Factors Affecting Discharges against Medical Advice in an Emergency Department of a Tertiary Care Center

Abstract

ABSTRACT

Introduction: Patients leaving against the advice of the treating team before being certified as fit is a major concern and challenge for the treating professionals as it possesses adverse medical outcomes. This study hence aimed at identifying the prevalence and major factors affecting such discharges so that advocacy can be done to help prevent it.

Methods: A descriptive cross-sectional study was conducted at emergency department of a tertiary center in Lalitpur. All the patients visiting the emergency department were included in the study and a non-probability purposive sampling method was used, excluding the patients who denied giving reasons for them leaving against medical advice. Data was collected using pre-structured questionnaire and analyzed using SPSS-v21 software.

Results: The prevalence rate was 4.08% with highest rates in male patients (54.8%), age group of 15-44 years (65.2%) and those living within a distance of 1km from the hospital (53%). The most common reason for the patients leaving against medical advice was found to be due to financial constraint (38.3%) followed by preference to other hospitals (16.5%) despite their triage category (45% being in emergent and urgent category).

Conclusion: Patients leaving against medical advice possesses a small percentage of actual hospital admissions but is still a major health concern as it drastically increases the morbidity, re-admission rates and total health-care costs. Hence, understanding the general characteristics and predictors of such discharges is of utmost importance to help improve the patient outcome and reduce the health-care costs.

Keywords: Discharge, against medical advice, emergency department