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What Happens to Patients Discharged Against Medical Advice?

Nagarajan Ramakrishnan1, Lakshmi Ranganathan1, Babu K Abraham1

  • 1Department of Critical Care Medicine, Apollo Hospitals, Chennai, Tamil Nadu, India.

Indian Journal of Critical Care Medicine : Peer-Reviewed, Official Publication of Indian Society of Critical Care Medicine
|September 7, 2018
PubMed

Insights

Discharge against medical advice (DAMA) in Indian Critical Care Units (CCUs) affects 15.1% of patients, often with severe illness. Understanding DAMA patient outcomes is crucial for improving research and quality audits.

Area of Science:

  • Critical Care Medicine
  • Patient Outcomes Research
  • Health Services Research

Background:

  • Discharge against medical advice (DAMA) by family members in Indian Critical Care Units (CCUs) results in lost follow-up and unknown patient outcomes.
  • Excluding DAMA patients from research and quality audits can skew findings and hinder quality improvement initiatives.

Purpose of the Study:

  • To determine the proportion of patients discharged against medical advice (DAMA) from Indian CCUs.
  • To identify the primary reasons for DAMA.
  • To ascertain the 30- and 90-day outcomes for patients who left against medical advice.

Main Methods:

  • A prospective study was conducted on CCU patients admitted between July 2013 and February 2014.
  • Data on demographics, APACHE scores, and outcomes were collected for DAMA patients and compared to regularly discharged patients.
  • Telephone follow-up was used to gather 30- and 90-day outcomes for DAMA patients.

Main Results:

  • 15.1% of 663 admitted CCU patients were discharged against medical advice (DAMA).
  • DAMA patients had a significantly higher baseline APACHE score (29.5 ± 8.6) compared to regularly discharged patients (26.1 ± 10.3).
  • At 30 days, 56% of DAMA patients had died; at 90 days, mortality reached 62% with only 14% survivors. Common reasons included transfer to another hospital (21%), treatment refusal (12%), and financial issues (9%).

Conclusions:

  • A substantial percentage of critically ill patients in Indian CCUs are discharged against medical advice (DAMA).
  • The high mortality observed in DAMA patients underscores the need for better patient support and understanding.
  • Incorporating DAMA patient outcomes into CCU quality audits and research is essential for accurate reporting and improved patient care.
Abstract

Keywords:
APACHE scoreCritical Care Unitdischarge against medical advicemortalitystandard mortality rate

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