The Influence of Hospital Image and Service Quality on Discharge Against Medical Advice through Patient Satisfaction

The purpose of this study is to examine the impact of hospital image and quality of service on Discharge Against Medical Advice (DAMA) via patient satisfaction at Majene District Hospital. This research was performed in the hospital room of the Majene District Hospital from July to August 2020. The type of analysis used is quantitative research to explain the dependent variable's effect on the independent variable and the mediating variable. This study population was all 102 patients with DAMA at Majene Hospital, as the population was deemed limited and the whole population was sampled. The test results of the coefficient of determination of the path analysis of substructure 1 resulted in a modified R square value of 0.235. In this case, it is argued that patient satisfaction is affected by the hospital picture and quality of service by 23.5 percent. In comparison, the remaining 76.5 percent is influenced by other variables not analysed in this review. The outcome of the measurement of standardized beta coefficients, the effect of the hospital picture (X1) on patient satisfaction (Y1) is 0.228, and the service quality (X2) on patient satisfaction (Y1) is 0.325.

Pediatric Discharge From the Emergency Department Against Medical Advice

In this Ethics Rounds we present a conflict regarding discharge planning for a febrile infant in the emergency department. The physician believes discharge would be unsafe and would constitute a discharge against medical advice. The child’s mother believes her son has been through an already extensive and painful evaluation and would prefer to monitor her well-appearing son closely at home with a safety plan and a next-day outpatient visit. Commentators assess this case from the perspective of best interest, harm-benefit, conflict management, and nondiscriminatory care principles and prioritize a high-quality informed consent process. They characterize the formalization of discharge against medical advice as problematic. Pediatricians, a pediatric resident, ethicists, an attorney, and mediator provide a range of perspectives to inform ethically justifiable options and conflict resolution practices.

Discharges against medical advice and 30-day healthcare costs: an analysis of commercially insured adults

Aim: Prior literature detailing the consequences of a discharge against medical advice (DAMA) has not focused on costs. We examine costs following a DAMA. Materials & methods: This retrospective cohort study utilized the IQVIA PharMetrics® Plus database to identify adults hospitalized during 2007–2015. We compared 30-day postdischarge healthcare costs between matched DAMA and routinely discharged groups. Results: Thirty-day healthcare costs for the DAMA group were US$1078 (95% CI: US$434–1730) higher, driven by inpatient readmissions (US$979; 95% CI: US$415–1543) and emergency department visits (US$79; 95% CI: US$56–102). Costs due to prescription drug fills were lower in the DAMA group. Conclusion: A DAMA was associated with higher 30-day postdischarge healthcare costs compared with routine discharges.

Neonatal morbidity and mortality: A 5-year analysis at federal medical centre, Gusau, Zamfara State, Northwest Nigeria

Objectives: Neonatal morbidity and mortality have remained embarrassingly high in Nigeria compared to some countries in Sub-Saharan Africa. Nigeria ranked first in the burden of neonatal deaths in Africa. Therefore, there is need to know causes of newborn diseases and deaths in our neonatal unit. The objective of the study was to describe the morbidity and mortality of newborns admitted into Special Care Baby Unit of Federal Medical Centre, Gusau, Nigeria over a 5-year period. Material and Methods: This is a retrospective study covering January 2012 to December 2016. The case folders of all newborns admitted during this period were retrieved and the following information were extracted: Sex of babies, diagnoses, outcome in terms of discharges, deaths, referrals, and discharge against medical advice (DAMA). Results: A total of 3,553 neonates were admitted during the period under review. The sex ratio for males and females was 1.4:1, respectively. The major diagnoses were neonatal sepsis (NNS) 36.5%, birth asphyxia 25.6%, and prematurity 16.1%. Mortality rate was 6.6% with major contributions from birth asphyxia (35.6%), prematurity (28.1%), and NNS (12.0%). DAMA rate was 1.7%. Conclusion: This study has shown that NNS, birth asphyxia, and prematurity are the dominant causes of morbidity and mortality. These are largely preventable.

