Discharges against Medical Advice: A Study on Patient’s Profile from the Emergency Ward of BPKIHS, Dharan in East Nepal

Abstract

Introduction: Discharge against medical advice in the emergency department (ED) is particularly important as the patient may be threatening his life by choosing to leave and thus not receive adequate or timely medical care. Patients who leave against medical advice (LAMA) may be severely ill and at risk of experiencing adverse events and revisit to ED. Reasons for LAMA include, but are not limited to, family obligations or financial responsibilities. In Nepal, however, a paucity of data exists regarding LAMA and factors that might influence it. Therefore, this study will find out the characteristics of patients leaving LAMA and also identify factors and reasons behind LAMA discharges that might allow the physician to decrease such discharges and improve patient care. Methods: A semi-standardized questionnaire was used to record relevant demographic and clinical information’s. The questionnaire included sociodemographic characteristics (age, sex, marital status, education status, occupation, etc.) and clinical and administrative elements (diagnosis, date of admission and discharges, length of stay, previous LAMA history, and hospital stay). They were also asked for a reason for LAMA, hospital as well as patient-related factors. Results: Out of 358 LAMA discharges, the mean age was 51 SD (21.73). The majority of patients had an Australian triage score of 2 (61.5%) at triage. The majority of the patients were married 79.6%, illiterate (40%), and uninsured as well (87.7%). About 50% of the patients stayed for 12–24 h in the ED before LAMA. Discharge diagnosis was mainly gastrointestinal (GI) (21.8%), poisoning (12%), neurologic (11.5%), and pulmonary (11.2%). Most of the patients who left against medical advice were due to patients related factors accounting 94.7% rather than hospital-related factors 16.8%. Critical conditions and patients not improving were the most common reasons 31.6% followed by feeling better (28.8%). Conclusion: Critical patients, mainly with GI diagnosis, non-critical patients with poisoning, and patients with a longer length of stay are high-risk patients for LAMA discharges.