DISCHARGE AGAINST MEDICAL ADVICE IN EMERGENCY DEPARTMENT HOSPITAL UNIVERSITI SAINS MALAYSIA; ASSOCIATED FACTORS, REASONS, AND SHORT-TERM FOLLOW-UP RATE

Authors

  • Wan Syahmi Wan Mohamad Department of Emergency Medicine, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia
  • Faizatul Anum Mukhtar Hospital Kuala Lipis, 27200 Lipis, Pahang, Malaysia
  • Nik Hisamuddin Department of Emergency Medicine, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia
  • Mohamad Masykurin Department of Emergency Medicine, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia
  • Mohd Faiz Mohd Shukri Department of Emergency Medicine, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia

Abstract

Discharge against medical advice (DAMA) is a topic of global study. However, research on DAMA within Malaysian emergency departments (EDs) is limited. This study examines DAMA prevalence, associated factors, causes, and short-term follow-up rates. This was a prospective case-control study involving 264 patients (88 cases and 176 controls) at the ED of Hospital Universiti Sains Malaysia (HUSM) over a three-month period. Consent was obtained for phone interviews conducted a few days after the discharge of DAMA patients to determine 72-hour follow-up rates and the reasons behind DAMA. DAMA’s prevalence was 6.36 per 1000 patients in the ED. The odds of having DAMA increased by 8% for each year of age (AOR: 1.08, 95% CI: 1.01 - 1.17), and the likelihood of DAMA was lower for females compared to males (AOR: 0.27, 95% CI: 0.12 - 0.62). In the interaction effect between age and triage, the odds of DAMA were 9% lower in green zone patients with increasing age (AOR: 0.91, 95% CI: 0.83 - 0.99) compared to red zone patients. DAMA was 35% higher in green zone patients with an increasing length of stay in ED (AOR: 1.35, 95% CI: 1.00 - 1.82) than red zone patients. One-fifth of DAMA patients returned for short-term follow-up, with most others reported to be fine. The most stated reason for DAMA was relief of symptoms or feeling well. DAMA was found to be associated with increasing age, male patient, and interaction of triage factor to the age and length of stay in the hospital. Although the prevalence of DAMA was low, tailored findings from the studied facility may warrant prompt improvisation.

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Published

2023-12-28

How to Cite

Wan Mohamad, W. S., Mukhtar, F. A., Nik Abdul Rahman, N. H., Mafauzy, M. M., & Mohd Shukri, M. F. (2023). DISCHARGE AGAINST MEDICAL ADVICE IN EMERGENCY DEPARTMENT HOSPITAL UNIVERSITI SAINS MALAYSIA; ASSOCIATED FACTORS, REASONS, AND SHORT-TERM FOLLOW-UP RATE. Malaysian Journal of Public Health Medicine, 23(3), 28–36. Retrieved from https://mjphm.org/index.php/mjphm/article/view/2035