Rate and Causes of Discharge Against Medical Advice From a University Hospital Emergency Department in Iran: An Ethical Perspective



Halvaei SR¹ ; Vahedi HSM² ; Ahmadi A³ ; Mousavi MS⁴ ; Parsapoor A⁵ ; Sima AR⁶ ; Shojaei AA^{5, 7} ; Shamsigooshki E⁵ Show Affiliations
Source: Journal of Medical Ethics and History of Medicine Published:2020

Abstract

Discharge against medical advice (DAMA) is a common problem in the health-care system. It imposes risks to both patients and medical staff and could be the subject of ethical deliberation. This cross-sectional study was conducted in 2017 on 400 patients who were discharged against medical advice from the emergency ward of Shariati Hospital, Tehran, Iran. Patients’ information was collected using clinical records and telephone calls. The collected data were analyzed using STATA software. DAMA rate was 12% in the emergency department of Shariati Hospital. Male gender was found to be a risk factor for DAMA (OR: 1.90; CI (95%): 1.44-2.52; P < 0.0001). In addition, younger patients were more likely to leave hospital against medical advice (p-value: 0.04). The more common reasons for DAMA were feeling better, long delay in diagnostic and therapeutic procedures and the hectic ambience of the emergency ward. Patients’ self-discharge is a multi-dimensional phenomenon that is affected by patients’ characteristics, medical conditions and hospital circumstances. It raises some ethical concerns, mainly due to a conflict between patients’ autonomy and beneficence. It is helpful for the medical staff to create an effective relationship with patients who are at higher risk of DAMA, in order to increase their compliance and prevent the consequences of leaving hospital against medical advice. © 2020 Medical Ethics and History of Medicine Research Center, Tehran University of Medical Sciences. All rights reserved.