Rate and causes of discharge against medical advice from a university hospital emergency department in Iran: an ethical perspective

  • Sanaz Rouhbakhsh Halvaei ORCID Researcher, Medical Student at Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
  • Hojat Sheikh Motahar Vahedi ORCID Associate Professor, Faculty of Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
  • Ayat Ahmadi ORCID Assistant Professor, Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran.
  • Maryam Sadat Mousavi ORCID Researcher, Medical Ethics Supervisor, Medical Ethics and Professionalism Office, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
  • Alireza Parsapoor ORCID Assistant Professor, Medical Ethics and History of Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Medical Ethics, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
  • Ali Reza Sima ORCID Assistant Professor, Digestive Disease Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
  • Amir Ahmad Shojaei ORCID Assistant Professor, Medical Ethics and History of Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Medical Ethics, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
  • Ehsan Shamsi-Gooshki ORCID Mail Assistant Professor, Medical Ethics and History of Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Medical Ethics, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Keywords:
Discharge against medical advice (DAMA); Emergency department; Iran; Medical ethics.

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.

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Published
2020-09-28
How to Cite
1.
Rouhbakhsh Halvaei S, Sheikh Motahar Vahedi H, Ahmadi A, Mousavi MS, Parsapoor A, Sima A, Shojaei A, Shamsi-Gooshki E. Rate and causes of discharge against medical advice from a university hospital emergency department in Iran: an ethical perspective. J Med Ethics Hist Med. 13.
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Original Article(s)