Cover Image

Discharge Against Medical Advice: A Qualitative Case Study

Tahereh Shafaghat, Alireza Jabbari, Zahra Kavosi, Seyed Mojtaba Hosseini, Ali Ayoubian, Amir Aidun, Mohammad Kazem Rahimi-Zarchi

Background: The most important criterion for healthcare success is customers’ satisfaction. The number of patients leaving the hospital on their own decision or Against Medical Advice (AMA) can be a sign of their discontent and a problem with considerable importance. In this regard, the present study was designed aiming at evaluating the causes of AMA discharges at a hospital affiliated with Shiraz University of Medical Sciences. Materials and Methods: This is a qualitative study on all patients who were discharged AMA from the studied hospital during 3 months in 2012 (March 21 – June 21). Data were collected through telephone interviews. All interviews were written by the researcher and analyzed using grounded theory with thematic method. Results: The most frequent reasons for discharge AMA were classified into 3 general themes: issues related to hospital status, the staff and the patients. Additionally, the most frequent reasons causing discharge AMA were as follows; 1. Sense of recovery; 2. Failure to register discharge order despite verbal order, 3. Physicians and nurses’ inadequate care (technically); 4. Lack of informing the patients and their relatives as to the patient’s condition properly; 5. Crowded wards; 6. Lack of attention to patients by the staff (emotionally).  Conclusion: It seems that if hospital managers want to reduce discharge AMA, it is better to consider the causes. Based on such causes, effective intervention can be implemented which may differ in terms of resource-consuming. [GMJ. 2016;5(1):31-41]

Discharge; Medical Services; Medical Advice; Hospitals

Alam I, Perry C. A customer-oriented new service development process. J Serv Mark. 2002;16(6):515-34.

Swayne LE, Duncan WJ, Ginter PM. Strategic management of health care organizations: John Wiley & Sons; 2012.

Hwang SW, Li J, Gupta R, Chien V, Martin RE. What happens to patients who leave hospital against medical advice? CMAJ. 2003;168(4):417-20.

Tavallaei S, Sh A, Habibi M, Khodami H, Siavoshi Y, Nouhi S, et al. Discharge against medical active from psychiatric ward. J Mil Med. 2006;8(1):24-30.

Alfandre DJ. "I'm going home": discharges against medical advice. Mayo Clin Proc. 2009;84(3):255-60.

Fiscella K, Meldrum S, Barnett S. Hospital discharge against advice after myocardial infarction: deaths and readmissions. Am J Med. 2007;120(12):1047-53.

Weingart SN, Davis RB, Phillips RS. Patients discharged against medical advice from a general medicine service. Journal of general internal medicine. 1998;13(8):568-71.

Rezaeiimofrad M. Patients’ Reasons for Discharge against Medical Advice in University Hospitals of Kashan University of Medical Sciences in 2008. Hakim Res J. 2010;13(1):33-9. [Persian]

Youssef A. Factors associated with discharge against medical advice in a Saudi teaching hospital. J Taibah Univ Med Sci. 2012;7(1):13-8. [Persian]

Manouchehri J, Goodarzynejad H, Khoshgoftar Z, Sheikh Fathollahi M, Aghamohammadi Abyaneh M. Discharge against Medical Advice among Inpatients with Heart Disease in Iran. J Tehran Heart Cent. 2012;7(2):72-7.

Pennycook AG, McNaughton G, Hogg F. Irregular discharge against medical advice from the accident and emergency department--a cause for concern. Arch Emerg Med. 1992;9(2):230-8.

Anis AH, Sun H, Guh DP, Palepu A, Schechter MT, O'Shaughnessy MV. Leaving hospital against medical advice among HIV-positive patients. CMAJ. 2002;167(6):633-7.

Saitz R, Ghali WA, Moskowitz MA. Characteristics of patients with pneumonia who are discharged from hospitals against medical advice. The American journal of medicine. 1999;107(5):507-9.

Jeremiah J, O'Sullivan P, Stein MD. Who leaves against medical advice? J Gen Intern Med. 1995;10(7):403-5.

Seaborn Moyse H, Osmun WE. Discharges against medical advice: a community hospital's experience. Can J Rural Med. 2004;9(3):148-53.

Kavosi Z, Hatam N, HAYATI AH, Nemati J, Bayati M. Factors Affecting Discharge against Medical Advice in a Teaching Hospital in Shiraz, Iran. 2012. [Persian]

Kariman H, Khazaei AR, Shahrami A, Hatamabadi HR. Dealing with Discharge against Medical Advice in Emergency Department. 2013.

Shirani F, Jalili M, Asl-e-Soleimani H. Discharge against medical advice from emergency department: results from a tertiary care hospital in Tehran, Iran. Eur J Emerg Med. 2010;17(6):318-21.

Onukwugha E, Saunders E, Mullins CD, Pradel FG, Zuckerman M, Loh FE, et al. A qualitative study to identify reasons for discharges against medical advice in the cardiovascular setting. BMJ Open. 2012;2(4).

Karimi SA, Saravi BM, Farahabbadi EB, Zamanfar D, Fallah M, Abokheily MA. Studying the rate and causes of discharge against medical advice in hospitals affiliated to mazandaran university of medical sciences. Mater Sociomed. 2014;26(3):203-7.

Noohi K, Komsari S, Nakhaee N, Yazdi Feyzabadi V. Reasons for Discharge against Medical Advice: A Case Study of Emergency Departments in Iran. Int J Health Policy Manag. 2013;1(2):137-42.

Roodpeyma S, Hoseyni SA. Discharge of children from hospital against medical advice. World journal of pediatrics : WJP. 2010;6(4):353-6.

Baptist AP, Warrier I, Arora R, Ager J, Massanari RM. Hospitalized patients with asthma who leave against medical advice: characteristics, reasons, and outcomes. J Allergy Clin Immunol. 2007;119(4):924-9.

Fiscella K, Meldrum S, Franks P. Post partum discharge against medical advice: who leaves and does it matter? Matern Child Health J. 2007;11(5):431-6.

Moy E, Bartman BA. Race and hospital discharge against medical advice. J Natl Med Assoc. 1996;88(10):658-60.

Refbacks

  • There are currently no refbacks.