Indian Journal of Critical Care Medicine

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Related articles

VOLUME 23 , ISSUE 3 ( March, 2019 ) > List of Articles

ORIGINAL ARTICLE

Retrospective Evaluation of Patients Leaving against Medical Advice in a Tertiary Care Teaching Hospital

Rubina K Mahajan, Gunchan Paul

Keywords : Discharge against medical advice, Leave against medical advice

Citation Information : Mahajan RK, Paul G. Retrospective Evaluation of Patients Leaving against Medical Advice in a Tertiary Care Teaching Hospital. Indian J Crit Care Med 2019; 23 (3):139-142.

DOI: 10.5005/jp-journals-10071-23137

License: CC BY-NC 4.0

Published Online: 01-03-2019

Copyright Statement:  Copyright © 2019; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Context: Leaving against medical advice (LAMA) is a worldwide healthcare problem, occurring due to various contributing factors, seen more commonly in developing countries like ours. Aims: To retrospectively study the prevalence of LAMA alongwith its affecting factors. Settings and Design: We screened the hospital record for one year, of a tertiary care teaching hospital, after obtaining approval from the institutional ethical committee. Patient demography, disease characteristics and status at the time of LAMA were noted and statistically analysed. Results: During the study period, 4.95% patients took LAMA.The mean age was 47.2±21 years (range newborn to 103 years) with 2:1 Male: Female ratio. Forty nine percent of patients resided in rural areas and around 1/3rd were dependent on others for their living. The mean length of stay in hospital was 6.1±9.3 days. Around 60% patients required mechanical ventilation and 51% patients had been explained guarded prognosis. About 53% of patients taking LAMA were admitted in medical wards, trauma being the most common diagnosis (17.2%). History of alcohol abuse and poisoning with suicidal intent was seen in 11.47% and 3.9% respectively. Conclusions: The number of patients taking LAMA from our country is quite high. This necessitates formulation and implementation of strategies to reduce the prevalence of AMA discharges like further investigations to look into the causes contributing to patients taking LAMA, attending to substance abuse issues, recognizing psychological factors & strengthening the social systems, encouraging insurance cover, helping patients’ treatment expenses through charity care and optimizing healthcare delivery and patient centred policies. Key Messages: LAMA is a global health issue precipitated by unemployment and alcohol abuse, commonly taken due to financial reasons. This necessitates a strong social system and national health insurance schemes to reduce the cost of treatment.


PDF Share
  1. Jimoh BM, Anthonia O, Chinwe I, Oluwafemi A, Ganiyu A, Haroun A et al. Prospective Evaluation of Cases of Discharge against Medical Advice in Abuja, Nigeria. Scientific World Journal 2015;2015:314817.
  2. Alfandre DJ. “I’m Going Home”:Discharges Against Medical Advice. Mayo Clin Proc 2009;84:255-60.
  3. Gautam N, Sharma JP, Sharma A, Verma v, Arora P, Gautam PL. Retrospective Evaluation of Patients Who Leave against Medical Advice in a Tertiary Teaching Care Institute. Indian J Crit Care Med 2018;22:591-596.
  4. Eze B, Agu K, Nwosu AJ. Discharge against medical advice at a tertiary center in southeastern Nigeria: sociodemographic and clinical dimensions. Patient Intell 2010;2:27–31.
  5. Ti L, Miloy M, 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
  6. Smith DB, Telles JL. Discharges against Medical Advice at Regional Acute Care Hospitals. Am J Public Health1991;81:212-5.
  7. 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;25:13.
  8. Paul G, Gautam PL, Khullar R, Paul BS. Prospective Evaluation of Patients Leaving against Medical Advice of a Tertiary Care Hospital: Comparison of Emergency and Intensive Care Units. Int J Med. Public Health 2018;8:18-23.
  9. Jeong J, Song KJ, Kim YJ, Cho JS, Park JO, Lee SC etal. The association between acute alcohol consumption and discharge against medical advice of injured patients in the ED. Am J Emerg Med 2016;34:464-8.
  10. Ti L, Leaving the Hospital Against Medical Advice Among People Who Use Illicit Drugs: A Systematic Review. Am J Public Health 2015;105:e53-9.
  11. David Alfandre. Reconsidering Against Medical Advice Discharges: Embracing Patient-Centeredness to Promote High Quality Care and a Renewed Research Agenda. J Gen Intern Med 28:1657–62.
  12. 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.
  13. 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.
  14. Manouchehr J, Goodarzynejad H, Khoshgofta Z, Fathollah MS, Abyaneh MA. Discharge against Medical Advice among Inpatients with Heart Disease in Iran. J Teh Univ Heart Ctr 2012;7:72-77.
  15. Singh T, Sharma S, Nagesh S. Socio-economic status scales updated for 2017. Int J Res Med Sci 2017;5:3264-3267.
  16. Nasir AA, Babalola OM. Clinical spectrum of discharges against medical advice in a developing country. A. Indian J. Surg 2008;70:68– 72.
  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. El-Menyar A, El-Hennawy H, Al-Thani H, Asim M, Abdelrahman H, Zarour A et al. Traumatic injury among females: does gender matter? J Trauma Manag Outcomes 2014;8:8.
  19. Census 2011 [Internet]. Punjab religion Census 2011. [cited 2018 Dec 25]. Available from https://www.census2011.co.in/data/religion/ state/3-punjab.html.
  20. Census of India 2011 [Internet]. Rural urban distribution of population (provisional population totals). [cited 2018 Dec 25]. Available from http://censusindia.gov.in/2011-prov-results/paper2/data_files/india/ Rural_Urban_2011.pdf.
  21. Jung JH, Kim DK, Jung JY, Lee JH, Kwak YH. Risk Factors of Discharged Against Medical Advice among Adolescents Self-inflicted Injury and Attempted Suicide in the Korean Emergency Department. J Korean Med Sci 2015;30:1466-70.
  22. Karimi SAP, Saravi BM, Farahabbadi EB, Zamanfar D, Fallah M, Abokheily MA. Studying the Rate and Causes of Discharge Against Medical Advice in Hospitals Affiliated to Mazandaran University of Medical Sciences. Mater Sociomed 2014;26:203-7.
  23. 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.
  24. Richard Saitz. Discharges against medical advice:time to address the causes. CMAJ 2002;167(6):647-8.
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.