Original Research Article
Year: 2019 | Month: October-December | Volume: 4 | Issue: 4 | Pages: 116-124
A Cross-Sectional Study on the Correlates of Discharge against Medical Advice in a Multispecialty Tertiary Care Hospital in Kolkata
Manasij Mitra1, Maitraye Basu2, Amrita Roy3, Priya Srivastav4, Rupali Bhattacharya4
1Associate Professor, Department of Anesthesiology, MGM Medical College and LSK Hospital, Kishanganj.
2DGM, Quality Assurance, Apollo Gleneagles Hospitals, Kolkata
3Asst. Manager, Quality Assurance, Apollo Gleneagles Hospitals, Kolkata
4Manager, Quality Assurance, Apollo Gleneagles Hospitals, Kolkata
5Executive, Medical Records, Apollo Gleneagles Hospitals, Kolkata
Corresponding Author: Maitraye Basu
ABSTRACT
Patients taking Discharge Against Medical Advice have an increased risk of hospital readmission, morbidity, mortality, which leads to increase in healthcare costs and puts an undue burden on the healthcare system due to an inadequately treated initial condition.
Studies on the incidence, predictors and outcomes of DAMA have been limited in Indian settings. Studying the correlates of DAMA can help in interventions with an aim to reduce the rate of DAMA, increase patient satisfaction, and improve the quality of patient care and services provided at the hospital.
Materials and Methodology: This study was a retrospective cross-sectional study and was carried out in a 700 bed multi-speciality tertiary care hospital in Kolkata from January 2018 to October 2019. From, 68,010 patients admitted in the hospital during the said period, 2028 patients took DAMA.
Data for the study was collated and entered into SPSS-v19 software.
Frequencies and percentages were used to report the results of the descriptive statistics. Chi-square test was used to determine whether there was any significant association between the categorical variables. Statistical significance was defined by a P value ≤ 0.05. To determine the factors affecting the DAMA further, logistic regression was also used.
Results: From a total of 2028 cases who took discharge against medical advice, full data was available for 1807 cases from the Discharge Against Medical Advise Consent Form and follow-up phone calls to the patient or next of kin. The DAMA rate in the hospital was 2.98%.
Logistic regression was significant for male sex (P value=0.000), area of residence from adjoining districts of the city (P value=0.000), type of admission as emergency (P value=0.000), unstable condition at time of taking DAMA (P value=0.000), conservative treatment line (P value=0.000) and length of stay ≤ 5 days (P value=0.000).
The highest DAMA cases are from the Critical care unit 52.74%, from the General ward 36.25%, from the Emergency and High end wards like single rooms and twin sharing rooms 5.42% each and a nominal 0.17% from the Day care unit.
44.86% DAMA patients were taken home, 42.75% were taken to a low cost set up, while only 12.39% were taken to an equivalent setup.
Discussion: The DAMA rate as observed in this study is in consonance with many studies while other studies have reported much higher DAMA rates.
Our findings are in consonance to the findings of DAMA studies done in the developing countries where financial reasons were the more common causes for DAMA. However, personal problems also played a role in the reason for taking DAMA.
Therefore, combinations of economic, psychological and logistic factors lead patients and their next of kins to premature discharge against the advice of the treating physician.
Conclusion: Discharge Against Medical Advice from private hospitals is a problem in the Indian healthcare scenario. Considering the importance of DAMA and the negative consequences it can have, it is recommended that practical measures like financial counseling at the time of admission, providing assistance for patients in need, mitigating the accommodation problems, dedicating single points of contacts for patients to address their problems and help them liaison as and when required can reduce DAMA. Further studies on broader and mixed hospital settings will be beneficial in framing concrete policies not only at the unit levels but also at the public level to address the issue of Discharge Against Medical Advice.
Key words: Discharge Against Medical Advice, next of kin, correlates, area of residence, condition at the time of discharge, financial constraints.