharge against medical advice from inpatient psychiatric treatment: A literature review. Psychiatr Serv 2006;57:1192-8.
  13. Mohseni M, Alikhani M, Tourani S, Azami-Aghdash S, Royani S, Moradi-Joo M, et al. Rate and causes of discharge against medical advice in Iranian hospitals: A systematic review and meta-analysis. Iran J Public Health 2015;44:902-12.
  14. Manouchehri J, Goodarzynejad H, Khoshgoftar Z, Sheikh Fathollahi M, Aghamohammadi Abyaneh M. Discharge against medical advice among inpatients with heart disease in Iran. J Tehran Heart Cent 2012;7:72-7.
  15. El Sayed M, Jabbour E, Maatouk A, Bachir R, Dagher GA. Discharge against medical advice from the emergency department: Results from a tertiary care hospital in Beirut, Lebanon. Medicine (Baltimore) 2016;95:e2788.
  16. Marcoux J, Alkutbi M, Lamoureux J, Feyz M, Saluja RS, de Guise E, et al. Discharge against medical advice in traumatic brain injury: Follow-up and readmission rate. Can J Neurol Sci 2017;44:311-7.
  17. Myers RP, Shaheen AA, Hubbard JN, Kaplan GG. Characteristics of patients with cirrhosis who are discharged from the hospital against medical advice. Clin Gastroenterol Hepatol 2009;7:786-92.
  18. Muthusamy AK, Cappell MS, Manickam P, Levine DL. Risk factors for discharge against medical advice in patients with UGI bleeding or abdominal pain: A study of 170 discharges against medical advice among 11,996 emergency department visits. Minerva Gastroenterol Dietol 2015;61:185-90.
  19. Tabatabaei SM, Sargazi Moakhar Z, Behmanesh Pour F, Shaare Mollashahi S, Zaboli M. Hospitalized pregnant women who leave against medical advice: Attributes and reasons. Matern Child Health J 2016;20:128-38.
  20. Fiscella K, Meldrum S, Franks P. Post partum discharge against medical advice: Who leaves and does it matter? Matern Child Health J 2007;11:431-6.
  21. Shirani F, Jalili M, Asl-E-Soleimani H. Discharge against medical advice from emergency department: Results from a tertiary care hospital in Tehran, Iran. Eur J Emerg Med 2010;17:318-21.
  22. Franks P, Meldrum S, Fiscella K. Discharges against medical advice: Are race/ethnicity predictors? J Gen Intern Med 2006;21:955-60.
  23. Smith DB, Telles JL. Discharges against medical advice at regional acute care hospitals. Am J Public Health 1991;81:212-5.
  24. Ibrahim SA, Kwoh CK, Krishnan E. Factors associated with patients who leave acute-care hospitals against medical advice. Am J Public Health 2007;97:2204-8.
  25. Devitt PJ, Devitt AC, Dewan M. An examination of whether discharging patients against medical advice protects physicians from malpractice charges. Psychiatr Serv 2000;51:899-902.
  26. Ayed IA. What makes patients leave against medical advice? J Taibah Univ Med Sci 2009;4:16-22.
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.