Reasons for Discharge against Medical Advice among Patients Admitted to Ghaem Research-Training and Medical Center of Mashhad, Iran, in 2015

Introduction: Discharge against medical advice (DAMA) indicates the existence of serious problems in the quality of hospital services, which can exacerbate the disease and increase the risk of hospital readmission. This study was targeted toward examining the reasons for DAMA among the patients admitted to Ghaem Hospital of Mashhad, Iran, in 2015. Materials and Methods: This cross-sectional, descriptive study was conducted on 6,645 patients discharged from the Ghaem Hospital of Mashhad with their own personal desire in the first 9 months of 2015. Data collection was performed using the information recorded in the health information system of the hospital; in addition, the required information which was not available in this system were obtained via making a telephone call with the respondents. The data were analyzed using descriptive statistics in SPSS, version 22. Results:Out of the 53,558 patients admitted to Ghaem Hospital of Mashhad in the first nine months of 2015, 6,645 (12.4%) cases were discharged with their own desire. Regarding the reasons of DAMA, 13.1% and 86.7% of the patients had called for DAMA due to the reasons related to hospital and personal issues, respectively. Accordingly, the main reasons for DAMA were categorized into patient- and hospital-related reasons, including patient s personal and family reasons (41.8%) and overcrowding of wards (6.6%), respectively. Conclusion: Improved communication between physician and patient, patient’s increased awareness regarding the probable complications of early discharge, improved quality of hospital services, use of clinical aids, and designing green space and a pleasant environment are the recommended strategies to reduce the rate of DAMA.

Keywords:

Discharge against medical advice , Hospital services , Quality Improvement