Factors Influencing Patients to Make the Decision to Discharge Themselves Against Medical Advice at Tertiary Hospitals: A Cross-Sectional Study

Background:DAMA is defined as any instance when a patient wants to leave the hospital against the managing physician's decision.This study aimed to identify the most common factors that influence patients to decide to choose DAMA.Results: Between March and April 2021, 510 responses were collected from participants and included in the analysis. Most of the study participants (31.4%) were over the age of 54. Our findings showed that 12.5% of our participants have had taken discharge against medical advice in the past.Conclusion: The long wait time to be seen by a physician was the major factor that forced patients to leave the emergency department against medical advice.

Factors Influencing Early Readmission after Discharge against Medical Advice from the Emergency Department

Discharge against medical advice (DAMA) and readmissions are important issues worldwide and can lead to adverse clinical outcomes, financial burden, and exposure of healthcare workers to unintended medical disputes. This study aimed to identify factors that affect readmissions within 48 h after DAMA. This retrospective study utilized the medical records of patients who visited an emergency medical center in Korea for treatment and were readmitted during a 10-year period. Factors predicting readmission after being DAMA were identified using logistic regression analysis. The total number of patients who were DAMA during the study period was 5445, of which 351 were readmitted to the emergency department within 48 h (6.4%). Factors influencing readmission included medical aid (odds ratio (OR) = 2.02, 95% confidence interval (CI): 1.46–2.83) and foreign worker insurance (OR = 2.07, 95% CI: 1.04–4.09) as their health insurance, as well as presenting for readmission by car (OR = 1.41, 95% CI: 1.08–1.82). Healthcare workers should treat patients who are DAMA and those who are likely to return with a more careful and preventative management strategy so that potential clinical, legal, and economic impacts of DAMA can be mitigated.

Ethical Issues around Death and Withdrawal of Life Support in Neonatal Intensive Care

Amongst all the traumatic experiences in a human life, death of child is considered the most painful, and has profound and lasting impact on the life of parents. The experience is even more complex when the death occurs within a neonatal intensive care unit, particularly in situations where there have been conflicts associated with decisions regarding the redirection of life-sustaining treatments. In the absence of national guidelines and legal backing, clinicians are faced with a dilemma of whether to prolong life-sustaining therapy even in the most brain-injured infants or allow a discharge against medical advice. Societal customs, vagaries, and lack of bereavement support further complicate the experience for parents belonging to lower socio-economic classes. The present review explores the ethical dilemmas around neonatal death faced by professionals in India, and suggests some ways forward.

Characteristics and outcome of road traffic injured patients in the emergency department of a tertiary teaching hospital in Nigeria

<p class="abstract"><strong>Background:</strong> The exit modes from the emergency department (ED) for road traffic injury patients are namely planned discharge; admission to the wards/intensive care unit or transfer to the operating theatre; discharge against medical advice (DAMA). The aim of this study was to assess the characteristics and outcomes of non-poly-traumatized road traffic injury (RTI) related ED admissions of a tertiary health care facility in a developing country and the exit pattern from the ED.</p><p class="abstract"><strong>Methods:</strong> This was a retrospective hospital data-based study of outcome of RTI patients seen in the ED of a tertiary teaching hospital in Nigeria from January to December 2017.<strong></strong></p><p class="abstract"><strong>Results:</strong> 1120 RTI patients were recruited consisting of 774 males and 346 females with a male: female ratio of 2.24:1. The age range was 1 to 94 years with a mean age of 37.5±17.5 years. Peak ages were in the fourth (24.2%) and third (20.4%) decades of life respectively. 85.5% of the patients were commercial vehicles passengers. Motorcycle accidents constituted 44% of the patients while 41.8% were in cars. The commonest injuries were head injuries (31% m:f 2.7) and fractures (21% m:f 3). There were 11.5% DAMA and 7.1% deaths. Motorcycles injuries had the highest mortality rate while the motorized tricycles injuries had the highest DAMA rates.</p><p class="abstract"><strong>Conclusions:</strong> Motorized tricycles may be considered as a safer means of commercial mode of transportation compared to motorcycles despite its own limitations. There is a need to educate patients against the common practice of discharge against medical advice.</p>