Discharge against medical advice in emergency department of a general hospital in Tehran
Journal Title: International Research Journal of Applied and Basic Sciences - Year 2013, Vol 5, Issue 12
Abstract
Patients with against medical advice (AMA) discharge, are exposed to the risk of getting inadequate treatment and readmission. In The present study we studied AMA discharge rate and its reasons in addition to evaluating the effect of a consultation program on AMA discharge rate in Shohada-e-Tajrish hospital in Tehran. In two comparable consecutive periods of 12 weeks between Feb. and Jul. 2010, patients who decided to sign out of the emergency ward of Shohada-e-Tajrish hospital in Tehran Against medical advice (AMA), were invited to participate in this study. During the first period, A questionnaire was used to interview the participants for their reasons to leave the hospital. In the second period, the patients were also consulted by a physician and a trained nurse before discharge. AMA discharge rate and reasons of discharge was compared between the two study periods. Among 12843 patients who referred to the emergency department, 1516 patients (11.8%) were discharged with self-consent (Against Medical Advice). The main reasons for leaving the hospital against medical advice were: feeling better (78%) and looking for better care in another center, In the intervention group, 1178 of 14001 patients left the hospital against medical advice and the AMA discharge rate dropped to 9.41%. The main reason behind this decision was still feeling better which dropped to 84.4% of patients. However, the second most frequent reason (looking for better service in another hospital) slightly increased. AMA discharge poses a serious problem which may be addressed and decreased by properly educating the patients on the associated risks. More studies on the outcome of AMA discharge including quantitative studies are necessary to clarify all aspects of this risky phenomenon in emergency wards.
Authors and Affiliations
Mohammad Mehdi Forouzanfar (MD)| Assistant Professor of Emergency Medicine, Department of Emergency Medicine, Shohadaye Tajrish Medical Center, Shahid Beheshti University of Medical Sciences., Behrooz Hashemi (MD)*| Assistant Professor of Emergency Medicine, Department of Emergency Medicine, Shohadaye Tajrish Medical Center, Shahid Beheshti University of Medical Sciences. , Alireza Baratloo (MD)| Assistant Professor of Emergency Medicine, Department of Emergency Medicine, Shohadaye Tajrish Medical Center, Shahid Beheshti University of Medical Sciences., Ali Arhamodolatabadi (MD)| Assistant Professor of Emergency Medicine, Department of Emergency Medicine, Imam Hossein Medical Center, Shahid Beheshti University of Medical Sciences., Hamidreza Hatamabadi (MD)| Assosiated Professor of Emergency Medicine, Department of Emergency Medicine, Imam Hossein Medical Center, Shahid Beheshti University of Medical Sciences., Ali Shahrami (MD)| Assistant Professor of Emergency Medicine, Department of Emergency Medicine, Imam Hossein Medical Center, Shahid Beheshti University of Medical Sciences., Saeed Safari (MD)| Assistant Professor of Emergency Medicine, Department of Emergency Medicine, Shohadaye Tajrish Medical Center, Shahid Beheshti University of Medical Sciences.
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